Last week was one of those where all my patients seemed to have a need to drop their trousers, hitch up their skirts and generally reveal themselves in ways they rarely would, even after a night in the pub.

As I said only last week history taking is a vital part of clinical assessment, but when it comes to problems “down below!” history taking can be a bit challenging.

Steven Seagal Movie about dysuria?

Patients seem to adopt one of two approaches when they have a problem below the belt, both of which are a little too extreme to be helpful (or pleasant).

The first extreme is the patients (mostly men), who have sat in the waiting room worrying about exposing themselves, and not thought about what they are going to say.   These patients think being called to the consulting room means they can start undressing on their way down the corridor. So before I can say “‘mornin’” I’ve got genitalia facing me and patient demands:

“Look at this, do I need to get a divorce?”

The other extreme is the patient who has been practicing exactly what to say (for approximately 4 weeks) and when it comes to examination they say “OK” and then stay exactly where they are.  Prompting encouragement to actually stand up and “drop ‘em” and “No, I’m not going to undo your flies for you, your hands were working before the consultation, I’m sure they are still able”.

Also history taking is only any good, when accompanied by a vague idea of what the hell the patient is talking about…

Key: Pt v’s Max

“I’ve a problem downstairs”  -  ”You have rats in your cellar?“

I’ve got sore “bits” - “I’ve heard of drill bits, but never saw bits“

“I’ve got a personal problem!” -  ”As oppose to a impersonal problem?”

“My cock sore!” - “What did your cock see?  Chickens??”

“My cocks got a rash” - “Take it to the vet, I don’t do poultry care“

“I’ve a problem with my toilet” - “Call a plumber!”

“I’ve a problem with my crack” - “See your drug dealer, but I doubt you’ll get a refund.”

“I’ve a problem with my plums” - “Tell the greengrocer about it!”

“I’ve got a problem with my wee’s” - “Do you use an inhaler?”

and thus it goes on.

One parting comment….whatever happened to sexual health, condom use and just good old fashioned common sense?  When I was growing up (debatable whether I actually have grown up or ever will), everybody was hyper-paranoid about AIDS. Now it rarely gets mentioned in the common media, but statistics show it is ever rising.

Brings a whole new meaning to the term sexual aids!  Sorry that’s a bit of a heavy image to end with, try this French Campaign…

Little Miss Muffet sat on her what???

Well you know what they say about Scorpios in bed…

Well, I’m not here next week, so in the meantime perhaps you should check out a newbies that came to my attention…..so take a peak into the world of : Circus Nurse.  Enjoy.

Taking a history from a patient is a challenge, sometimes the patient will give one word answers and sometimes it’s difficult to get the patient to stop talking. None-the-less a good and comprehensive history is essentially….

Is that Gina from Code blog?

Here is an example of why….

Little girl tells mummy she put a bead up her nose. Mummy looks and can’t find it, they rush to the hospital. Wait for a few hours and then the Doctor hears the story of a little girl who put the bead up her nose. He too can’t see anything…

Now perhaps I’m a bit of a tough nut, had this been my patient (or child), I would have gone down the “well as long as your chest is fine, I don’t think we need to worry too much, you’ll snort it back, swallow it and poo it out”

But I’m talking about the super keen shiny new registrar, who decided an Xray was necessary.  Exposed the young girl to some radiation and guess what….Nothing showed up.

Now the lesson here is simple…..if a child tells you they’ve put something up their nose, take a history detailed enough to find out if she then took it out again.  With tears in here eyes the little sweetie said…

“Everybody asked if I’d put it up and I did, but nobody asked if I’d got it down again!”…

(Rich sarcastic tone….)Oh, how her mummy laughed….having spent a quality 5 hrs hanging around the hospital….

The second lesson this week is in cheek biting. Essential behaviour to stop you laughing in your patients face when they come up with a corker.

My example this week was a lady who had felt achy and unwell and told me her “nymphs were up”.

Hylas has tonsillitis and his nymph loads where up again….

Hmmm, assume she meant Lymph’s….AKA Lymph Nodes.

I was of course a true professional, and doubt she even noticed the little grin that kept trying to sneak across my face….ho hum.

