Apply topically

Managing the Acutely Well.

Posted on January 31, 2018. Filed under: Apply topically, Journal from behind the desk... |

Patients grumble they can’t get an appointment, then they spend 5 minutes of their 10 minute appointment moaning how difficult it is to get an appointment, having rang up this morning and got an appointment. When they eventually tell me why they have come… some of them are actually ill, but a vast majority are acutely well.

If less well patients came to see me, there would be more readily available appointments.

The patients moan: “The NHS is in crisis” – because the Daily Mail told them it was.

The NHS is in crisis – it has been for as long as I have worked within it (not a reflection on me hopefully). Is it due to government under funding??? Well you could throw a few zillion pounds at it, and watch it get swallowed up quite happily, more funds would be good. However it is a case of; “look after the pennies and the pounds will look after themselves”… or at least; “look after the hundreds and the thousands will look after themselves”.

What’s my point?? Dross. I have sat in clinic today and seen several patients who really DID NOT have any sensible reason to be in my room. Someone who thought they were getting a cough . Someone who had a rash 3 days ago and it had now disappeared. Also around the holidays (Easter, Summer, Christmas or any other event, (the neighbours cousins cats wedding)) patients come in and say….”I wouldn’t normally have come for something so trivial, but I’m going away tomorrow!” The fact you are going away rarely changes my clinic decision making. Either you presently have something that needs treating or you don’t. I don’t have a crystal ball and there is no such thing as Santaclausacillin, despite my previous suggestion.

Back in 2014 it was estimated that a single 11.7 minute trip to the GP costs the NHS £45 and a 15 minute appointment with your nurse in a GP practice costs £13.​ (The 2013 Units Health and Social Care report): Now as a Nurse Practitioner I’m sure I’m somewhere between the two. So for every acutely well patient I’ve seen today the NHS has spent let’s say £30 on seeing someone who didn’t need to be seen. Multiple that by the amount of dross patients I’ve seen (and today that is about 20) that’s £600. Multiple that by the thousands of other clinicians seeing dross today and the cost is going to be pretty high. Multiple that by 5 days a week and we could surely afford to bail out a few struggling areas of the NHS.

So why do the acutely well keep on coming? Because they can. Because they live with the attitude that the NHS is free! They’ve already paid for it with there tax. They are “entitled”.

If only these people could see that “yes” they are entitled to use it if they need to, but it cost them (the tax payer) money that could be better spent on the acutely ill rather than wasted on the “just in case” visits.

If you add in the patients who come to get a”free” prescription, for a readily available over the counter drug, the price goes up more. One prescription from your GP costs £41.35 – which makes the whole “don’t want to pay for a 49p pack of paracetamol when I get “free” prescriptions” argument pretty lame. I just want to shout “It’s your NHS’s money your spending!”

Why can’t some patients just take responsibility for how they use their NHS?

If patients used the NHS when they NEEDED to, rather than felt they were entitled to and thought of it as an investment when they didn’t go for trivial nothingness, the NHS would be in a much safer place, with more money in reserve.

OK and relax.


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The Butterfly effect…

Posted on June 14, 2014. Filed under: Apply topically, Journal from behind the desk... | Tags: , , |

