Doctors

Thinking Aloud On a Sunday

~ beetleypete ~ 66 Comments

Going to the Doctor.

I know I did a post on Thinking Aloud yesterday, but I woke up thinking about something this morning, so you get an extra one.

When I was young, my Mum used to take me to the doctor. But I had to be quite bad before she went that far. Not that we had to pay anything, because we had the NHS. That had come into being five years before I was born, and the working-class people where I lived in London were incredibly grateful for it. So my Mum would not bother a doctor with anything trivial, as she had too much respect for this new service.

The system was very different back then. No need to telephone for an appointment, just turn up for morning or evening surgery, and wait your turn. Most people where I lived didn’t have a telephone anyway, so appointments wouldn’t have worked. We sat on long benches around the walls of the waiting room. The first person to arrive sat closest to the door leading through to the doctor, and everyone took their place in turn, with not a thought of queue-jumping.

The only distraction provided for those waiting was a stack of old magazines piled on a small table in the centre of the room. I saw my first ever copies of National Geographic, along with the familiar Reader’s Digest, and some newspapers left behind by anyone who had already left. There were no screens offering TV or recorded messages, and definitely no toys for the amusement of children. We were expected to behave, and we did.

Nobody talked to each other either, even though many of the faces were familiar, and some of those in the waiting room were well-known to us. It wasn’t done to discuss your ailments in that situation, or to ask anyone else why they were there to see the doctor. When it got to our turn, the doctor opened the door and we walked in. There was no calling-out of our name, and no mention of whether or not he knew us. His office was like a study, and he sat at his desk with a serious demeanour. Once he had heard the story, and perhaps made some examination, he would either tell us what to do, or give out a prescription for the necessary medication, which was also free then.

Everyone called him ‘Doctor’, even though his name was on a sign on his desk. He was better educated than anyone we knew, and older than my Mum, and most of the others in the waiting room. His word was never challenged or questioned, and his advice or treatment was always acted upon. He was a doctor, so that was enough for us. We looked on him with some reverence, and gave him respect, and our best manners at all times. In return, he was polite, caring, and efficient. He was also rather condescending and superior, but I didn’t realise that at the time. Once he had finished with us, profuse thanks were in order, and even when I was still very young, I was taught to say “Thank you, doctor”, before we left his consulting room.

Things are very different now.

Getting an appointment can be exceptionally difficult in some areas of Britain, especially in the big cities. Most doctor’s surgeries have three or four doctors working there, to cope with the increased workload. They also employ skilled nurses to deal with minor injuries and illnesses, as well as technicians to take blood, or receive samples. At our local doctor’s we no longer have to go anywhere else to collect drugs or medicines, as they have a pharmacy attached, operated by three full-time staff. You can even get minor surgical procedures done there, which saves travelling to the hospital like we used to have to. In my opinion, the expansion of such facilities into larger clinics has been a positive move, and the doctors seem to be younger and more dedicated too.

But the most noticeable change has been in the attitude of the patients. Despite the provision of toys and games, children run around like crazy all over the place. Their parents stare into their phones, generally ignoring the bad behaviour. And people argue. They shout at the receptionists, complain that they haven’t bee seen quick enough, and debate their treatment with the doctor, based on some rubbish they have read on Facebook, or looked up online.

Despite being able to telephone, or book an appointment time using the Internet, many still just walk in and expect to be seen immediately. The last sixty years have imbued the people of this country with a sense of entitlement, and a worrying arrogance. They threaten staff, complain to local authorities, and take to Social Media to moan about the service at the local doctor’s.

They should think themselves lucky that we have such a system funded my small National Insurance payments, and backed up by huge amounts of public money. They are not old enough to remember a time when you queued patiently, sometimes for hours, and gave respect to the people who were treating you.

My conclusion is that if those people can get to the doctor’s just to be rude and horrible, they are not sick enough to be there in the first place.

