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Are all GPs hypochondriacs?

22 Mar 2018Registered users

I’ve never quite understood why every doctor isn’t a hypochondriac. Or maybe the rest of you are, but you hide it rather better than I do. I have had more potentially fatal conditions in the course of 24 hours than anyone I have ever known.

The patients that never come back

22 Feb 2018Registered users

'None of my patients has ever returned for further therapy, and so I mark that down as satisfaction and success,' the orthopaedic surgeon told me.

Identifying specimens has never been my strong point

23 Jan 2018Registered users

‘I bet you’ve no idea what this is,’ he said. Thrusting his hand deep into his back pocket, my 74-year-old patient pulled out a small pebble-like object and held it up. What on earth was it? I had thought the consultation had come to an end. He was proffering me a curious organic object. Could it be a gallstone? I really wasn’t sure.

Diagnoses may tell us more about the GP than the patient

20 Dec 2017Registered users

Have you noticed how often you read about a condition, only to diagnose it for the first time within a few days? Sometimes a little cluster of cases will appear, and then just as suddenly will disappear again. It’s pretty clear that many of our patients’ diagnostic labels may be greatly influenced by the interests of his or her doctor. Diagnoses often tell us more about the doctor than the patient. One doctor's diagnosis of depression is another's ‘pull yourself together’.

Would you refer this patient?

23 Nov 2017Registered users

A few weeks ago, just after I had gone to bed and was propped up reading a novel, I developed indigestion. After the initial and inevitable paranoid thought:'Oh my God, it’s a heart attack!' I realised that it was indigestion. But what now? I’m the age I am – which is almost certainly older than you, and this was a new onset of indigestion – albeit relatively transient. So should I be consulting my GP, and being subjected to endoscopy?

A salutary tale of one man and his dog

23 Oct 2017Registered users

He had been admitted to hospital because his diabetes had slipped hopelessly out of control. The experts were baffled. It was fascinating listening to all the great minds at the teaching hospital trying to fathom out why this had happened. However, the discussion was going nowhere until a dishevelled figure in the audience put his hand up. ‘Excuse me,’ he said. ‘You’re all forgetting about his dog.’ The great and the good shifted with embarrassment and tried to avoid his eyes. 

Gratitude and survival are not evidence of effectiveness

28 Sep 2017Registered users

I sometimes suspect that everything that I learnt at medical school will one day be proved to have been wrong. When it comes to therapeutics and management, then few drugs or theories ever survive the onslaught of new research. This is almost certainly a good thing, however frustrating it might seem when we have to try to keep up. We need high quality evidence to ensure that we don’t keep on making the same mistakes with ever increasing confidence. Simply believing that something works, and having stories of grateful patients, can never be sufficient.

How do you explain the concept of risk to patients?

28 Jul 2017Registered users

Patients consult GPs all the time wanting advice about risk. Risk is a quite extraordinary topic. People vary hugely in their appetite for, or their tolerance of, risk. Some people see a risk of 1 in 100 as being nothing to worry about. Others can’t face the idea of living with a risk of 1 in 1,000.

Do surgeons or GPs take the greatest risks?

22 Jun 2017Registered users

Ask ten thousand people which they think is the riskiest – surgery or general practice – and the only ones who will answer general practice will be surgeons or GPs. To the vast majority of the population, the drama of surgery looks horrifically risky. The drama of general practice may not be as great as it is for those who skilfully wield a scalpel while working medical and surgical miracles. However, a life that is saved by early diagnosis is just as much a life as one that is rescued from a life-threatening event.

If I knew then what I know now…

23 May 2017Paid-up subscribers

Directly in front of me sat a woman whose neck I can picture perfectly even after all these years. It was the suspicious looking lesion just below her hairline that had caught my attention. I felt it could well be a malignant melanoma. What should I do?