In a recent edition of the ”Nursing Standard” they had an article about laughing…  It’s the kind of article that defines why I don’t subscribe to the Nursing Standard - very little clinical benefit.  Laughing is natural and not something that can be considered in great detail.  Either you act in a strict professional manner, or a friendly relaxed manner.  None the less the article came to my attention and read:

“Everyone likes a good laugh but is it appropriate to use humour with patients?” 

Obviously not always: “Well, the good news is you’ve got a week to live, and the bad news is, I should have told you last week”.

“Humour is a social phenomenon with 95% of laughter likely to occur in a social situation“….

Another case of bollocks statistics, which scientist spent quality time following people around with a stopwatch recording how much of the laughing was in a social situation….This would mean 5% is antisocial laughter?  Is that when you laugh at your own farts in a secluded place? - Max’s tip of the day….Don’t fart in enclosed spaces.

The useless article goes on “…It is claimed that laughter can promote health by lowering blood pressure, reducing pain and boosting immune function“.

I’m sure a good belly ripping laugh makes your BP rise.

I don’t strictly doubt these claims, but for acute injuries I find a good swear word is much more effective than laughter.

“Ha, Ha, I’ve got a knife stuck in my leg….What a corker!!”

verses

“OH F***, that F***in’ knife is in my bloody, and I mean bloody, leg….Sh*t!

Apparently “Humour can be risky and does not come with guidelines“…really who does write this stuff?! I wonder if they meant risque, rather than risky???

Max: “and so how did the accident happen?”

Imaginary colleague: “Well, I was just about to defib my arresting patient, then I recalled an article I’d seen in the Nursing Standard about laughter, so I thought I’d try telling him a joke first.  He gained consciousness a split second before I defib’d him and laughed so hard he wet himself. Unfortunately the rest of the crash team were standing in his urine and got electrocuted too.  Tee- hee! What a good giggle we had!”

Come here there’s more, the Standard goes on…”but, good or bad, humour is an integral part of interpersonal relationships and nurse-patient interaction is a fundamental aspect of healthcare“…WOW! I am stunned by the insight and I have no more to say on the matter.

PS….The Brits are on form….

Another Newbi to look out for is a Northern Nurse.

And Julie from Life in the NHS has taken on Change of Shift, maybe we should call it hand over this week…

In the news this week…broke the amazing story of two jag’s, secretary shagging, member of the public punching ex- deputy prime minister John Prescott’s eating disorder.

Flippin’ fried food.

Mr Prescott states: “With my weight, people wouldn’t suspect it. I wasn’t a very successful bulimic, in that my weight didn’t really drop.”

My only thoughts on the issue are this….

Aren’t you supposed to make yourself sick after you binge eat?  Is it just me, or does John Prescott’s racing snake physique make you think he forgot to stick his fingers down his throat?

Bulimia is a serious complaint, and I am not making light of it (well, only at JP expense).  I just hope this isn’t all just a publicity drive to sell his new book.. (ooops, wrong link…if you are really interested it’s this one…)

Public service bit….if you need help with Bulimia click here.

My own eating disorder is in peril this week….as news break that Food Colourings are to be phased out.

oooh, pretty colours….gimme, gimme, gimme.

The colourings involved are sunset yellow (E110), quinoline yellow (E104), carmoisine (E122), allura red (E129) , tartrazine (E102) and ponceau 4R (E124).

Does this mean I’ll have to hang around in dark street corners to get my fix of E’s?

Other consequences exist, those nice coloured medicines that you get for you cough will not look so pretty anymore.   I’m sure half the effect of over the counter cough mixtures is as a side effect of the colourings.

“OK so I have the ‘flu’ but I want to run around and shout now I’ve had my medicine”.

Before Medication…After Medication….

Still perhaps a few patients will stop wasting their money on “cough syrup” (and anyway shouldn’t that be anti-cough syrup?)

As part of my unending mission to find amusing nursing stories, I recently received an email from Melanie Herson telling a funny nursing story… 

About a someone who…”was doing a shift with a student nurse, and looking after a patient on complete bed rest. The student nurse took this word for word & when the patient needed a commode she heaved the commode ONTO the bed & there he sat on the commode on the bed. My friend said she walked down the ward & all she could see was the top of his head peaking over the screens. True story”.