The NHS: Something good

~ beetleypete ~ 13 Comments

There are always stories in the media about the poor state of the Heath Service in this country. We have all heard the sorry sagas of unacceptable waiting times, botched operations, and postcode-lottery drug administration. You could be forgiven for believing that the NHS is on the verge of collapse; swamped by high demand, pressurised by an increased immigrant population, employing staff who have no interest in the job. This is not my experience though, and I feel that someone needs to put the opposite view, just for a change.

In any organisation as large as the British National Health Service, there will always be errors. It is impossible to provide a service envied the world over, without accepting the reality of mistakes being made occasionally, and the odd member of staff who is not up to the job. I do not wish to detract from individual cases of tragedy, or to comment on them. Instead, I would like to offer an overview of where it does work, instead of criticising every tiny aspect of where it does not. I must start by stating that I know of nowhere else where a system like this exists, and works. We pay a relatively small amount into our National Insurance Scheme, and receive huge benefits in return. Those not working, or unable to pay, receive exactly the same care, free of charge.

Of course, I would like to see an end to prescription charges, still paid in England. I would also like to see a return to completely free dental care. With the right party in government, this would all be achievable. Despite this, the care provided really is exceptional. Those of you who are healthy enough not to need to visit a doctor, hospital, or other medical service provider may wonder what all the fuss is about. One day, you will find out. It is naturally more difficult to provide a good service in areas of high population density. Or is it? When I lived in London, I could normally see a GP within a week. If that wasn’t satisfactory, I could sit in the surgery, and would be seen after the other appointments. Attending a clinic in one of London’s busiest hospitals, University College, I was seen in under an hour. I only waited one week for the appointment to arrive too. At the same hospital, I waited just fifteen minutes for a blood test, and the results were with my doctor in four days. By my standards, by any standards, that’s very good.

Here in Norfolk, despite constant publicity to the contrary, it is even better. My GP has contacted me at home in the evenings, something unheard of in London. The out-patient appointments at the Norwich and Norfolk hospital are efficient, and thorough too. The staff are friendly and committed, and patients are never left to feel that they are an intrusion. The consultants and junior doctors take time to explain your case, and their treatment, and interact with you as if you are an adult, who wants to know what is going on. It is true that the regional Ambulance Service has a poor record. Given the legacy of poor management, under-funding, and the sheer physical geography of this region, that is understandable, if not excusable. The whole county has only two main roads, few dual-carriageways, and no motorway. Remote villages, weather problems, and the logistics of running a service covering six counties, all adds up to a problem that needs to be solved.

There are few major hospitals in this county. The ones that do exist are constantly criticised, with little balanced reporting of their struggle against the problems that they have to deal with. But there is little mention of the many good things. Mobile clinics, that remove the difficulty for patients of having to travel into the towns and cities for treatment. Sensible use of smaller hospitals, to provide out of hours GP clinics, geriatric care, and other community-based services. Widespread use of mobile community nurses, offering visits and treatment in the patients’ own home. We have had occasion to attend Eye clinics and Diabetic clinics, and my step-daughter has received very good service from the Maternity Department and Midwife team. Nothing seems to be too much trouble. Telephone calls to any branch of the NHS here are dealt with quickly and professionally. E mails are answered promptly, letters are sent out when due, and text message reminders of appointments are also commonplace.

I didn’t need the NHS for most of my life; but as soon as I did, it came through.

There is no magic wand to wave to make this service faultless. Given the increasing and ageing population, financial restraints, and new advances in medicine, it is always going to appear to be catching up. But it is undeniably good. And when you need it most, you will realise just how good it is.

New diagnosis, same rash

~ beetleypete ~ 11 Comments

With thanks to those of you who told me to  carry on blogging about anything, I will continue with what is becoming something of a ‘serial’ post about my ongoing skin affliction.

With no remission in sight, and itching and rash unabated, I went back to see my GP today. I made the wise decision to make sure that I saw that same doctor, as in the surgery I attend, they will book you in with anyone. This is fine normally, but when a condition is running into it’s second month, I feel it is important to maintain continuity. Also, she seems very good, which never hurts, let’s face it.