For reasons not fully understood by a mushroom like me…(I’m kept in the dark and fed on poo!!) it seems the world at large is a little crazy.  (Perhaps I should finish the post there!!)  On some occasions though you can see the logic – and it may be blatant logic or more of a butterfly effect.  Does the flap of a butterfly’s wings in Bognor Regis set off a tornado in London – or is it just all the hot air coming out of the Houses of Parliament?
Can you smell the guff Rik?
Let me explain….
Anyone who has ever had the pleasure of working in an Emergency department is more than a little aware of the effect of environmental factors that impact on a days work…. Some of these are obvious and some are considered by the generally public to be urban myths, but we know the truth (not so kept in the dark and fed on poo after all!!)
The obvious environmental impacts:
It’s an icy day – cars impact with cars…. busy health services.
it’s a windy day  – little old ladies’ hips impact with pavements…busy health services.
Sometimes it’s more complicated:
It’s a windy and icy day – consequently emergency department staff are going out for a stiff drink when they eventually get off duty and when they come back for the early shift, they will be hung over and knackered and will be more prone to slapping the hyperventilating teenager who says she had to come in as she has overdosed on three paracetamol as her boyfriend of three days has left her.
Sometimes these environmental factors are simple but considered an Urban myth unless…. you’ve had the pleasure of working a night shift when it’s a full moon….yes they ARE called lunatics for a reason.
You can see it in their eyes!!
The point is that a full moon on a windy and icy night can increase the pressure on the health service, (not to mention make it treacherous if you a werewolf):  the opposite is true if it’s a nice sunny day.  Suddenly I find myself sat peacefully in the world of primary care – having been mad busy for months on end, and today NOTHING is happening.
Now the winter has long since dried up, so we can’t blame that for us being busier yesterday when it was overcast, any more than we can the fact that it may be overcast tomorrow and busy again, but one day of brilliant sunshine seems to almost guarantee that no one is quite bored enough to hassle me with their acute or chronic symptoms.
One sunny day dries up everyone’s depression, anxiety, sexually transmitted diseases, rashes and wee infections.  Frankly what I normally get told is a horrendous symptom and needs to be dealt with today, can wait until tomorrow if the sun is shining.
Look the sun is shining – I can’t possibly bother Max with my cold!!
So I find myself free to actually catch up on all the stuff I ought to do from time to time….including a bit of reading.
I find a study on alcohol use in Britain, that states:
“Among adults who had drunk alcohol in the week, 55 per cent of men and 53 per cent of women drank more than the recommended daily amounts, including 31 per cent of men and 24 per cent of women who drank more than twice the recommended amounts in 2012”
It also says that people are spending more on alcohol at home and less down the pub….I’m not surprised after I bought my wife and I a glass of wine for the same price as two bottle of the same wine I get in the supermarket.
£12 for 2 glasses of wine….Do I look mad to you!?!?!?!
The report also said men are more likely to end up in the Emergency department drunk than women…. (I don’t think that included the nursing staff after a windy, icy night when there is a full moon!!)  Concerning though the opposite is true in the teenage population.
“That between 1998 and 2012, the amount of antidepressants dispensed in the community each year rose by 25 million – from 15 million items in 1998, to 40 million in 2012. Almost half of that increase occurred in the four years between the 2008 financial crisis and 2012, the last year for which data are available”.
Half the patients I prescribe anti-depressants for are members of the overworked mental health team. Obviously they are nurses, as there are no consultant psychiatrists!! Some butterfly in Bognor Regis flapped it’s wings and subsequently some hot air came out of the House of Parliament leading to the decision to blow the whole mental health budget on Cognitive Behaviour Therapy, (which I am not adverse to), and dementia management (also important), but left no money to pay a consultant.
One day, you’ll look
To see I’ve gone
But tomorrow may rain, so
I’ll follow the sun
 I’d rather have a bottle in front of me than a frontal lobotomy.
Good bye Rik.
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Spanish Inquistion….

Posted on March 13, 2014. Filed under: Apply topically | Tags: , , |

NOBODY expects the Spanish Inquisition! Our chief weapon is surprise…surprise and fear…fear and surprise…. Our two weapons are fear and surprise…and ruthless efficiency…. Our three weapons are fear, surprise, and ruthless efficiency…and an almost fanatical devotion to the Pope…. Our four…no… Amongst our weapons…. Amongst our weaponry…are such elements as fear, surprise…. I’ll come in again.

Oooh, sorry I went a little Monty (not the full monty you’ll be glad to hear, but just a little monty)…and what in heaven’s name has bought this about…. Well we have just been inspected, by the CQC….

The CQC??

For those outside the British Empire I shall explain….The CQC stands for the Cruel Quality Critique  sorry that’s the Checking for Quality Crimes, no, no, urm it’s the Care Quality Commission, that’s the one.

Basically for years general practice has been allowed to doss along, minding its own business, up until the point the police identify that we’re giving morphine to all our patients. Now however the CQC has been introduced to inspect surgeries to ensure we actually know what we are doing, don’t have more maggots than patients and that all the patients are happy for reasons other than morphine addiction.

The CQC first came about in hospitals a few years ago, causing uproar from staff, who pointed out that they were now spending nursing hours filling in forms to keep the CQC happy and not actually having time to keep the patients happy. It caused so many problems, nursing break downs, and time off sick with stress they thought it was a good idea to introduce to primary care too!

