The Official Website  for Carol Margaret Tetlow

1 June at 11:26 ·

Will somebody give the pen back to the practice manager as the author's waxing lyrical again?

When I was a houseman (ie just qualified), I had the most wonderful patient on the surgical ward. He was in for many weeks after a tricky operation and subsequent wound infection but nothing would dent his sense of humour (putting his thermometer in his tea which put the fear of God in me) and having a joke every time I passed by. I found him doing a jigsaw one day of Buckingham Palace. He pointed at one of the windows and said that that was his niece's bedroom. I laughed but he was adamant that he was serious and would prove it to me.

Thinking no more about it, he got better, I moved on to another job and then lo and behold, months later, a Christmas card arrived for me -the official Royal Household card! And one arrived every year for about the next ten years. So for once he hadn't been joking.

One day, some time after a Royal wedding, I came downstairs in the morning, saw the post on the mat and wondered why there were lots of crumbs there too.

Closer inspection revealed one of those little boxes people used to send (possibly still do) pieces of wedding cake in and a posh card, which read, 'with best wishes from Sarah and Andrew and the Royal Family.'

Oh lawks - a piece of royal wedding cake, eaten by the dog! Was this treason, I wondered?

To this day, I still have the card, which has a pawmark on one corner and two sultanas which have resiliently withstood the test of time.

I have, of course, had to change my name, appearance, voice.....just in case..…


2 June at 14:47 ·

Memo to doctors and nurses from Dr John Britton

We are not recording enough blood pressures, whether patients smoke, what their alcohol intakes are and whether they have any family history of stroke or heart disease. As you are aware, recording these facts mean points and points mean money.

I would like to suggest an open day at the practice on Saturday next month. We would all come in along with one practice nurse (nurses - you can fight over who has the honour). Patients will be invited to come in and have a 'health check', targeting the over fifties but anyone is welcome. They will rotate round consulting rooms - I will check blood pressures, Ed can ask about smoking and provide cessation advice as necessary, Clare can ask about family history (make this generally Clare so that we can pick up other significant possibly inherited conditions), Ellie can tackle the alcohol issue and whichever nurse is in can do height and weight (and thus BMI) and offer screening for diabetes and cholesterol.

I'm not suggesting this will be a picnic but it does offer a one -off opportunity to pick up some medical details.

Thoughts please......

Memo from Ed to John:

Is this really necessary? I'd much rather go climbing

Memo from Clare to John:

I'm away at least two of the Saturdays next month but otherwise I could probably spare a bit of time

Memo from Ellie to John:

It'll be the same old patients who come in -ie those who come in every day as it is. I bet we don't see many new ones, no matter how hard we try. Plus the twins have gymkhanas most weekends and Ian really can't cope with that on his own....

Memo from John to doctors and nurses:

My idea hasn't quite been met with the enthusiasm I was hoping for. I'll have a re-think and get back to you.


4 June at 11:52 ·

The author is covered in dust and cobwebs -she's unearthed one of her many old work diaries. These date back to the late 1980s and most of the 1990s when we did our own on call, which meant none of this going to a drop in centre but us driving out to see people. You started being on call at 0800 and finished at 0800 the next day

Here's a Christmas Day from the early 1990s - a day of joy, family union, happiness. Or is it?

0800 -phone call from the partner who was on last night, wishing me a happy Christmas and sounding relieved his on call is over.

0802 - lady in the early stages of pregnancy is vomiting and has decided she wants to terminate the pregnancy.

0810 - parent whose child has a fever and sore throat.

0815 -91 year old feeling nauseous -she rings regularly and investigations have found nothing but there is always that feeling that one day there will be something. She lives on her own out in the country and has no nearby family. It will take the best part of an hour to do her visit.

It's not getting off to a good start. I abandon all plans of opening presents and grab a quick breakfast, during which two more visits come in, a middle aged lady feeling dizzy and a man, staying in a local hotel who thinks he has a cherry tomato stuck in his gullet.

It's a day of do one house call and get two more as a reward. I make my way around Harrogate - at least the roads are quiet. I visit a baby who's crying -it's 1030, baby's mum and her two male teenage friends are all half drunk with cans of lager in their hands, watching TV. At another house, where two children are feverish, snottty and not eating, the cotton wool, which has been lying on the window sills since December 1st, simulating snow, is dusty and grey. I'm given a chocolate for going out. Funny the things you remember.

