Haslam's view


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.

Can you really die from a broken heart?

05 Dec 2013Registered users

Three weeks later, after a lifetime of perfect health, with the slimmest set of records, and not a symptom to report, he died at home. It was absolutely clear to me what the diagnosis was  — a broken heart.

We need more generalists

23 Oct 2013Registered users

Most people with problems have multiple problems, and need a generalist to care for them, and of course generalism is the hardest specialty of all. Instead of the insulting question that we have probably all been asked: ‘Are you a specialist or just a GP?’ I can’t wait for the day when I hear the question: ‘Are you a generalist, or just a partialist?’

Why do our memories play tricks on us?

23 Sep 2013Registered users

I can never understand why I still remember useless pieces of information – such as the name of the bass guitarist in a long-forgotten group that was a one hit wonder in the early sixties – but struggle to remember some of the things that really matter. And before you tell me that it’s just my age, it’s happened all my life.

Is there a doctor on board?

25 Jul 2013Registered users

Halfway across the Atlantic, the inevitable happened. ‘If there is a doctor on board. . .’ I made my way towards the back of the plane, where I could see two men in suits leaning over another man who had collapsed on the floor.

Try to put yourself in your patient’s shoes

24 Jun 2013Registered users

As doctors we often wonder why patients fail to follow our advice. This was one occasion when it became all too clear where the problem really lay – our advice was impossible and thoughtless.

GPs can be key advocates for older patients

23 May 2013Paid-up subscribers

Many older patients worry that they are receiving less care than their younger counterparts for the very good reason that the care they are receiving is less good. The Care Quality Commission found that while much care is good, fewer hospitals than on previous inspections were shown to be respecting people’s privacy and dignity, with nearly one in five failing to meet people’s needs. It is all the more important that those of us in general practice really do act as the powerful advocates for our patients that we can be.

Looking at cases through the retrospectoscope

25 Apr 2013Registered users

We can only do the best we can with the knowledge we’ve got at the time, so I don’t feel too embarrassed when looking at old notes makes you think you got something wrong. Looking back to today’s diagnoses from 35 years in the future, who knows which ones will have been discarded?

I’ll never forget that advice you gave me, doctor…

21 Mar 2013Paid-up subscribers

It’s a phrase that I’m sure has been said to you. It’s certainly been said to me over and over again. The thing that has always puzzled me is when the wonderful advice attributed to you is something you simply cannot imagine ever having said in the first place. One thing general practice has taught me is that while we often get the blame for things that absolutely are not our fault, we also get the credit for things we didn’t do.

Do we just pay lip service to patient-centred care?

21 Feb 2013Paid-up subscribers

‘I’m absolutely certain that patient centredness should be at the very core of our being. The worry is that it is sometimes a soundbite served up as a policy.’ 

Time to end the ten minute consultation?

24 Jan 2013Paid-up subscribers

Many practices are bringing in changes, but others are just struggling, overwhelmed and exhausted.

The enduring power of print

12 Dec 2012Registered users

‘There is certainly a particular place for books that are there for all time on your shelves, ready to stimulate, challenge, in a way that no online work could ever achieve’

Time to put dad to sleep?

30 Oct 2012Paid-up subscribers

'I’m worried about my dog. Dyson is now 12 – nearly 13 - which isn’t a bad age for a Labrador. Over the past few months he has started to struggle. He loves his food, and he loves the idea of chasing a tennis ball and going for a walk. However, all too often he will come back from a walk struggling with a limp. And he does seem to get exhausted much quicker than he used to. Are we being cruel and selfish in keeping him going? Is it time for him to be put to sleep? Isn’t it fascinating how a question like that has become the norm? So what is the risk that this could become the norm for humans too? One day might my children and grandchildren have a discussion about whether it is cruel to keep me going, or if it is now time to have me "put to sleep"? I’m not being facetious. I’m not equating a human life with a dog’s life. What I am doing is noticing just how easily a concept like being "put to sleep" can become the unremarked norm. Is that what we really want?'

Fictional doctors do us no favours

20 Sep 2012Paid-up subscribers

'Don’t you find docs on the box intensely irritating? I’m not talking about the real doctors who pop up on factual programmes putting minds at rest, nattering to presenters, giving an instant update on whatever medical condition has come to the fore overnight. It can’t be easy, getting a call asking you onto breakfast TV to discuss the ins and outs of Rocky Mountain Spotted Fever, just because some minor celebrity has been diagnosed with it on holiday. In fact, it’s just about as straightforward as doing an average morning surgery when patients can descend and ask anything and everything and you don’t even get a moment’s notice...'

Should we rethink the way we practise?

21 Aug 2012Registered users

'These are really difficult times for general practice. Wherever you practise in the UK, or indeed the world, we face extraordinary challenges. It’s not just the ramifications of politics. There is the ageing population often with multiple comorbidities, not to mention increasing expectations, the impact of the internet and the explosion in widely available knowledge, funding pressures, regulation and revalidation, and workforce issues.'