The power of the placebo

24 Apr 2017Registered users

In reality, I was probably dispensing a placebo that both the parents and I believed in. The parents will have relaxed, the children will have responded, and peace will have descended. However, I suspect none of those visits did anything but provide face-to-face reassurance. It certainly taught me about the power of the placebo, and that a therapist believing in something is no proof of effectiveness. 

What do GPs really do?

22 Mar 2017Registered users

I don’t really have any idea what people in different professions actually do all day. Do you? What do actuaries, astronomers or ethicists do when they arrive at work? In the same way, I’m pretty certain that not many people really understand what GPs do either. Pundits love to write about what GPs do, and what might be done differently or better, but I often wonder whether they really do understand the role and the challenge.

Doctors as patients

22 Feb 2017Paid-up subscribers

I don’t know about you, but I’m hopeless at being a patient. It is, of course, something that every single one of us will experience eventually. After all, there is nothing about working in the medical profession that exempts us but it can be more than a little difficult changing hats and adjusting to being on the other side of the consultation. This has all been very much to the forefront of my mind over the past few weeks as I’ve recently undergone surgery. Nothing even remotely life threatening – though thank you for your concern. However, recuperating from surgery has been a very instructive reminder of what life can be like for our patients.

Don’t judge a book by its cover

23 Jan 2017Paid-up subscribers

Our patients can frequently surprise us and those initial assumptions we may make can turn out to be wholly and emphatically inaccurate. It can certainly be a great way of uncovering one’s conscious or unconscious biases.

Why is it easier to give advice than to take it?

15 Dec 2016Paid-up subscribers

 ‘I suddenly realised that it was my pain, not yours. It was my job to sort it out, not the physio, or you doctor or anyone else. And so, for the first time, I actually started to do the exercises, and follow the advice you’ve all given me.’

Taken to task by my older patients

24 Nov 2016Paid-up subscribers

A crowd of around 20 people had gathered, and in their midst I could see a crumpled bike, and an even more crumpled elderly lady. I recognised her immediately as a lady in her late eighties who had been my patient for many years. I elbowed my way through the cluster of onlookers, and knelt by her side. She looked up at me from the ground, smiled, then turned to the crowd and announced: ‘Now you know. If you can’t get an appointment, this is how you get to see Dr Haslam.’

A memorable lesson in patient-focused consultation

24 Oct 2016Registered users

When I eventually turned back to the patient, I discovered that he was sitting there silently crying, tears running down his face. This, of course, was clue number two. It was not so much a clue, rather a slap in the face for my insensitivity. I apologised. I felt embarrassed and annoyed with myself. I immediately turned the computer off.

Better the devil you know?

23 Sep 2016Registered users

I tried to explain to my patients that the fact that they trusted me and were used to seeing me did not necessarily mean I was any good. But I also acknowledged that I knew how they felt, and how unsettling it can be when you have to see a new healthcare professional.

Treat all your patients like VIPs

01 Aug 2016Registered users

... That taught me a lesson. From that moment on, I tried to treat everybody equally. Either no-one should be treated as a VIP, or everyone should. I felt embarrassed at how rapidly I had been seduced into treating someone differently simply because of who they were. If you think a patient is a VIP, treat them just the same as everyone else. Treat all your patients like VIPs.

A little praise goes a long way

23 Jun 2016Registered users

Have you any idea how much your patients appreciate you? It’s so sad that so many doctors only find out how much they are appreciated, when they decide that enough is enough.

A lesson from a patient

23 May 2016Registered users

It was such a wonderful, unforgettable moment. The scene was a dermatology outpatient clinic, way back when I was a final year medical student. I can still picture it perfectly. A striking, red-haired young woman had come into the consulting room, smiled, and sat herself down....

Keeping yourself on track

25 Apr 2016Registered users

Making the same mistakes with ever increasing confidence probably applies to the way that many of us practise, or have practised, medicine. It’s a hard thing to admit, and probably a very hard thing to recognise. After all, if you do something that isn’t quite right – something as simple as taking a very minimal short cut – and you get away with it, then whether you are skiing or practising medicine the likely outcome is that you will keep doing it.