Hmmmm, I’ve heard this before. It is always about a girl who worked with a friend and the tale is never told in the first person.

Quite frankly I find it difficult to believe. Not only would the student have to be bloody stupid, but the patient too.  Adding the fact that the Moscow State Circus would find it difficult to balance a patient on a commode on a single hospital bed. 

Featuring Rhinitis the Sneezing clown!

Then taking into account the patient is probably quite unwell if on bed rest and therefore unlikely to be capable of performing such an act, it all seems a little far fetched.

None the less this did get me thinking about other Nursing Urban Legends.

During my training and life in general I have moved about a fair bit, and on occasions you hear the same stories that happened “once” or happened to “a friend of a friend”  The commode on the bed is a bit of a classic, it just might have happened once, but as stated, I have my doubts.

The other that springs to mind, is again a student nurse (poor blighters even get blamed for things in fiction), who was advised to clean the patients teeth and so collected up every patients false teeth putting them into soak in one big bowl, and then had difficulty pairing them back up again… I’m not saying this definately didn’t happen but….lets look at what we know.

Generally, ward staff might assist a patient to get ready for bed - sure, and they do ob’s rounds 4hrs T.P.R’s etc. However I can’t imagine anyone coming up with a combination - eg - nurse one washes their faces, nurse two cleans their teeth etc.  (nurse three puts a commode on the bed)…

Now for the commode on the bed tale, I did say that whoever invented the story forgot to think about the patient.  In generally they are at least partly intelligent creature and would say “What the hell are you doing trying to get me to balance up here?” In the denture story the patient advising the nurse not to walk off with their dentures does seem likely, but would anyone understand the gummy patient saying:

“Mare arb ew goon wib me teep?”

Hmmmm, not convincing.

Now I’m sure there are lots of other Nursing Urban Legends/myths, but none more spring to mind.  So feel free to join in…(as always).

Incidentally the story about the student nurse leaving the main ward to get some milk for a patient and not coming back for 30 minutes is true, that was me… We had a special milk fridge (bit like a cool water system, but for milk), the tap came off in my hands, milk started spraying everywhere and  I had to pinch the plastic pipe together, and wait for someone to finally wonder where the hell I (or the milk) was.

The little dutch boy with his finger in the dyke….hmmm isn’t that some seedy porn movie?

…and the story about someone trying to kill themselves by jumping out of a hospital window and landing in front of the accident department is also true, I was there too!

NB: Heads up to the New (Danny) Boy in the blogisphere….

It’s been another frantic week.  So I am going to give you the bare facts…

1: Polar bears are a potentially endangered species living in the circumpolar north.

Eh!?

2: Brown/grizzly bears are found from the islands of southeastern Alaska to the arctic.

What!?

3:Black bears inhabit most of Alaska’s forests.

Hang on a minute……

4: Polar bears frequent the pack ice and tundra of extreme northern and western Alaska.

Stop…..

5: Winnie-the-Pooh, commonly shortened to Pooh Bear and once referred to as Edward Bear, is a fictional bear created by A. A. Milne.

WAIT…STOP RIGHT THERE….THAT IS NOT WHAT I MEANT.

OK don’t get grumpy….

Right the bare fact  - b.a.r.e:

1: The naturist philosophy has several sources; many can be traced back to the health and fitness philosophy in Germany in the early twentieth century, though the concept of returning to nature, and creating equality are also cited.

WAIT!!!! THAT IS STILL NOT WHAT I MEANT!

THE bare facts about my working week…. Jeees, you could have written something witty, in the time it’s taken to Wiki this stuff…. anyhow get on with it…

1: I will always giggle quietly to myself when a patient tells me they’ve been sucking a fisherman’s friend.

2: I don’t like it when patients leave my room moaning that I didn’t give them antibioitics for a slighlty sore throat they’ve had for 1 day.

3: I don’t like it when patients are dissatisfied with what I’ve told them, so go and get an appointment for 1 hour later with the Doctor.

4: I DO like reading the same patients notes when the Doctor write:

“History as above, finding as above, agree with diagnosis and management”

(Incidentally, this isn’t because we are conspiring against patients, it is actually that said patient has a virus and antibiotics REALLY, REALLY, don’t help viral infections).