Lessons from DIY training for general practice

20 Jun 2012Registered users

Somewhere in the middle of my second preregistration post, the equivalent of a modern FY1, I finally made my mind up. General practice it was going to be. In those days, extraordinary as it may seem now, vocational training for general practice was not compulsory. If you wanted to be a GP, you could simply apply for a partnership straight after registration, something that quite a few people in my year at medical school seemed happy to do. Crazy! Like you, on the day that I qualified I felt pretty confident that I knew enough to be able to do the doctoring, and after about ten minutes in my first job I realised that the depths of my ignorance were almost unfathomable. And when it came to having to know the range of topics that would be involved in life as a GP, then panic really set in...

Nursing home patients are falling through the net

23 May 2012Registered users

'I recently visited a friend's father in a nursing home. He is very aged and very frail but still has all his marbles. When we remarked that he was looking rather miserable, he replied: ‘The night-time staff are really mean to me.’ Every evening he got more and more agitated about the staff who were coming on duty. I offered to have a word with the manager. ‘Oh no,’ he exclaimed. ‘You mustn't say anything. That will only make it worse.’ How many old people suffer in silence because they fear the repercussions?...'

Haslam's view: When does a phobia become an illness?

25 Apr 2012Registered users

'My wife hates spiders. I learnt long ago that a shriek from another room didn’t mean that a maniac with an axe had broken in, but that a half-inch spider had just careered across the carpet. An ability to tackle spiders has given me a touch of hero status in her eyes, as if I had seen off a gang of feral hooligans single-handed. There is no logic to phobias....I bet there’s something illogical that petrifies you...' writes our regular columnist Professor David Haslam.

Haslam's view: The healing touch

21 Mar 2012Registered users

'For doctors, touch can be a vitally important part of our therapeutic armamentarium. I’ve lost count of the times that I've leant over and held someone's hand when they started to cry in the consulting room. Perhaps it is its rarity in contemporary society that makes this act so important, so symbolic. Even the simplicity of a handshake at the start of the consultation carries symbolism beyond mere ritual. But it may be becoming threatened...'

Haslam's view: How supportive are your partners?

25 Feb 2012Registered users

'They had been partners for 15 years but on the day his father was taken critically ill Tom first discovered just how supportive partners can turn out to be....'

Haslam's view: It’s easy when you know how

24 Jan 2012Registered users

'I've always been deeply in awe of musicians. They seem to hold some mysterious secret that the rest of us mere mortals can only marvel at. Music of all kinds matters hugely to me. Despite this passion, the only things I can really play with any proficiency are my iPod, CDs and my residual and much treasured vinyl collection. Over the years I have attempted to play all manner of musical instruments – including the most recent bizarre trilogy of bluegrass banjo, ukulele, and dulcimer – but none of them will release their treasures to me. I am well aware that the musically proficient among you would barely consider any of those three a proper instrument anyway. The closest I’ve ever got to any proficiency was when I brought a sitar back from India when I travelled there overland as a student. By proficiency I simply mean that I was as absolutely useless as almost every other amateur sitar dabbler at the tail end of the sixties...'

It’s a fine line between health and illness

16 Dec 2011

'The more I study depression the less I think I understand it. The fact that someone has massive social problems doesn’t automatically mean that he or she can’t be suffering from a biochemical depression and vice versa. However, discerning the point at which medication is appropriate can be ludicrously difficult, and full of unintended consequences. For instance, if a GP offers treatment to someone who is distressed by their living conditions and the intransigence of an unsympathetic council housing department, and as a result of medication he or she feels better, then will those living conditions ever improve? But how can we be certain that the cause of the depression really is the living conditions? Could it not be that the cause is infinitely more complex? When do we become agents of the status quo?...' Professor David Haslam, President of the BMA, Past President RCGP, National Clinical Adviser, to the Care Quality Commission

Saving face in front of your patients

22 Nov 2011Registered users

'It’s long intrigued me how the world seems to be split into those who are desperate for a prescription, despite all the medical profession’s advice to the contrary, and those who will do anything to avoid a prescription, and want to ‘leave it to nature’. I am fascinated by this perception of nature as being fundamentally benign. You can’t get anything much more natural than salmonella, or cholera, or even man-eating sharks. But still there are those who believe that the adjective natural bestows a healthy glow on whatever noun follows it. And aren’t you also fascinated by the way that general practice seems to revel in situations that set us up for an inevitable fall. How many times have you waxed lyrical about a particular treatment, only to hand over the prescription and have the patient say: ‘Oh, but the other doctor gave me that and it was useless?’ ' 

Patients should have access to their records

20 Oct 2011Registered users

I hate to think how long ago it all happened, but I’m guessing it was some 30 years. It’s not that I remember everything I did that long ago, but the occasional situation remains unforgettable, and this was one. I was doing a fairly routine surgery, in which 20 patients had expected me to make some sort of sense of what was going on in their lives. One of these patients was a young woman whose problem I don’t recall, but as she was getting up to leave I clearly remember her asking, ‘Oh, could I possibly have a look at my medical records?’ I passed them to her. She looked at the envelope, weighed them in her hand, and then – without opening them or reading a word, she passed them back.