It’s not quite the Spanish Inquisition – the element of surprises comes with a 48 hour warning. That’s about enough time to remove maggots from the surgery and remember to put your name badge on, but not enough time to fill everyone’s clinic with the nice patients who think we’re great, so on interviewing they all say nice things.  I suppose it is more of a witch hunt, they have been commissioned to find problems – so find problems they must, or else they will be made extinct and have to find another irritating admin post in a sidewards management shuffle…we know how these things go.

So the night before the inspection I was not stressing – I know our practice is fab. I also know that as with the witch hunter general of old – the CQC inspectors know they have to find fault otherwise they’ll be out of a job, so I had a low-grade anxious feeling.  I was visualising a Men-in-Black-esq team of crack professional invading the surgery, quizzing patients, inspecting the back of the radiators for dust, ensuring that we didn’t have pillow cases that could be harbouring life threatening viruses and performing rectal swabs on any soft toys….


Teddy – you’re not going to like this…

On the day of the inspection rather than a witch hunting crack team, there was in fact one witch, hunting.

A solitary hump-backed lady, with clipboard in hand. Nonetheless – she gave us a working over. we had role plays to do, patients were interviewed, the practice manager even had to take her to the boiler room!!! (ooooo- errrrr!)

As predicted we passed with very little intervention required. Our Practice Manager has a list of intriguing jobs to do to prove we weren’t perfect and that we did in fact needed inspecting.

All the Practice Manager has to do is to supply all patients with sterile balaclavas in the waiting room to ensure confidentiality.  Then install soap dispensers above and below the current soap dispensers, so you can wash your hands before you touch the soap dispenser and after you’ve touch the soap dispenser.  Then he needs to take the doors off the toilet so nobody has to touch the door as this may be an infection control risk. Obviously it doesn’t matter if someone sees you having a pee, as your balaclava will protect your identity. Or something like that.  Thank god we passed!

So for those of you with inspections yet to occur, don’t panic…. unless you are crap!

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Winter Wonderland.

Posted on December 17, 2010. Filed under: Apply topically |

It’s that time of year again when I like to destroy a perfectly good seasonal song…. so here we go again… thought with all the snow we’re having it was time to pick on winter wonderland!

Chesty coughs, are you listening? 
In the waiting room, snot is glistening
A hideous sight,
We’ve been coughing all night.
Sneezing in a winter wonderland.

Slipping down,  went the old bird,
Fractured Hip… How absurd?,
In hospital for too long,
Sleeping in the NHS corridor.

 “Can you make my cold go by Christmas, Man?”
This makes the clinician frown
Patients say: “Antibiotics?”
We’ll say: “No man”, 
But you can have them…
 …when your snot turns to brown

Last night, we had a hall for hire,
All got drunk, filled with desire
Now to face unafraid, 
The mistakes that we’ve made,
Shame in the staff party wonderland.

 In reception we can build a snot-man
from all the snotty tissue left around



We’ll have lots of fun with mister snot-man,
Until a new super virus is found.

When surgery closes it’s thrilling,
Though in out-of-hours we could make a killing

We’ll frolic and play, through the bank holiday,
Working in a winter wonderland.

Well that’s that job done for this year. Have a smasher of a christmas period, and remember to go careful out there!!

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More excuses to eat chocolate.

Posted on August 20, 2010. Filed under: Apply topically |

I’m sure somewhere in the deep dark vault that is the “It shouldn’t happen…” archive there is a post getting its knickers in a knot about whether wine and chocolate are good for you or not.

The more intelligent of my readers…

…are probably well aware that rich dark chocolate can improve blood pressure and has other cardiovascular advantages.  Now however research has found that chocolate also decrease the risk of heart failure.  Personally it seems highly likely to me, if I don’t get chocolate I get total body failure and a broken heart…surely it’s the same thing. Those poor researchers spending time finding out something that we all already knew made us feel better. 

Closer inspection is obviously going to reveal that we should only eat small amounts…oh hang on it says…”moderate habitual chocolate intake”.  Ooooh, “moderate”.  Cool, that’s nicely subjective.  One lorry load is moderately less than two lorry loads…

For those of you who are perhaps a little unfamiliar with the term “Heart failure”. It’s one of the diagnosis that sounds a little more acutely severe than it actually is. “Failure!”  Oh my god, If  you get brake failure then they completely stop working and you end up dead….(although confusingly if your brakes fail you keep going!) So heart failure sounds pretty much like death. Fear not if you don’t like chocolate*. It’s not quite that drastic (it’s not great but not immediate death either).