Looking at my hips, back, and arms, she immediately reviewed her first diagnosis, that it was either an allergy, or some form of eczema, and promptly scrapped that idea. The rash is visible in a pattern known as a ‘Christmas Tree’, sweeping down in levels. like the branches of said seasonal arbor. Apparently, this makes it possible to firmly reach a diagnosis of a yeast infection/fungal skin rash, similar in origin to dandruff. (Which I never actually suffered from) Armed with this new information, she immediately advised cessation of the steroid creams, as they will not help, and can make it worse. I have also been given a stronger, soporific anti-histamine, to help me sleep at night.

To lessen the irritation caused by this condition, I have been prescribed a foaming body wash, (think anti-dandruff shampoo all over) and a cream that even the doctor described as; ‘basically- Lard’. This greasy concoction is almost impossible to have on the body, as it will contaminate clothing and bedding, and stain any furniture. I fail to see how I could possibly live normally, covered in some sort of white grease that ruins everything.

At least she is trying to help, and seems genuinely concerned, both minor miracles in my previous contacts with GP surgeries. It is usual, so she tells me, to wait 4-6 months before referral to dermatology at the hospital; but she will monitor my progress, and get an appointment for me before then, if she thinks it will help. I asked why she felt it could not be Lichen Planus, the previous guess. The lesions are not conforming to the normal pattern for LP it seems, and the other symptoms suggest a Candida related condition. The tree-like rash is so classic, that it leads down one distinct diagnostic path.

I don’t know what to think. I don’t much like the sound of having a fungal yeast infection, related to Candida. This is similar to Thrush, and it all sounds a bit ‘yuk’ (to use a non-technical term). I suppose, that on balance, it is marginally better than the auto-immune disease, which was previously diagnosed.

For those of you remotely interested, that is the progress to date.

As my Mum always said, ‘It’s not much fun, getting old’.

Getting on a bit

~ beetleypete ~ 8 Comments

I have been posting lately about having a skin complaint, and high cholesterol. I have been to the doctor’s more times this year, than in the previous five years. I also suffer from Glaucoma, and have been trying to get an appointment at the hospital all year, for routine eye checks. My reading glasses were changed for varifocals some years ago. I now find that I am wearing them for a lot more than reading. Looking at products in the supermarket, watching some TV programmes, or foreign films with subtitles, all becomes a lot clearer with the glasses on. I can no longer read anything, except maybe huge font headlines, unless I am wearing the glasses. This means that I always have to have them around, and make sure that I always have them when I go out. Although I don’t yet need them to drive, as my long distance vision if still good, I would need them to use the mobile phone, or read a menu in a restaurant.

Tonight, I cut (what is left of) my hair. I stopped going to the barber’s shop years ago, when it started taking him less than five minutes to clipper off what remained. I bought my own hair trimmers, and have done my own barbering, sheep-shearing style, ever since. Julie remarked that my hair was now ‘completely white’. There are traces of the brown visible when it is slightly longer, but cut down to a ‘number one’, it is as white as snow. This will also stop me ever considering the growing of a beard or moustache, as I would look like a crop-haired Santa Claus.

Last week, we went on a trip to have a look at Downham Market, another small town in Norfolk. During our wander around, Julie bought me a jar of locally produced morello cherry jam, my personal favourite toast topper. When I fancied trying it the other day, I was completely unable to free the lid. I donned rubber gloves, still no luck. I tried wrapping it in a cloth, but it wouldn’t budge. I took the jar through to Julie, and complained that I was unable to open it. She gave it a twist, and it opened with a pop. I stood humiliated, a grown man having to get his wife to open a jar. It was like being a child all over again. Except a child doesn’t care who opens their jam.