Minor symptoms can cause major anxiety

19 Sep 2011Registered users

I’ve long enjoyed a cartoon in which a doctor is saying to a  patient: ‘No, you're not a hypochondriac. You only think you're a hypochondriac.’ Well, I quite often think that I’m a hypochondriac. I don’t know how medical school was for you, but I well remember that almost every symptom or sign of serious disease that I heard or read about, with the probable exception of haemorrhage and convulsions, made me panic. ‘I think that I’ve had symptoms like that,’ I thought to myself. As a male, it was a massive relief whenever we did obstetrics or gynaecology. I could sit back and relax, whatever we were studying couldn’t happen to me.'...

‘While I’m here doctor…’

08 Aug 2011Registered users

 I've never been an admirer of GPs who say 'only one problem per consultation. If you want to ask something else, you'll need to make a fresh appointment.' I absolutely understand why it happens - I get pressured by time as much as anyone. But it makes a mockery of pretending that we practise holistically.

Keeping up to date with the changing evidence

22 Jun 2011Registered users

'Don't you find it fascinating how fashions in medicine change? What is dreadful practice one year can become exemplary practice the next. Many years ago, when I was chairing the MRCGP Examination Board, I was contacted by a medical lawyer who needed to know how serious a crime it was to prescribe a beta-blocker to someone in heart failure. Now it's considered to be good practice. That's the glory of science, constantly checking and questioning, turning hypotheses upside down, refining the evidence. It's exactly how it should be, but it doesn't half make life confusing at times...'

Listen to your patients

25 May 2011Registered users

'The secret is probably in the caring bit. I don't mean it in some soft and fluffy psychobabble way, I mean just be interested in, and really engaged with, the human being in front of you. If you do that, and you combine this with knowledge and some skill, you're almost there.'

Patients keep us anchored in the real world

20 Apr 2011Registered users

I think I started this column way back in 1996. Since that time in England we have had eight Secretaries of State for Health. Since I started as a GP we have had a total of sixteen. Throughout the decade and a half that I have been writing this column - during which I have found myself knee deep and bloodied in the politics of the NHS - I have steadfastly ignored every single development that has come along when choosing what I should write about. Whether it has been fundholding, total purchasing, practice based commissioning, the role of the health authority, FHSA, PCG, PCT or whatever that year's great new idea has been, I have ignored the lot.Partly that's because you can read quite enough about medico-political shenanigans elsewhere, but mainly it's because what has gone on in my consulting room has been resolutely unaffected by what has gone on in Whitehall.My patients kept on coming with their dis-ease and disease. They were worried, and frightened, and puzzled. In the privacy of the consulting room, in that extraordinary intimate exchange between doctor and patient, they shared their hopes and fears.

GPs and patients divided by a common language

22 Mar 2011Paid-up subscribers

'There are great advantages and disadvantages in having English as one's native tongue. There is so much less incentive to study a foreign language when so many people around the world have apparently mastered English. But it's all too easy to assume that understanding exists when it doesn't. If America and Britain are two nations divided by a common language the same can also be said about doctors and patients.'

What do you mean my results are ‘normal'?

21 Feb 2011Paid-up subscribers

'I have known patients ask after a blood test if they can be told what their blood group is, and are surprised to discover that this was not tested. Many of our patients appear to believe that a blood test will test for everything - a not unreasonable expectation in these high-tech days. What does this potential misinterpretation really mean? If a doctor performs a blood test to measure the haemoglobin level, and simply informs the patient that his or her blood test was normal, might not the patient assume that everything - including maybe even the HIV status - was normal? If so, the public health implications of blood testing are enormous...'

Risky actions can have long-term consequences

23 Jan 2011Registered users

The problem with writing any column like this is the inevitable gap between my writing it and you reading it. As I write, it is bitterly cold outside. As you read, the sun may be shining and you may be revelling in the most beautiful of crisp winter days. But my guess is that you will be shivering too. It looks like it's going to be a long and very cold winter. Indeed, whatever your views about the cause, there seems little doubt that the changes to our climate seem likely to become more and more dramatic as every year goes by. We are having hotter summers and colder winters. The impact on our lives as GPs may be very considerable, particularly when it comes to home visits, and even more so for those of us who live in the country - though having seen the devastating effect that an inch of snow can have on central London, rurality may not be the sole marker of transportation chaos...