The symptoms are of heart failure are: Shortness of breath on exertion, swollen ankles, lethargy, nausea and often weight gain… interestingly this is the same symptoms you get if you eat too much chocolate.  Perhaps the research just identified that if people eat lots of chocolate it’s difficult to spot heart failure from chocolate over dose.

Oh well. I’ll take the risks… back in that next lorry load for me.

*if you don’t like chocolate please seek psychiatric help immediately there is clearly something wrong with you!

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H1N1…to jab or not to jab…that is the question?

Posted on November 16, 2009. Filed under: Apply topically |

It’s crunch time…the H1N1 jabs are here.

We were one of the last places to receive the first batch. Patients and staff are approaching me, asking whether they should have one or not.   My instinct is to shirk the issue and hide under my couch, but alas I can not do that.

Everyone asks me all the questions, and I can give the answers to all but one….”Are you going to have the jab?”  So lets answer that now….

I virtually hang out with a few conspiracy theorists who tell me that the jab is a government ploy, or that the jab itself has been rushed through the testing stage. I know the 1976 jabs were blamed for neuro problems including Guillain Barre, see below…

but convincing evidence is difficult to find.   The coincidence factor is always a concern.

Every year I hear : “I had my flu jab, and the next day…<add any random common presenting feature here>…my hair turned blue!

I argue with myself….I’m perfectly healthy (physically, mental health is debatable….I mean I blog therefore I must be a tad nutty!)

So why should I have the jab??? Well….

In 1991 I did a research project looking at the effect of the Measles, Mumps and Rubella vaccine (MMR) and specifically looking at the WHO target of complete UK eradication of the three childhood diseases.  My research found that indeed the three nasties would be eradicated by the year 2000 as planned…. it didn’t happen of course as some twit Andrew Wakefield in 1998 decided the vaccine caused autism… which was later disproved ad nauseum, none-the-less the damage was done and the diseases were not eradicated. So I am quite pro- immunisation and aware of the detrimental effects of negative press.

The H1N1 vaccines are much the same as any other flu jab, just one aspect of it has changed, surely the risks must be fairly minimal.

Perhaps a microbiologist opinion might be worth having….

Then I argue back with myself… It’s just another upper respiratory tract infection, mild flu symptoms in the vast majority of cases, why bother getting stabbed.

Then the good angel appears on the other shoulder…if I get piggy flu and feel just a bit sick, I can still pass the bugs on to someone else who may not cope with it as well, that may be an immune suppressed patient or one of my precious kids, and that wins the case.

I get the jab and I get some brain altering weird extra head growing side effect…well that is rotten luck. Cash in on the critical illness cover, pay the mortgage off.

I don’t get the jab, I pass the bugs to my nearest and dearest and they get really ill… and it’s my fault, the mortgage doesn’t get paid off early.

Yes I’m a cynical nurse, but I’m a dad first.

…and “Yes” Deborah, that’s just a government ploy to get us all jabbed, but it’s a good one!

and “No” Sister, you don’t have to make any jokes about just having a small prick, my sleeve is up, just get on with it!


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Heroin for free decreases crime!

Posted on September 24, 2009. Filed under: Apply topically |

So over my few weeks off I hear a story on the news, that makes me stop and scratch my head a little…

(and no I didn’t get splinters).

Now perhaps I’m missing the point, perhaps I’m being controversial and am going to get slated for the following post, but it seems to me I am not the one missing the point, and from what I hear and read about the subject the more I seem to be the only one who thinks it’s laughable.   Anyhow, lets look at the story….

The BBC website entitled their article :

Heroin supply clinic cuts crime

No! Not crimes against heroines!