Choosing the right words

21 Mar 2016Registered users

In general practice, communication is everything. If the doctor and the patient don’t understand each other, the chance of any consultation being successful is dramatically reduced. It’s bad enough when dealing with straightforward but potentially embarrassing clinical conditions, when multiple euphemisms abound. However, when it comes to consultations about sexual health then the opportunities for crossed wires and misunderstanding are legion.

Communication skills are as important as diagnostic skills

22 Feb 2016Registered users

For your doctor to recognise and name the problem that ails you is the first step to treatment. In this world of ever increasing availability of medical information, clarity of diagnostic name is going to become more and more important, and the potential for misunderstanding becomes all the greater.

Mobile phones have transformed GP care

25 Jan 2016

When it comes to the world of general practice, I have a strong suspicion that during my professional lifetime the mobile phone is the single item that has had the most effect on GPs’ lives. It has fundamentally changed so much of emergency and out-of-hours care, and the way that it is delivered.

A tale of the unexpected

22 Dec 2015Registered users

She looked at me with total calmness and said: ‘I woke up during the night, looked at the clock – I remember it was half past four – and then I realised he was standing stock still at the end of the bed. He looked fine, that’s how I know he’s alright, but it was still a bit of a shock seeing him there.’

The simplest things can make the most difference

25 Nov 2015Registered users

General practice can be tough, but everyone gets thank you messages from time to time. Hold on to yours. When you have those inevitable days of self-doubt, take a quick look at your thank you cards.

Helping our patients to understand risk

21 Oct 2015

Every GP develops a profound understanding of risk, and of the sudden changes that can impact on anyone at any time. We see patients who are so unnerved by the risks that face them that life becomes impossible. We see patients who take so little notice of risk, that for instance, they smoke, and they smoke only to stop the moment that cancer is diagnosed. Helping our patients understand risk is a critical part of every doctor’s work.

Today’s facts will be tomorrow’s fallacies

24 Sep 2015Registered users

For many years I have collected old medical textbooks. The joy of these old textbooks is reading facts that we now know are totally wrong, but this is countered by the recognition that great chunks of what we know now will turn out to be wrong too.

We need to learn how to stop medication

05 Aug 2015Registered users

It was about 30 years ago, but I can still tell you every detail. I can picture his living room, the state of the front garden, every irrelevant pixel of the whole picture. I was doing a routine home visit to a 70-year-old patient of mine. Bill suffered from COPD but had also amassed a host of other conditions. Today we would have described this as multimorbidity. Back then we called them all chronic illnesses. Indeed, I don’t think we had such a thing as COPD – it was simply called chronic bronchitis. Anyway, as I looked at the extraordinary number of medications that my patient had accumulated over the preceding years, I vowed that it was time to try to rationalise them. Surely they weren’t all really necessary?...

Trust is the fulcrum of the doctor-patient relationship

22 Jun 2015Registered users

There is a great deal more to knowledge than mere facts, and there is more to caring than curing. For all human beings there remains a deep and continuing need in healthcare for a human relationship based on trust. Trust is hugely important in the doctor-patient relationship.

Plan for the unpredictable

21 May 2015Registered users

Time has to be the one thing that almost all doctors feel they lack. Within general practice the pressures on the typical ten-minute appointment seem to build all the time. If you know that unpredictable things are going to happen, then plan for them.

How my dog influenced the way I practise

23 Apr 2015Registered users

In a long professional lifetime, a huge number of people have affected me but one of the most profound influences was my very first dog. A Welsh terrier called Stan, an animal with the brains of a rocking horse.

All doctors should have their own GP

23 Mar 2015Registered users

I’m going to ask you a personal question. ‘Have you got a GP?’ It matters. You never know when you might need help. Doctors aren’t always very good at recognising their own healthcare needs. I know how busy you are, but doctors matter too. Please don’t neglect yourself.

Whose body is it, anyway?