5: I’m not overly keen on Americanisms (no offense folks).

6: I think the Americans have got it right referring to a bacterial tonsillitis as “Strep throat”, therefore making a clear diagnosis from viral tonsillitis/pharyngitis etc. etc.

7: I think the study in “Neurology” (2008, 70, 1258-64), that found people with depression are 2.5 times more likely have dementia is… well…..depressing!  Still I’ve never been clinical depressed, however I DO have a strong family history of Alzheimer’s. If I start to act slightly demented please email me so I know!….

8: While talking about family traits….I’d like to say…”Diarrhoea runs in our family”. (Not quite as funny as sucking a fisherman’s friend, but it still makes me grin a little).

9: I liked my patient giving me a big bear hug earlier this week.

10: I would not appreciate any of my patients giving me a bare hug! (Well, perhaps a few exceptions!)

A hectic week….My predictions we’re right.  It just got busy…

Normally when it gets busy, I have plenty of “material” to write about.  However this week it has been so bloody hectic, I could scarcely write patient notes, let alone sketch a few things down to blog about, and with a memory the size of a dust mites left testicle I promptly can’t remember much of what’s happened apart from to say it was busy.

A few things stick out (oo-eer).  The clocks sprang forwards into spring, and the signs of spring arrived as predicted:  “I’ve come on holiday and forgotten my pills, love”.

One of our respiratory patients came in today as his chest was “playing up”. I examined him and then he asked me a deep and spiritual question…. “Do I believe in……”

….wait for it……

did he say:

a: Fairies;

b: God;

c: Life after death;

d: sex after marriage;

e: None of the above….

Yep….answer E.

“Do you believe in dust mites?”.

When I assured him they did exist, and yes they could be worsening his respiratory condition, he asked a further theological question….

“Where do they come from?”

So did I answered….

a: “Dust”

b: “God gave us all the little creatures to create a colossal universe and unique ecosystem”.

c: “The devil created them, so that bad people who ask silly question suffer by wheezing on the debris of the dust mites faeces.  You therefore must be evil, and you don’t need my help, ring the priest so you can be exorcised”. (Do fat people need to be exorcised or exercised?)

d: Answer in a true philosophical/political way, and merely add another question….eg: “Where do any of us come from?”

OK I confess, I opted for answer “d”, which seemed to satisfy his curiosity.

In the news this week….

Apparently the size of you beer belly is proportionate to the risk of you suffering dementia.

Apparently incidence of dementia increase steadily with the amount of belly fat those with the most belly fat are over two and half times more likely to develop dementia that those carrying the least body fat.

Now that’s all very interesting….but is it news? After all it is called a beer belly. Drink enough beer and I can quite quickly become demented.

On that note I’d like to say: ” I f***kin’ lurve ya, yer me best mate, I love yer ser much -wuheeeeeeerrrrggg!!!”  

Footnote: My blog spell check doesn’t recognise the word “blog”!!!

Two items in the news this week have caught my attention….

Firstly the news that yawning is a sign that you are tired (no….really?), and that the government is spending money to remind drivers that if you start yawning you should pull over and take a break.

Dr Neil Stanley, a sleep expert from the Clinical Trials and Research Unit at the Norfolk and Norwich University Hospital, said:

“Yawning quite simply means you’re on the roadto falling asleep - so if you’re yawning behind the wheel it really is time to pull over.” (Hmmm, Dr Stanley’s example of researchers humour.)

Well alas I shall have to quit my job, I’ll never manage to get to work on time if I pull over for a rest every-time I yawn.  I’ll have to find some way of entertaining myself as I drive through the countryside to work…perhaps I should count sheep!

Doesn’t work anyway…

My obvious tiredness is likely to make me irritable and angry….but what to do….

That brings me to the second item…

People who cannot control their anger have nowhere to turn leading to family breakdown, sickness and mental health problems, a charity has warned.

Anger management in Primary care is a bit of a nightmare. I have had several patients requesting anger management. There really seems very little services available to these patients. Mental Health trust, which appear grossly under resourced, state they can help for the related depression and anxiety, but have no facilities that actually focus on anger management.