The morning passes in a trice. Delicious smells of roast dinner are in most houses. I have driven back and forth and am on the point of heading for home when I get a call from a patient whose elderly dad is visiting and he has chest pain. Remember in those days, the GP went out to assess all chest pain. He was very ill, pale, shocked, breathless and I wait with him for the ambulance.

God is smiling on me as I get home mid afternoon and have a couple of quiet hours. A call from someone who has discovered they have left the giblets in a plastic bag in the turkey and cooked it can be dealt with over the phone.

But as the novelty of Christmas day wears off, calls start pouring in.

'We're visiting our elderly mother - she's not well and has deteriorated since we last saw her. Something must be done now!'

'My daughter won't come out of her room and open her presents. We think she's depressed.'

'My baby's got a rash and a temperature.'

'It's the xxxxxx nursing home. Mrs B has died.'

'My wife won't stop crying. She's threatening to take an overdose.'

I finally fall into bed, too tired to eat but can't sleep as I'm just waiting for the phone to ring. And it does. A breathless patient who turns out to be in rip -roaring heart failure, so that's another admission. So it's not a fifteen minute trip out, it's more than an hour, because drugs have to be administered and then you waited, to see them safely into the ambulance.

But that was it for that day - in all 22 visits and if I recall, most of Boxing Day was spent fast asleep. Oh, and if you're interested -yes, he did have a cherry tomato stuck in his gullet and no the girl who wouldn't open her presents wasn't depressed -she'd had a row with her boyfriend. And the pregnant lady went on to have a healthy, lovely and much loved baby seven months later.


5 June at 15:56 ·

I loved the reminiscence from Gill Ellison yesterday and it reminded me of another story I'd like to share, to brighten your day, just in case it needs brightening.

The question is - why do so many people assume that doctors are male?

I was out on house calls but was bleeped to go to an elderly lady who had collapsed. She lived in a warden controlled flat, which had an intercom system, so that all the residents could be checked up on, on a daily basis.

I rushed in and found the lady, flat out on the floor. The warden from the flats was with her and stood watching me while I attempted to take a history, undressed her so that I could examine her, opened my huge bag, checked blood pressure and pulse, examined the backs of her eyes, listened to her heart and checked her limbs and reflexes for signs of a stroke. I then took a drop of blood from her finger to check her blood sugar.

An eerie voice came through the intercom;

'Is the doctor there?'

And the warden replied,

'No, he's not but the cleaner's arrived.'

I am lost for more words.....this is a true story


6 June at 16:23 ·

Extract from the practice information leaflet, given to new patients when they register with the doctors....

For patients' convenience, all the doctors have bookable telephone appointments in the morning and the afternoon. This may be the ideal way for you to get advice or discuss your problem with the doctor to see if you need to be seen in a formal appointment. It can also be an efficient use of time to discuss test results or follow up on a previous appointment.

It is easier for the doctor to ring you, so be sure we have up to date details of your landline and/or mobile phone. You will be told the time at which the doctor will ring eg 1100-1130 in the morning or 1400-1420 in the afternoon. Please make sure that you are available for the call as the doctors cannot keep ringing back as they have other work to be doing.

Use these appointments wisely. They are not a way of finding out the answer to 3 across in the crossword, nor can the doctor diagnose a rash without seeing it. Asking for telephone calls outside these times is not acceptable, so please bear this in mind before you book your hairdressing, leg waxing, aromatherapy and Indian head massage appointments. You may also find it helpful, if you are at work for example, if you ensure that you are in a room on your own as whispering down the phone can be hard to interpret and you may be given the incorrect advice.

While on the subject of telephones, please ensure you switch off your mobile phone on entering the medical centre. Taking a call while you are in the middle of a consultation with the doctor or nurse is totally inappropriate and may destroy the rapport that the doctor has worked hard to establish. Texting while describing your symptoms or having an examination (including those which are intimate) is not advised either.

Thank you.