On Monday, there were things to put into the loft. I got the ladder in, and inspected the parcels, prepared by Julie the previous day. Nothing too arduous, I reasoned. Two suitcases, wrapped in plastic for storage. Two bags of clothes to go away until next winter, and some small boxes. By the time I had finished hauling them individually up the ladder, crawling around in the loft to place them, and tidying away afterwards, I felt whacked out, and ready for a coffee, and a sit down.

So, with all this medical stuff, failing eyesight, snowy hair, and diminishing strength, I have had to come to an unpleasant conclusion.

I have to admit that I am getting on a bit…

Statins

~ beetleypete ~ 30 Comments

About three years ago, I had a routine blood test at my GP. He diagnosed excessively high Cholesterol, and said that I would have to immediately begin taking Statins, a drug designed to reduce the Cholesterol in my bloodstream. I read up about this drug on the Internet, and voiced my concerns to the GP, before getting the prescription. He was having none of it. If I wanted to stay in his practice, I would take the drugs he prescribed, and heed his advice, or leave, and find a new doctor.

So, I began three and a bit years of taking Simvastin, the proprietary brand of Statin. Regular blood tests were carried out at the local hospital, and I received no more information, so presumed all was well, and that the tablets were doing their job correctly. When I moved to Norfolk this year, I was readily given a repeat prescription, no questions asked, so continued to take them as before. However, I had started to experience sharp pains in my arm muscles, especially after exercise. This was accompanied by a marked reduction in the size and strength of my upper arm muscles, and an inability to lift weights of any consequence. I convinced myself that the Statins were something to do with this, and decided to make inquiries again, at the new GP surgery in Norfolk.

On the day that I attended the surgery, I was fortunate to see a locum doctor. She confirmed that it may well be the Statins causing the problem. She also told me that Simvastin was the cheapest option for prescription, as it only cost 20p a box, and that ‘better’ ones were available.  She suggested extensive blood tests, this time targeted specifically at trying to discover the extent of muscle damage. The bloods were taken and sent off, and I was advised to await a call, then to make a further appointment.

What happened next, was something that has never happened to me, in over 50 years of visiting a GP. I was telephoned at home, at 7 in the evening, by a Doctor who told me that I must stop taking the Statins immediately, and not resume them at all, under any circumstances. It seems that my fears were grounded. The Statins had worn away the Cholesterol sleeve around the muscles, and that tissue was being carried in the bloodstream, where it was detected chemically in the liver and kidneys. In effect, my forearm and upper arm muscles had ceased to develop, and it was unlikely that exercise would help. If anything, it would only cause greater discomfort in the long term.

I now wait to hear what, if anything, can be done. They may prescribe a ‘different’ Statin, but that is unlikely. The chances are, I will just be left to ponder bad advice from the GP in London. So, if any of you are told that you need this catch-all ‘wonder drug’, think very carefully before starting to take it. Do some research, and make sure that there is not a better alternative.

Ambulance stories (6)

~ beetleypete ~ 37 Comments

F.O.I.R.

The above abbreviation stands for Foreign Object In Rectum, and was something that I would use on paperwork, completed during and after Emergency calls, in my time in the London Ambulance Service. Abbreviations were commonly used, to save time, ensure privacy, and because the space on the form for diagnostics and treatment was very small! Other frequently used abbreviations were;  WTASOS (Walked to Ambulance and sat on side). PMCCAH (Patient made comfortable and put in chair at the Hospital), and a personal favourite, MAMH (Mad as a March hare). They are not used these days, as the new forms have various tick boxes and codes, leaving little space for ‘artistic expression’.

In the early 1980’s, the Earls Court area in West London, was a well-known gathering point for the homosexual and lesbian communities in London. There were gay clubs and bars, many of which had been around for decades, and a general tolerance in the district, that made it a lot safer than most areas for those communities to get out and about in, or to live there. The local hospital was called St Stephen’s, now re-built extensively, and re-named The Chelsea and Westminster Hospital. This hospital served the area well, and did pioneering work in the early days of HIV/AIDS, always showing great respect to Gay patients, whatever their reasons for attending. It also offered all the usual services to the area, including a busy Casualty Department.

