The Chronicles of Dr Dave: 22 February

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The Chronicles of Dr Dave: 22 February

Chronicles of Dave

Dave

Hand up in class
When faced with a difficult diagnosis

Welcome to the world of Dave, a GP somewhere in New Zealand who will be documenting his working life in diary form twice a week. His diary is updated on Tuesdays and Thursdays

Thursday, 22 February

These light mornings mean I can go for a quick run before work.

Not being a creature of change, I stick to the same route always. I meet an elderly couple whom I used to see on a regular basis walking the route in the opposite direction.

I hadn’t seen them for a while and I feared for their health. I am really pleased they both look so well and, although I have never spoken to them before, except for a grunt of acknowledgement, I stop to tell them all this.

But before I can get a word in the man says they are so pleased to see me out running. They had just been saying they hadn’t seen me for a while and that they thought something terrible might have happened to me, adding, “None of us are getting any younger, are we?”

Tuesday, 20 February

A quick dash to the supermarket at lunchtime for a few basics and $40 cash from the ATM. I like to use cash; it allows those essential small purchases (coffees) to fly under the radar.

And on the way back to the surgery I do indeed order a coffee but I can’t find any cash! I have my ATM card but I couldn’t have taken the notes from the machine. Later on, I ring the bank and talk to a very helpful Hamish.

In official bank language this has now escalated to being an ATM transaction dispute. I chip in to say that there is no dispute as such, as it was just my stupid fault for being in such a hurry and forgetting to pick up the money. I just thought the machine sucked back in the money if it was not picked up.

Hamish from the bank says the machine does suck back the money if not picked up within a certain amount of time but in this case, it being a busy supermarket, someone probably saw what had happened and took the money.

I agreed this was a distinct possibility (it is a supermarket, after all, where a lot of my patients shop).

Hamish suggests, I think, that I might get the money back. This puts me in a relatively good mood for the rest of the afternoon’s sniffles and aches.

Thursday, 15 February

My best Christmas present was without a doubt a 15-minute hour glass. The blurb in the packaging suggested that in a busy world we should all take 15 minutes out to meditate and relax. There is something mesmeric about watching the yellow sand travel from one bulb to another.

Being a geek I actually timed it.

The 15-minute label isn’t too inaccurate; after 10 readings the average time was 14 minutes and 56.05 seconds.

The question is, of course, how to introduce this into the consultation. It would be great for the perennial “over stayers”: “Let me show you my Christmas present – an hour glass which accurately measures 15 minutes, which is more than the time we have left in this consultation.

“Let’s start it going. Now, tell me how can we help you today?”

Tuesday, 13 February

Yes, we do need to be careful using medical terms. Roger, a new elderly patient, has arrived without any past medical notes. He has an extensive coronary history. I ask if he has ever had a CABG (coronary artery bypass grafting). “A cabbage?” he asks, slightly bewildered.

“Yes,” I say. He replies he has but doesn’t like them much.

“Not many people do,” I reply.

I repeat his prescriptions and arrange blood tests. After he has left, Margaret at the front desk tells me Roger has decided to see another partner at the practice in future.

Thursday, 8 February

I receive the text notification at home.

“Hello Gorgeous….”

Opening up the message it actually reads: “Hello Gorgeous...

line space

"...weather isn’t it? Just to let you know your first patient cancelled - don’t hurry in. LOL ”

I manage to delete the message before anyone else sees the notification. Oh Margaret at the front desk and her risqué pranks.

Thursday, 1 February

Mrs Verbage has to be stopped early in her tracks or else the whole consultation is markedly lengthened, with the delay filtering through the whole session and then cutting into my lunch break. (Admittedly my lunch is now al desko – that modern term to describe eating your sandwich in front of the computer screen. In my case it’s while scrolling through laboratory results.)

It’s all well and good the academics saying doctors should start consultations by just sitting back and allowing patients to tell their stories but they don’t deal with patients like Mrs Verbage.

I interrupt her stream of consciousness. “Goodness me, Mrs Verbage, you do look hot.”