7 June at 19.559

Yes it's a big week coming up for the author, whose knees are already knocking together at the thought of her interviews. She has had mixed success with public performances in her life. In a school play, having been killed off at the end of the first half and supposed to be a corpse for the second half, she forgot to lie down on stage until the curtains had opened. In a radio quiz, in the school team, she forgot how many strings a violin has (she was very scared and little). Trying hard to get a job teaching anatomy to medical students, after no sleep at all, when asked which part of the anatomy would she find it hardest to teach, replied 'all of it.' Funnily enough, she didn't get that job.....

At last this is radio, and she doesn't have the worry of what to wear and how can she look twenty (or even thirty) years younger. To date (note optimistic tone here) her only television appearance was when she was on the Centre court at Wimbledon...........watching of course.

So, if you can, join her, please do. Both will be available to listen again if you miss it or if it's so memorable (for whatever reason that may be) that you want to catch it again.

And while she's on a theme, she would like to thank everyone for reading this page and enjoying it and sending encouraging messages. There's lots more to come!


8 June at 18:01 ·

What makes me want to write about this today, I really don't know but I guess that's one of the exciting things about writing, you never know where it's going to take you. This isn't for the faint-hearted, let me warn you now.

I'd just got home from work. It was pouring with rain, late Spring. Absolutely tipping it down. It had been a hard day and I'd been on call the previous night and been up and out visiting patients and to deliver a baby. So it was good to be home and I was looking forward to a nice meal, some TV and early bed. As I've said before - never ever promise yourself these things. Before I'd even taken my coat off, shaken the raindrops from my head or hugged the dog the telephone rang. My senior partner, on call for the police but unable to go out as requested as he was on a train and not yet home, so would I go?

Of course, I agreed, but to what?

A plane crash.

Shortly after taking off from the local airport, a small plane carrying three crew and twelve passengers had tried to turn back because of the awful weather but something terrible had happened and it had come down in a field. There were no survivors.

I had no idea what to do but luckily more experienced forensic docs arrived and I followed them around, trying to balance the horror of it all with the opportunity to learn. Stay in professional mode - it'll help.

What do I remember? I remember long, wet grass, the incessant rain, the overpowering smell of aviation gas. The hum of the generator in the tents that were set up, one a mortuary. Some friendly police officers trying to make jokes and my feet being sodden. The eerie sound of a watch alarm going off, echoing through the evening, a piece of the stewardess' uniform, birthday cards falling out of a burst suitcase. All poignant reminders of the loss of human life in tragic circumstances. What had those people felt as they realised their flight was doomed? What about their families and friends? Their lives had been changed for ever too.

Amidst the tragedy of it all, the incomprehensible horror of human nature as pillagers were on the scene within an hour, scouring for 'souvenirs'. Why? Had they no hearts?

I got home late but had another sleepless night for totally different reasons.

It lives with me to this day. The smell of avgas still makes my pulse quicken and I am transported back to that evening. Flying is not my favourite form of travel. I like my feet firmly on the ground, even though that is fraught with dangers too.


9 June at 15:20 ·

Memo from Elliott Douglas to partners.

Subject: We're doomed.

Extract from a patient satisfaction questionnaire. This survey was a review of the practice performance rather than a particular doctor. This patient attended one quiet lunchtime, came to the desk and asked to be seen as soon as possible. A lucky cancellation at the end of the Dr Diamond's surgery meant that they were offered an appointment in ten minutes time and were asked to sit and wait. They were in and out of the building within fifteen minutes. And this is what they put......

How would you rate the receptionists welcome at the surgery when you arrived?

Fair

Were you offered an appointment with the doctor of your choice?

Yes

Were you offered an appointment at a time that suited you?

No

How long did you have to wait to see the doctor?

5 minutes

Do you consider the time you waited to be reasonable?

No

Overall, how would you rate your visit to the surgery today?

Poor

This is actually a true story but it can happen anywhere.

And the moral of this tale is that you'll never ever please everyone but responses like this make you oh so angry.


10 June at 18:46 ·

I'm going to write about a patient today. Some people who have worked with me in the past will instantly recognise her but I am writing this with a huge amount of affection for her. Without realising what she was doing, she helped me understand mental health problems, coping with physical illness,social problems and life in general.

When I started at the practice, she used to see the other female doctor. Then I was asked to see her one snowy night, when she was sitting in the Samaritans, asking for help. I had already had to abandon one of our cars on a slippery hill and was under strict instructions not to leave main roads for the rest of the night!

