The Practitioner - 1868-2018: Supporting general practitioners for 150 years
 
 
 
 
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Haslam's view

 

Living near your practice can be a double-edged sword

25 Jul 2018Registered users

Living in the middle of the patch had a number of unexpected consequences. The most bizarre experiences tended to occur during social events. I will never forget the time I was taking part in a local charity fundraising fancy dress event dressed as Superman. Someone came up to me to ask if I would visit her granny the next week. Trust me, there is nowhere to store a notebook in a Superman outfit to record a request for a home visit.

Are you a bully?

25 Jun 2018Registered users

I’m sorry if the question offends you, but I suspect it is one we all need to ask.  After all, the chances are you will have no idea if you are a bully or not. Most bullies in medicine and healthcare are blissfully unaware of the fact. But it’s a real issue.

How often do patients cry in your consulting room?

04 Jun 2018Registered users

So many people used to cry in my consulting room that I had to buy tissues in bulk. I used to wonder what my remarkable experience of crying patients was triggered by. I eventually concluded that the main factor was safety. People should feel safe when they are in with their doctor. I think our patients should feel free to let their feelings out in the consulting room.

GPs must always be vigilant for the rare bird

24 Apr 2018Registered users

Isn’t it frustrating how the most complex and rare conditions can turn up when you are least expecting them? One fact that we must never ever forget is that even the world’s rarest condition will affect a patient who has a GP.

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.