Mrs Verbage stops in her tracks pondering what I have just said. Unusually for Mrs Verbage she breaks into a little smile after realising the possible ambiguity of it.

Under the tongue goes the rarely used mercury thermometer. Silent bliss while I write up her notes; or at least that is what she thinks I am doing.

Tuesday, 30 January

Patient Amanda tells me something I already know: 50 per cent of GPs would like to retire within the next 10 years. I guess, taken out of context, the figure might be true for any occupation and is likely to be higher for some.

Amanda asks me if I had thought of retiring. I am shocked. Do I look an age to retire? I laugh it away and say, of course not. I think Amanda looks disappointed. I want to retaliate and ask Amanda if she is looking forward to grandchildren but think better of it; she is only 38 after all.

Yes, I know we all have 38-year-old patients who are grandparents but Amanda is not one of those patients.

Thursday, 25 January

Driving home from a busy day at the office, I am following a car with a “Don’t give a f**k” sticker on the rear window. The driver suddenly turns left without indicating.

At least he (I assume it is a he) walks the talk, or drives the sticker, or whatever. I wonder where one can buy such a sticker and I also wonder what might happen if I were to stick one on my computer screen at work. Might the college disapprove? My concerns obviously mean I am not deserving of such a sticker.

Tuesday, 23 January

None of us is getting any younger in our Peer Support Group (or as I prefer to call it, our Victim and Survivors Support Group). The peer meetings are meant to help us but I feel woefully inadequate listening to my peers present complex medical cases and clever diagnoses.

One peer tells us that another health professional body has concluded there is no evidence whatsoever that any of the CME or peer group work they do has any benefit. I make a quick mental calculation of all the hours I have spent in re-accreditation over the past how-ever-many-years – hours I will never see again.

Thursday, 18 January

New patient Jake has arrived from Christchurch. I remember the protocol: new patients from Christchurch have to be asked which school they went to; patients from Wellington need to be asked who they work for; patients from Auckland should be asked how much money they earn; and patients from that city we all love, Dunedin, are asked, “How are you going?”

Jake says he has a history of several medical issues. We arrange for his old notes to be transferred electronically. The computer system crashes. The local technical “expert” says a large note transfer from Christchurch has crashed the system.

Should I believe the “expert” and anticipate several hours of reading through Jake’s large file. I remain positive - recent past experience tells me the “expert” is likely to be wrong.

Tuesday, 16 January

The incoming mail includes a record of a Healthline telephone consultation for Caroline who I saw yesterday.

Healthline had advised Caroline to see her GP (me) within 24 hours. Presumably, Caroline had rung for advice before she came to see me. But looking at the times this can’t be the case. I am devastated; she actually rang Healthline straight after seeing me.

Clearly, Caroline had not believed a word I had said and rang for a second opinion. Should I bring this up with her next time I see her?  Will there be a next time? Any remaining confidence I had in my abilities has been shattered.

Thursday, 14 December

A local banker friend (yes, I know) bumps into me before work and insists he buy me a coffee from the local cart. 

He orders the coffees, opens his wallet to pay, then sighs. He is completely out of cash and asks if I can lend him some money. I only have the two $50 notes I had taken out of the ATM yesterday. I offer him one of the notes. He quickly grabs at it - rather too hastily in my opinion.

He has a strange, gleeful smile on his face. He tells me he could do with the change for other excursions during the day (a euphemism I presume for the many coffees these bankers drink) and informs me that I don’t really need the change just now (do I?) and promises he will get a new $50 note back to me ASAP.

I feel obliged to agree. Reflecting back, I feel this scenario might be a metaphor for life, or at least a metaphor for the banking world, but I can’t quite work it out. I do wonder why he didn’t use an eftpos card. I ponder if I should charge him interest. I also mull over why ATMs push out $50 notes; no one, aside from bankers (and orthopaedic surgeons), likes dealing with such large denominations.

Tuesday, 12 December

Ryan says he was told cell phones reduce sperm production by a third. This is quite a non-sequitur.