One of its ‘accidental’ specialities, was the treatment of FOIR. These objects, were inserted into the rectums, of  (always) men, for various reasons, predominantly sexual gratification of some kind, and almost always by the men themselves, and not by a third party. The frequency of these arrivals at St Stephen’s was such that it often went without undue notice. Sex toys that had gone in slightly ‘too far’, household objects, and some fruits and vegetables, were commonplace. There were some more unusual efforts, I recall a shower head attachment on one occasion; however, one night duty, a nurse drew my attention to something that I still remember, 30 years later.

A man in his 40’s had arrived at the department after midnight. He complained of stomach pains, and after further investigation and questioning, claimed to have ‘fallen’ onto a large light bulb. The screw-in connector for this bulb could clearly be seen by staff, protruding from his somewhat distended anus.  An X-Ray revealed that this was an enormous Theatrical Spotlight bulb. It had some material inside that was visible to X-rays, similar to the chemicals in a fluorescent tube. The size of this bulb had moved the organs inside the man, pushing them all into a small cavity below his diaphragm, causing great pain, and the glass seemed to still be intact. When he was advised that emergency surgery would be necessary to remove it, and that this would be major abdominal surgery, carrying great risk, the man admitted that he had inserted the bulb himself. Apparently, he had practiced this insertion for some time, adding more and more lubrication, until he was able to get the entire object inside himself. It was something that he had obtained from work, as he worked in a theatre, in Covent Garden. We saw the X-ray, and heard the story, then had to carry on with our work for the night, and the man was taken off to the operating theatre.

When we were next in that area, a couple of nights later, I asked the nurses what had become of the man. I was told that he had died. This was not as a result of the surgery, or even as a consequence of the original insertion of the bulb. It seems that there had been a crack in the glass, and this had allowed some of the powdery material to escape into his bloodstream. This had caused numerous blood clots, which had resulted in his death.

I still have a vision of this man, alone in his home, tentatively trying to insert this huge bulb into himself. It has always haunted me, for some reason.

Ambulance stories (2)

~ beetleypete ~ 22 Comments

Jimi Hendrix pubes

For those of you who do not know, Jimi Hendrix was a once-famous rock guitarist, who reached his height of popularity in the 1960’s. More information, and pictures, can be found at; http://www.jimihendrix.com For the purposes of this post, his hair is the only thing of interest. It was quite wild, usually in an Afro style, with a headband habitually worn around it. The reasons for this explanation will become apparent later.

Not all the interesting things that happen to you in the Ambulance Service happen as a result of 999 calls. It is a popular misconception that ambulances operate from specific hospitals, and are run by those same hospitals. This is not the case. In London, the whole area is covered by the London Ambulance NHS Trust, and the vehicles and crews are based on Ambulance Stations, at various points around the Capital. This means that they can go to any and all hospitals, usually choosing the nearest one to the incident, for convenience. In recent years, this has changed a lot, with specialisation, but at the time I am writing about (early 1980’s) an ambulance could go to almost any hospital, and as a rule, chose the nearest one to their own base. Where I worked, in the area between Notting Hill and Paddington, we tried, as often as possible, to use the small Casualty Department just off Ladbroke Grove. Our frequent arrivals here meant that we knew the staff well, and we were conversant with the layout of all the wards and departments. It was more or less a second home to us, where we could get the occasional cup of tea, meet up with other ambulance crews from different areas, and generally feel like part of the furniture.

This accepted familiarity also meant that we would help out, when we could. At that time, there was no computerised admission procedure, so we would fill out the name and details of the arriving patient in a large ledger book, like something Uriah Heep would have used in Dickens’ ‘David Copperfield’. These details were transferred to a smaller card, for the nurses and doctors to add comments to. If the staff were all busy, and we were at the reception window, we would also enter the details of people walking in off the street, as well as those of the person we had brought in.