Now if you don’t fancy reading the article here are the basics of it…

100 drug addicts are given either FREE methadone or FREE diamorphine (AKA medical class heroin), and then assessed to see how much they were getting in trouble with the Police, how much they were using street drugs and how much they were spending on drugs…

Guess what…the pilot scheme showed that:

Three-quarters reduced use of street heroin
Offences down from 1,731 in 30 days to 547 in six months
Spending on drugs down from £300 to £50 a week
Everyone seems to be screaming what fantastic results these are and that it should be rolled out nationally.
Really am I missing the point? Of course these drug addicts are spending less on drugs and committing less crime to support their habit…they are being given them for free on a trial partly funded by the tax payer…
Perhaps the next big incentive will be to give free mobile phones to everyone and free upgrades every few weeks to stop people stealing mobile phones, or free BMW’s to all car thieves to stop them stealing cars. 
 “Stop Police!!! Let me get that for you sir!”
If this approach continues to spread I am going to become an alcoholic so I can get free beer when that incentive comes in!  Maybe we could also reduce gun crime, by allowing people previously convicted of gun crime to ask members of the armed forces to shoot people for them, thus stopped them from re-offending!
The drug addicts on the trial talk about reducing their intake over the coming weeks, well of course they do…if they said otherwise they’d be kicked out!
Here’s another quote:

“One of the heroin addicts on the programme, a 34-year-old man called John, had been addicted for eight years when the trials began.  He fed his habit by dealing.

“My life was just a shambles… waking up, chasing money, chasing drugs,” he said.

But John said the scheme had transformed his life “100 per cent” and he now had a part-time job.”

Well of course his life has been transformed, some nice clinic is supplying his drugs so he does not have to worry about it.

I’ve been thinking more about this kind of initiative, I commute to work, and that’s not very environmentally friendly, so perhaps the government can do some research on the benefits to the environment by paying me the same wage to stay at home and get someone else to do my job… I bet the results show I use less fuel by not driving to work!

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He’s with us, not US!!!

Posted on August 19, 2009. Filed under: Apply topically |

Now before I crack into this little post, I would clearly like to clarify something… I am actually quite keen on Americans. I mean I’d have to say that because a fair chunk of my readers are from “across the pond” and some of my favourite bloggers are Americans, but despite the stereotype I like them! 

Anyhow…the reason I’m heading down this road is that the debate about the American health care system, seems to have turned into a bit of NHS bashing exercise.  This is partly due to a British Conservative politician going on American TV and having a moan about the NHS.  I was going to ignore it…I’m not too interested in blogging on politics really and try to keep the blog more for light relief on a rare coffee break.  However I found amusement in the ongoing debate following an editorial from the “Investor’s Business Daily”  which stated: 

“People such as scientist Stephen Hawking wouldn’t have a chance in the UK, where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.”

Stephen Hawking awarded Presidential Medal of Freedom by Barack Obama

Stephen Hawkin as I am sure you know has an American accent via a computerised voice-box.  He is however a BRITISH physicist and after being used as an example against the NHS he stated:

“I wouldn’t be here today if it were not for the NHS,” and pointed out: “I have received a large amount of high-quality treatment without which I would not have survived.”

Not only does this make the editorial team at the “Investor’s Business Daily” look like a bunch of idiots, it also does nothing to quash the American stereotype of being slightly insular…It’s a stereotype and not my opinion, although having a “World Series” for a sport that most of the world has no interest in also seems to be a bit of a bummer!

Next you’ll be telling me you though that grumpy Doctor House was American….oh please!!!

“House old boy…is that you?”

I digress! People complain about the NHS it’s true, but people complain about health care from any provider.  I have worked within the NHS and been on the receiving end of NHS care at a life and death level on two occasions, and I love it (I love the NHS that is, not particular in love with life and death situations themselves).  Sure it’s not perfect, but as the biggest employer in the country there is always going to be a few imperfections, maybe even in some cases a bit of a postcode lottery, but apart from a few variations the NHS provides a good standard of care for everyone, regardless of your financial package and insurance policies.

Whether or not Obama is going to win this battle, or even whether it is the right thing for America, well I have no idea. Either way it’s a big country and I’m sure they are big enough to look after themselves without having a go at the NHS and without the unnecessary opinions of our politicians.  Here endeth the sermon…

Just one more thing…my mate is raising money for Cancer Research, by swimming in the fricking cold September waters.  She is a bit of a contributer on this blog and could do with some support, so if you want to donate a few quid to a good cause and a friend of mine…then click here… Donating isn’t means tested and won’t effect your long term health care…(although it might mean Rachel gets Pneumonia and needs NHS treatment!)  Ta!

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Not scared enough??

Posted on August 6, 2009. Filed under: Apply topically, Benign |

Bored with swine flu?  Increased war zone fatalities not decreasing population adequately?  Need something new to worry about?  Why worry about new killer bugs when you can worry about good old fashioned BLACK DEATH!?!!