He asks, if he were to carry three phones about his body, could he forgo condoms? It is difficult to know what to do when patients joke.

I reply, “Very good, Ryan. I like that.”

Ryan goes on to ask, “No, really can I?”

Now I am unsure if he is joking or not. “No Ryan you can’t,” I reply and leave it at that.

He looks disappointed. I should ask, but I don’t really want to find out, how many recent downloads he has had and whether he is likely to have contracted a virus.

Thursday, 7 December

I pass a high street lawyer’s firm advertising “free will advice”. They must be finding it tough. I wonder how professional philosophers feel about lawyers encroaching onto their patch.

I do wish the new government well. I have known a few MPs on all sides of the political divides and they seem good sorts (no, really!).

Many GPs are confused on where they stand politically. They like the tax breaks the Right offers. They also like the increased spending on health the Left promises, an increase in spending which not only brings more punters and more money to the front desk in the first place but also means we can off-load complicated cases more easily on to the DHBs. Some GPs even consider patient welfare issues when deciding which way to vote.

Tuesday, 5 December

John presents for his regular blood pressure check. He tells me he caught a glimpse of me playing spring soccer for the oldies last weekend. I like to think of our team as the middle-agees rather than the oldies but there we go, everything is relative.

Vanity strikes and I ask him how he thought I played. “Very….umm…. Messi,” he replies.

I know by comparing me to Lionel Messi, one of the world’s greatest-ever soccer players, he is joking, but the way things are going at the moment I’ll take any compliment.

I smile both inanely and smugly at the same time. I like John. I go to pick up the prescriptions from the front desk (when will my printer ever be fixed?) and as I return to the consulting room I realise he doesn’t mean Messi at all. I hate John.

Thursday, 30 November

Elizabeth’s cough is no better. She moans, “You said it was viral, then you said it might be undiagnosed asthma, then you said it might be acid reflux, then you did an x-ray which showed nothing, now you’re saying it’s likely to be whooping cough but it’s too late to test for it. 

"What sort of doctor are you! Who are you trying to fool?”

Tuesday, 28 November

Morning: My desk printer isn’t working properly. This is the third episode in as many weeks. I have to repeatedly run to the front desk to print out lab forms and prescriptions. It is all remarkably inconvenient. But I think back to the Al Jazeera TV documentary I watched last night about turmoil in yet another forsaken part of the world.

We really are lucky here: no famine, no plagues, no civil war. We have little to complain about. A printer not working is a trivial inconvenience. The problem, the technician says, is the paper we use is too shiny and is slipping. He invoices us for some less shiny paper from the back of his van. Problem solved!

After lunch: The printer is faulty yet again! I swear if that technician doesn’t sort this printer out soon I’ll….well, I don’t know what I’ll do.  Now he says the problem is my desk isn’t completely level. Such excuses. He reminds me of our security “expert” who said the most likely reason our intruder alarm was falsely triggering was because of an (unseen!) spider swinging in front of the sensor! What sort of technicians are these people! Who are they trying to fool?

 

Thursday, 23 November

The dermatologist has reviewed the patient with scabies. The rash hasn’t improved and now the dermatologist thinks the diagnosis isn’t scabies at all but some fancy lengthy Greek term. A biopsy has backed up his assertion. (I do wonder whether the biopsy was done before or after this new diagnosis was made.)

The dermatologist says the patient can now step up his steroid creams. I see a potential crossword clue: Dermatologist’s initial rash diagnosis (7).

Tuesday, 21 November

I don’t know why, but patient X asks me if I had heard about the German nurse suspected of having murdered scores of patients. I had, and I am reminded again of the world’s only famous GP, Dr Harold Shipman, whose claim to fame was having killed tens if not hundreds, of his patients.

I was at a GP conference when the Shipman verdict was announced. One conference delegate, clearly shocked at the depth of Shipman’s depravity, blurted, “I can understand you might want to get rid of one or two of your patients, but not hundreds…. That is so terrible.”