One particularly busy night duty, there had been a lot of serious incidents. Added to the usual parade of unconscious drug users, violent drunks, and patients awaiting admission to the ward, it had all made for a difficult night for the staff. By the time things had quietened down a bit, around 4am, we arrived with instructions to take home a frail old lady, who had been waiting almost all day to return home after treatment earlier. The staff were having a well-earned tea break, when we entered their rest room to let them know we had arrived. After a brief discussion about keys, whether or not she had eaten, and what clothes and possessions she had, we heard the bell ring at the desk in reception. I told the staff to finish their tea, and that I would go and see what it was. In the small waiting room at the front, I saw a tall man, about 30 years old. He was of mixed race, with frizzy hair, and wearing a raincoat. He spoke politely, though he was obviously agitated, and asked if he could see a doctor immediately. I advised him that I would take a note of his details, fill in his card, and pass it to the nurse for assessment, and I began to do so. When I reached the section requesting a diagnosis, I asked why he had come to casualty at this late hour, and why he needed to see a doctor so urgently. “It’s my pubes”, he said, “they won’t stop growing”. This was uttered without a trace of sarcasm, and with complete sincerity, his face remaining severe and grave throughout, his expression one of concern, with furrowed brow. I thought at first that he must be mentally ill. I asked why he had not done anything about this condition previously, or seen his GP, instead of bothering a busy Casualty Department in the early hours. He was close to tears, telling me that his family doctor was of no help, and he could not be taken seriously, as it was not painful, or life-threatening. However, he told me, it was affecting his life in many aspects, and making him distressed, as well as depressed. I went back and told the staff. They were too tired to argue, and asked me to book him in, then someone would get round to seeing him eventually, and probably refer him to a psychiatrist.

We left, to take our old lady home, and had a bit of a chuckle about the ‘man with the pubes’. A couple of hours later, we had another job nearby, and had to go back to that same hospital. As soon as I dropped off my patient, I was met by an excited nurse, who ushered me into the rest room, hardly able to contain her giggling and obvious delight in something. ” You have got to have a look at that guy’s pubes” she hissed. She continued by telling me that she had never seen anything like it, in all her years of nursing. As the story unfolded, it turned out that they had brought the chap into a cubicle, deciding to have a quick look, before writing him off as a nutter. When he got undressed, he revealed a thatch of pubes, the like of which had never been seen before, by any of the staff. It was so amazing, that they were ringing other wards, so that their colleagues could get a look at the phenomenon. This man had been examined by more staff than if he had been at a private clinic, he must have thought that he had finally gone to the right place to get his problem sorted. Little did he know, that he was the subject of morbid curiosity, in the same way as John Merrick would have been displayed in Victorian times.

I was not going to miss out, that was for sure! I was given a white coat to cover my uniform, and I borrowed a stethoscope from a nurse. I would have to trust to luck that he did not remember me from earlier, or just presumed that I was one of the staff. I entered the cubicle with a flourish, barking in a loud voice, “good morning, what seems to be the problem?” He lifted the sheet, and raised his gown, no other explanation necessary. Luckily he was wearing underpants, though they were of the Y-Front type, so could hardly contain the veritable forest of pubic hair that greeted my gaze. From above the belly-button, extending down both thighs, almost to his knees, covering his genitalia to the point of invisibility, stood a four inch tall mat of hair, as frizzy as that on his head, and where the underpants intervened, sprouting like dark cauliflower florets, under some pressure. ” I cut it, and it just grows back like this really quickly” he told me, and I heard tiredness and resignation in his voice. ” Can you do anything about it please?”  “I will have to see” , I replied. Of course, what I did do, was to stifle my near hysterical laughter, then pass on my coat to the next in line to have a look, with the added inspiration, ” his pubes are like Jimi Hendrix’s hair, his pants even make the headband effect, you’ve got to see this!”

Sometimes, you just have to look on the lighter side.