So what do we do….well perhaps we need to address the underlying issues.  Simon Usbourne and Tim Walker identify there is lots to be angry about. Including road rage….perhaps next time I get stuck behind a tractor I should just take a deep breath, yawn, pull over and have a rest.

If as a consequence of this I never got to work, I would get stressed by it - problem solved!

credit

 credit

It really is the calm before the storm….both metaphorically and meteorologically. Taking the latter first - they are talking of a White Easter! I’ll believe it when I see it. 

Metaphorically it’s that time of year, where tourist towns (and the GP surgeries within), have a real feeling of  calm.

Everyone has a sudden urge to clean their stethoscopes for the first time, polish the proctoscope, irradicate ear wax for the ear pieces and just look at the dust behind my monitor…

Meanwhile all the locals who work in the tourist industry are trying to enjoy their time in Majorca, as they know that soon it will be time to come home, soon they will realise their business has made it through another difficult winter. 

So currently there are very few tourists, and quite a lot of the locals are sunning themselves in foreign climates. Consequently the surgery is fairly calm.  Even a few empty appointment slots. The new Registrar is getting used to his role and thinking he has landed on his feet in this relaxed little sea side town…..has anyone warned him?  Any day now things will change.

Round here we don’t listen for the first cuckoo, or look skyward to see the first swallow to know it is spring. Other things happen…

What’s in the sky? Spit or Swallow?

With the Easter holidays the tourist season begins….the signs of spring around here are different…..

Metho the clown takes his first bath of the year and tries to detox. 

 His alcohol induced jaundice saves him a fortune on face paint, but the over whelming pong of stale alcohol and cigarettes makes parents not so keen to book him…so detox is essential.

The hoteliers all arrive in the surgery, showing off foreign infected insect bites, blistered sun burn and telling tales of holiday doctors who “didn’t speak one bit of English” (why should they, they were in Spain) and gave them tablets, “I’m not sure what they were called or what they were for, but could I have some more?”

And then the coaches of holiday makers arrive… more “I’ve forgotten my tablets, yes dear, the little white ones for my chest I think”

Oh yes,

Ready for your coil fitting?

Spring is nearly here.

If the storm hits, and I can’t get to write next week, you’ll have to amuse yourself with the fantastic Kim and her Change of Shift, and gem as always!

Patients Question of the week…

Having been given that rounding up statement by me, you know the one that tells the patient it really is time you left, my patient gets his coat and before leaving asks….

Do I go out the same way I came in? 

What I said was “yes!”

What I was wanting to say was….

a: “Yes, we like the patients in the waiting room to see people leave, so they know we didn’t kill you”

b: “No, I’m afraid you have to climb out of my window, the door only opens from the outside, I’m a slave in this room and to ensure I don’t leave you can’t open the door from the inside!”

c: “No, it is imperative that you walk out doing a chicken impression.”

Max’s daft rhetorical question of the week…

Is a bowel habit something worn by a crappy nun?

Blog related giggle of the week…

I often take the time to browse my blog statistics, and often take amusement at the search phrases that led people to my humble blog.  Often they border on the perverse, “Nurse + uniform + sex”. 

Sometimes I wonder what the hell I have been writing about to get “hits”, such as: “Infinite Banging 5″. I assume it is a good film, but I’m sure I haven’t done a preview for it (or starred in it).

Othertimes I wish I could contact the person doing the search and perhaps offer them some professional help, for examples whoever Googled: ” My bowel symptoms are like rabbit poo” or “Xray tech did rectal exam”

But this week I was amused by: “Dead corpse”.  After all it’s the alive corpses you need to worry about.

Worst history giver of the week:

Chap comes in and starts talking about very vague symptoms, I finally manage to discover he had a blackening coming over his eyes, and neck and head pains earlier all of which have now gone.

I still feel that I’m not being told something. I ask him to take his shirt off so I can examine his neck and shoulders and that’s when I KNOW there is something he has forgotten to tell me, 3 ECG stickers….

Pt: “Oh those, I thought I’d taken them off”

Turns out he’d collapsed while shopping!  Don’t suppose I really needed to know that part of his vague symptoms….DID I???