AH YES…The scare mongery media have got bored….(although I think if the government were in trouble about something, this would have more attention…)

The BBC reports a second death from pneumonic plague….DOOOOOOOOOOOOOM!!!!! The report states that “…it is caused by the same bacteria that occur in bubonic plague – the Black Death that killed an estimated 25 million people in Europe during the Middle Ages”. 

(link for those out of the loop)

OMG…..what shall we do?? How about a nice digestive and a cup of camimile tea…. and look at the facts…

People infected with the plague usually experience flu-like symptoms, including fever and nausea, after an incubation period of three to seven days. If treated early with antibiotics, plague is curable….. oh my god it’s curable….oh how dull….

OK lets work harder….everyone is bored with invisible bacteria…lets go for a more visible threat…how about “Ladybird flu”? It’s a killer cross between a bird flu (avian flu) and the variant of the worst flu known to man….yes….Man flu!  It is transmitted by “killer” ladybirds.

ladybird-ireland-image-picture-phot.jpg image by gardenplansirelandArrrg!! Scary!!!

Symptoms of Ladybird flu are….urm….fever, and your skin turns red (probably due to the fever) and then you develop black spots…  oh crud, someones already got those symptoms for diagnostic purposes…

Damn you Rocky Mountain spotted fever and of course Anthrax…

OK, so the new symptoms are that after you developed the red skin and black spots, you get severe back ache and then your back splits open and wings emerge from your back…and start repeating tongue twisters.Flew or Flu?

A flea and a fly flew up in a flue.
Said the flea, “Let us fly!”
Said the fly, “Let us flee!”
So they flew through a flaw in the flue….hmmm, not sure anyone is going to buy this one….

Lets just find another historic disease and spin it for the media… don’t want the public to start feeling they might be healthy again…lets say…hmmm Smallpox….actually no lets not, that is actually quite fricking scary!

How about….”Highly contagious weeping sores rife amongst children and can be spread to adults and across species“…  Good…. Lets add a bit of science….”caused by staphylococcus bacterium“…. oh yeah sounds good.   OK, OK, it’s just impetigo and the death rate is close to non existent….and easily treated with antibiotics….not so good…..

We need something not treatable with antibiotics to get the media really interested and scare the general populous…. I know the media will love this one….

How about….

“Disease which may quickly spread around the whole population” that is “Untreatable with antibiotics”, that “Guidelines state that treatment is not recommended”…. Warts or verruca’s not really that scary sounding though…

How about a sexually transmitted parasite that increases in size inside your abdomen and then pushes it’s way out through sexual organs and spends then next few decades causing havoc and costing tax payers thousands of pounds? Yeah, pregnancy…not that scary really (well pretty terrifying, but people are aware…)

Why am I wasting my time trying to think of something to scare everyone? I’ll just wait a week or so, the media will think up some health scare to sell papers or the politicians will have something to hide so they’ll distract us.

Before I close, I must draw thy attention to my blog mum…she has just celebrated her 4th blogiversary and produced a cracking addition for Grand Rounds.  Keep up the good work Kim!!

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Catchy uppy!

Posted on June 3, 2009. Filed under: Apply topically, Benign |

Whoa….someone stop the ride….

I’ve been hellishly busy of recent, and I am just typing up a quickie!  So where have I been…here and there is the answer, meeting, greeting and patient bleatings, but for the most part I’ve been bringing in the cash for the surgery by meeting government targets.  I was given two weeks to do a years work that someone forgot about until the last minute and then went ” Quick get Max to sort it…”  and actually I feel I did quite well!  Maybe I should sign up for next years Apprentice.

So what have I missed the opportunity to blog about during this time.

Well Swine flu cases have increased, but the media has lost interest, mostly due to another pig related story….

or perhaps it is just that Swine flu is less of a concern since the release of…….

But due to my lack of time to blog, I’ve finally given up the resistance to Twittering!  So just in case anyone was worried I had dropped off the planet or finally given up blogging, I can pop in and post a few words up in the top right corner and keep everything a little fresh!

Right off I go…people to see, places to go, illness to diagnose, paper work to do, courses to study, phone calls to make, emails to respond to that I’ve ignored for the past fortnight…hmmmmm, perhaps I should get a job as a nurse or something rather that an office worker…oh hang on, my mistake, I AM A NURSE!!

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