Santa Claus requests an urgent house call

20 Dec 2010Registered users

Whether you are religious or not, and irrespective of the faith that you may or may not hold, the Christmas holiday break followed by the arrival of the New Year gives everyone a chance to ponder on the year that has gone and the year that is yet to come...

If you’re feeling under pressure, slow down

22 Nov 2010Registered users

In the years that I've written this column, I've talked about sickness and disease, receptionists and nurses, complexity and simplicity, guile and guidelines. But I don't think I've ever quite focused on the cornerstone of so many doctors' working day. A nice hot cup of tea.

Putting your stamp on general practice

20 Oct 2010Registered users

Have you seen the latest commemorative stamps? As the royal mail said when introducing them: ‘In a little over a century, British doctors and scientists have made a series of startling breakthroughs' - and the stamps rather beautifully depict those breakthroughs - beta blockers, penicillin, the Charnley hip replacement, lens implants, the understanding of malarial transmission, and CT scanners. So where are the British GPs in all this? I'm not denying the astonishing scientific achievements that these discoveries represent. But I'm always struck that we do 90% of the work of the NHS, caring for most of the health problems of most of the population most of the time. We are becoming busier every year, and clearly offering something that the public appreciates, expects, and demands. I can't think of a single week in the three decades of my professional career when I haven't had more work to do than I could readily complete, so we must be doing something that matters to people. So, if one day the Royal Mail were to notice our frenetic backwater of the medical universe, what half dozen images might sum up most clearly just what it is we do?

Art versus science in general practice

20 Sep 2010Registered users

I keep getting the very scary sensation that absolutelyeverything that I learnt at medical school will one day be proved to be wrong. Well, maybe I'm exaggerating. It's probably unlikely that much will change in the world of gross anatomy. But, when it comes to areas such as therapeutics and management, then few drugs or theories ever survive the onslaught of new research.The last straw seemed to be the recent reasonable questioning of whether lowering the temperature of feverish children is a good thing or prolongs their illness. I may have to add that to the list of activities that took up countless hours of my time in the early years of my career and for which it now appears there is no evidence that I was doing anything other than wasting time...

GPs not working fast enough for local PCT

21 Jul 2010Registered users

'If my PCT wants me to deal with my patients any quicker, for the simple sake of some ludicrous concept of efficiency and value, the answer will be a simple one. If somewhat anatomically challenging.'

Myth of the guitar man in a pale blue jumpsuit

14 Jul 2010Registered users

Aren't reputations strange things? Frequently based much more on fantasy than fact, they are often completely out of our control, and - whether good or bad - often ludicrously undeserved. These thoughts were triggered by a patient who had just registered with us. He had a wealth of medical problems, and was going to be someone I would get to know well over the coming years. At the end of the consultation he said: ‘I hear you're a pretty ace guitarist too.'

Read Codes don't tell half the story

30 May 2010

'But when the hospital team discussed discharging him to a nursing home, his wife would have none of it. He was coming home, and she would care for him. By this stage she was in her eighties, but she set to organising the house, rearranging everything to make her husband's last months or years comfortable.'

Why is your patient worried sick?

15 Apr 2010

"That's a fair amount you've got to deal with. You must be worried sick." I waited and the penny dropped

Better safe than sorry

15 Feb 2010Registered users

'I wake in the early hours suddenly wondering if I got a particular case that day right or not'

There’s nowt as queer as folks on holiday

15 Jan 2010Registered users

‘I always go back to first principles and explore the individual’s ideas, concerns, and expectations’

Reading between the lines to make a diagnosis

15 Dec 2009Registered users

'He could have looked cross. Instead he just looked through me into the middle distance as his eyes very slowly filled with tears'

Mobiles have distanced GPs from the community

01 Oct 2009Registered users

The simple invention of the mobile phone changed forever the living arrangements and lifestyles of generations of doctors

Haslam's view: Our view of lives from the cradle to the grave

27 Aug 2009Registered users

'When, 20 years later, I saw him happy and healthy then I knew that particularly stressful day’s work had really been worthwhile.'

Haslam's view: 'But I always like to see you, doctor...'

01 Jun 2009Registered users

'Will we still have a system that allows patients and doctors to develop a long-term relationship, in which trust is paramount?'

Haslam's view: should we accept gifts from patients?

21 May 2009Registered users

'I was deeply touched...It was certainly very generous, but there was no way I could ever let on.'

Haslam's view: Moments when life changes forever

25 Apr 2009Registered users

'There are the occasions when you decide to visit, rather than advise, and realise how close you might have been to a major error.'

Haslam's view: Ask who Thelma is on day one

01 Feb 2009Registered users

'Maybe my patients pretend they know what I'm talking about on occasions too, without actually understanding a word.'