23 Feb 2015Registered users

‘How do you feel about patients recording their own blood pressure at home?’ I would ask. My recollection is that around 95% of candidates were vigorously opposed to such an idea. They thought it unsafe, unprofessional, and unacceptable. I would ask them to explain the difference between their approach to self-measurement of hypertension and asthma.

Do you always reveal what you do for a living?

22 Jan 2015Registered users

I have certainly had times when I somehow managed to omit any mention that I was a doctor. It’s not that I’m in the tiniest bit ashamed of being a GP. It’s just that there are some situations where you really do not want to be asked your opinion on the best way to manage back pain.

The healing power of the magic sponge

15 Dec 2014Registered users

I ran onto the pitch, took one look at the dreadfully swollen and excruciatingly tender ankle joint, and knew exactly what to do. I shouted at one of the spectators to call for an ambulance, and totally disrupted the game. Everyone was standing around looking more than a little worried, when the trainer came running over with a bucket and a sponge ....

Why do doctors and patients speak a different language?

24 Nov 2014Registered users

Why do doctors use the complex when the simple would do very nicely? If 80% of diagnoses are made from taking the history, and if communication is the absolute essence of history taking, isn’t it rather a problem that doctors and patients spend half the time talking entirely distinct languages?

A lesson in understanding patients’ health beliefs

23 Oct 2014Registered users

Many years ago, during my first weeks as a GP trainee, I learnt  one of the critical lessons of my general practice life. I was well aware that everyone but my trainer knew that intramuscular penicillin was no longer the treatment of choice. Had I realised that I was totally failing to understand parental expectations, I could have handled these cases in a totally different way – though still avoiding the dreaded injections.

The changing face of general practice

23 Sep 2014Registered users

Just consider the extraordinary differences between general practice at the time of my birth and childhood and general practice as it exists now.

Technology can improve the doctor-patient relationship

25 Jul 2014Registered users

The potential for apps and add-ons to smart phones is almost beyond imagination. Patients will be able to download user-friendly health information that will radically change the relationship between doctor and patient to a much healthier partnership model, rather than the teacher/student, priest/supplicant hierarchical model that is still all too typical. However complex and digital and networked the world becomes, human beings will still need to feel safe and cared for. People who are ill will still be frightened, need someone to trust, and need a system that cares. We must never forget that.

Compassion should not be an optional extra

23 Jun 2014Registered users

If I ever did need to see him again, I would like to be under a general anaesthetic before the consultation started. Surely talking to patients with compassion shouldn’t be an optional extra. What do you think, doctor?

Education is not the filling of a pail but the lighting of a fire

22 May 2014Registered users

Education should inspire, not bore. Perhaps the most effective series of events I can recall involved different local surgeries and health centres hosting our monthly meetings. Each practice presented the three things that they were most proud of, and the three things that caused them problems. The things that may have caused one practice a problem had been solved by another practice and vice versa. By sharing our pluses and our minuses we were able to evolve and develop.

Work in partnership with your patients

22 Apr 2014Registered users

I was really struck by how many doctors thought it was a terrible idea for patients to be able to access their records, but were massively in favour of being able to access their own medical records.

Prevention is better than cure

20 Mar 2014Registered users

About ten years ago I remember a senior politician waxing lyrical to me about how fantastic the treatment of heart attacks had become, with rapid insertion of coronary artery stents and similar technical developments. I agreed with him that of course this was impressive, but then I asked him which he would prefer: a speedily fitted stent or not needing a stent in the first place.

Why we must be honest with our patients

24 Feb 2014Registered users

The more health information that there is available to our patients, in books, magazines, TV programmes, and the internet, the more important it is that we retain our trusted status as honest advocates who won’t necessarily just tell our patients what they want to hear, but will tell them the truth, and use the evidence honestly and openly.

What will be the next sea change in medicine?

22 Jan 2014Registered users

In the same way that you don’t really notice that a child is growing if you see that child every day, so the inevitable changes in the prevalence of different diseases tend to creep up on us unobserved.