Over tea and biscuits, we got to know each other and from then on, she always asked to see me. For years, she had struggled with brittle bipolar illness (manic depression), oscillating from being low and suicidal to completely manic, with wild, impossible ideas and beliefs. Like many, when stable on her medication, she would stop it, in the hopes it was no longer necessary, only to spiral out of control again and end up in hospital.

Bizarrely, as she got older and developed innumerable physical problems, including diabetes, she dealt with these with a wisdom and tolerance that amazed me. Somehow she could cope with this where she couldn't with her mental health.

She lived alone with her cat. Two loving daughters visited as regularly as they could but lived far away. She wrote me umpteen poems which were indicative of her mood, complete with drawings and cartoons. Desperate to stay at home, a package of care was put in place but despite their best efforts, the house became more and more dilapidated, damp, chaotic as she lived in just one room.

We found, with her agreement, a room for her at a residential home and they let her cat go too. I have never ever seen someone so grateful and happy as a result of being clean, looked after and having people to pop in and out all day long, even if it was just a quick hello. I remember taking a photo of her with my phone -she thought it was incredible this was possible, bless her.

By some cruel irony, she collapsed after not being there very long, had to be rushed to hospital and died soon afterwards. It seemed so unfair - life had become so much better for her and then it was all taken away again. One of the members of staff took the cat.

I'm not ashamed to say we were friends as well as doctor/patient.

I often still think of her and sometimes look at the photo in which she is happy and smiling, which is how I want to remember her


11 June at 17:31 ·

Wow! What have I been up to today. Lots of new things.

Firstly a train trip! I haven't been on a train in years and the countryside looked at its best in the glorious sun. Then a taxi to to BBC Tees. Perhaps not necessary as I got in the taxi at 1325 and got out of it at my destination at 1328! (I walked back to the station).

Then a radio interview on The John Foster Show at BBC Radio Tees, with my choice of music inbetween our chatting. What a great bloke, very skilled at his job, a joy to talk to because he made it easy.

Have a listen - it's on iplayer from 1930 this evening- http://www.bbc.co.uk/programmes/p02s9bhy#auto










12 June at 15:15 ·

The author's feeling cheerful after yesterday's interview and the sun is shining, the dogs are walking, the shopping is done, the donkeys and ponies are mucked out and the house is cleaned (after a fashion).

Let's talk babies today. Delivering them that is. I feel sad for today's GPs who don't have the chance to do this. I suspect the majority of them are mighty relieved but for me, it was one of the most exhilarating and at the same time scary parts of the job.

Having done more than the average amount of work on maternity units, out of choice, I was keen to carry on this work when I became a partner.

When I was a med student I was absolutely sure that I would not like obstetrics as I had no particular fondness for babies but after watching one normal delivery and understanding how nature has arranged such a careful route for baby to follow, with twists and turns along the way to facilitate its passage, I was mesmerised. Forceps deliveries were just as fascinating and when it came to Caesarian sections -well! I wanted to do one immediately.

When all goes well, it's a joy to be part of but the scary bit comes when all is not well; even a tiny hiccup and you are instantly reminded that you are looking after two people, not one and two lives are at stake.

When you're a GP though, it all takes on an additional meaning because you look after your patient from the moment they find out they're pregnant (sometimes before that) and then carry on after the baby is born. And then, dare I say it looking after the baby when she's grown up and having her own baby. Unbreakable bonds are forged.

I can think of innumerable incidents. The 'oh my goodness, there's another one!' shock, the patient who swore on various things that she did not want any pain relief whatsoever, then had one contraction and screamed for an injection and an epidural immediately and the awful day a lady was admitted in labour but her baby had died. And let's not forget the lady with the tattoo on the lower half of her belly which went from an orang-utan when she was in labour to a small monkey after she'd delivered. She had many visits from doctors wanting to examine her but she'll never know why.

Is there one named after me? Yes, somewhere. Only the one but the thrill is of knowing this lasts forever.


13 June at 15:20 ·

Teviotdale Medical centre is a training practice. This means it has young doctors, who want to become family medicine doctors spending time there, under the watchful eye of one of the partners, the trainer, as part of their postgraduate training. Becoming a GP takes at least three years and that's after qualifying and doing the mandatory foundation years, as they're now called. Moves are afoot to make GP training longer.....