Thursday, 16 November

A teaching pack arrives in the post. It outlines a new method to deal with depression. The cover of the glossy brochure shows a middle-aged man sitting to one side of a desk. He looks distraught, head held in hands. I presume he is meant to be the depressed patient. Sitting on the other side is a slightly younger woman. I presume she is the doctor.

There are no other clues to help determine who is who but these presumptions are surely correct.

But truth be told, during consultations, I often feel like that man wanting to hang my head in my hands and cry out that I can’t carry on any longer. I think I’ll start a new competition showing pictures of doctors and patients in consultations and asking punters to “spot” the doctor.

Tuesday, 14 November

An unusually heavy paperwork load today. I’m at an age where I’ve become pretty adept at reading between the lines of much of this burdensome correspondence. Although now I do struggle reading the actual lines.

Thursday, 9 November

At afternoon tea, I notice the flowers in the tearoom are beginning to droop and a few undesirable chocolates remain uneaten. I’m still unsure why they are here.

Margaret tells me patient P from Auckland has already decided to return to Auckland, something to do with our weather, and asks if we could send a copy of our notes to his old practice. I do worry about the codeine I had prescribed but, hey, the weekend is just around the corner.

Tuesday, 7 November

A small volume health funder (3)

I had stared at the clue long and hard the previous evening. The solution, only three letters, had eluded me. Now at 3am, I wake with the answer: ACC. I’m not sure the clueing would be accepted by cryptic purists but that’s not important.

Patients’ problems are like crossword clues. Some are straightforward and the diagnostic solution can be penned in confidently. The majority are less clear and answers are only gingerly pencilled in, often needing to be rubbed out at a later stage and re-written. Some presentations are just too cryptic and have to be left unsolved even after consulting with a specialist solver.

And, as with crossword clues, I often wake in the early hours pondering a possible solution to a patient’s problem and questioning whether that solution truly fits all the clues.

Thursday, 2 November

Patient P, who has recently moved down from Auckland, is going to be hard going; I can tell this just from this first visit. I’m not even sure how much of his story to believe.

We agree his electronic notes should be transferred as soon as possible, a remarkably easy process these days. That afternoon his notes duly arrive in my inbox. His previous practice encloses an electronic note thanking me, “so very, very, very much”, for taking over P’s care.

I have never received such a grateful letter. Later at afternoon tea, I notice flowers and a box of chocolates on the table. I ask Margaret, what’s the occasion? Margaret tells me that P’s practice in Auckland had arranged the gifts to be delivered from one of our local stores. As Margaret tells me this, she smiles. Again, I’m not quite sure how much to believe.

Monday, 16 October

The dermatologist has written a kind and generous letter. He thanks me for referring my patient with a “difficult” rash, and although he also “found the diagnosis troublesome” he has eventually come down on the side of this being a case of scabies. He adds he also often finds “scabies one of the most challenging diagnosis to make”.

All very polite as one might expect from the private sector. I do feel a little miffed though; I really should have picked that diagnosis! After all, scabies is a bread and butter condition for GPs. I am heartened, though, by the dermatologist’s acknowledgement that scabies can sometimes be a tricky thing to recognise.

I share the lesson – I refuse to say the word “learning” – with Doug my colleague. Doug, as his name suggests, calls a spade a spade. Doug has bad news for me, “That dermatologist is from England. I think you’ll find he is being extremely sarcastic.” 

Friday, 20 October

Bridget and I do agree the tropical storms in the Atlantic have been terrible this year but Bridget prefers to believe climate change is not the culprit. She dismisses climate change as a made-up conspiracy. She asks what I think.

I am honest and tell her my thoughts. I tell her that 99 per cent of climate specialists believe climate change is a human-made and growing problem. I put it to her that when she needs her hip replacement, which is surely to be soon, would she take the advice of 99 per cent of specialist orthopaedic surgeons or would she listen to the 1 per cent of outliers?

Bridget dismisses my argument saying she would only ever contemplate taking the advice from a hip surgeon after her mattress magnets had stopped working which, she adds, is likely to be never. I realise the world is doomed. 

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