The practice I worked at was also a training practice and for many years I was a trainer. I was lucky. I had a string of enthusiastic, keen, smart people working with me, who were a joy to teach. Maybe only one sticks out as hard work. Though a considerable amount of extra work for me, the plus sides were it helped me keep up to date and on my toes and I had the privilege of spending six months with a variety of delightful characters.

Let me just mention one today. What a star he was. Like an energetic labrador puppy, his love of the job knew no bounds, nothing was too much trouble, his glass was always half full. Keen to impress he would volunteer for as many house calls as he could and knowing this we sent him off to one of the local hotels where a visitor had rung in with sickness and diarrhoea.

the rest of us went about our work, we all had visits to do, of varying degrees of urgency and I was kept busy over lunchtime and returned to the surgery to scoff my sandwich quickly before the start of the afternoon, only to find that he had not returned. Not like him. Normally he was in the common room, eating pasties, cakes, sandwiches (his appetite was as voracious for food as it was for work). It seemed a little out of character and I thought nothing of it but as time ticked by and he was due to start seeing patients, I began to feel uneasy.

Then the phone rang. The receptionists put him through. He sounded breathless, anxious, tremulous. The visitor with sickness and diarrhoea had turned out to be 44 visitors, all with sickness and diarrhoea and there were still more to see as more were struck down with symptoms. Norovirus strikes again! All on the same coach trip, they were on a dancing holiday and performing the tango cheek to cheek had accelerated the spread of the virus.

The hotel had to be closed down for thorough cleaning from top to bottom. Three visitors (with other medical problems) ended up in hospital. Not much of a holiday for any of them.

And as for my lovely doctor -nobody was surprised when he rang in the next day with.........yes, you've guessed it.............sickness and diarrhoea.

Like many of my trainees, we kept in touch after he'd left. Tragically he was killed in an accident, maybe fifteen years ago. The world lost a vibrant character and a fabulous doc. Today's blog is dedicated to him.


14 June at 17:40 ·

The memoirs today are entitled 'Mad or bad?'

Many years ago I was a junior surgical doctor - a busy but fabulous job where I learned so much. One day a lady was admitted to have her gall bladder removed. I clerked her in and she appeared to be a normal, sensible person.The operation was straightforward and as she was a member of the hospital staff (non-medical) she was awarded a room of her own for her post-op stay. Days past and other patients who had been admitted the same day as her for the same op were discharged but she stayed. She never felt well, told us she was being sick and was struggling with abdominal pain and her bowels. She looked terrible -wan, almost purple. Her looks weren't improved by the fact that the hospital laundry was on strike and patients had to bring in their own bed linen and hers was mauve which seemed to make her look even more purple.

She had every test known to mankind -bloods, urine, xrays, scans and everything came back normal. She was the subject of many post-ward round discussions. Nothing we did for her made her feel any better. We were about three weeks post op by now, the usual post op stay being a week. She still pushed away food, moaned a lot and barely drank.

Then one day on the ward round, the consultant checked all her vital signs, her latest test results, her wound and all was well. He then plucked one of her tissues from the box and approached her, wiped her face and off came a thick layer of make up, leaving some very normal looking skin behind! Closer inspection revealed that her locker was full of food -chocolate bars and sandwiches that her family had brought in.

Why? A psychiatric opinion was considered. Was this a type of Munchausen? But she was discharged promptly and I never found out what happened to her, sadly. She did give me her gallstones though, as a leaving gift!


15 June at 18:11 ·

One more story from the archives today, fairly short as my arms are aching from too much tennis (note to self, must do blog on side effects of playing tennis, including insatiable appetite for food).

Perhaps better not to say where I was working when this happened. I was doing orthopaedic clinic and the nurses presented me with the sort of patient file that makes your heart sink......ie it's 8 inches thick and has a second volume slightly thicker. That's one of the prerogatives of being a consultant, you can get your junior staff to see these patients. Shame I never made it to the top to get my revenge.

The nurses wheeled in a man in a wheelchair, who helped by two of them struggled to his feet, shuffled with their help and a walking frame to the chair and sat down. He was wearing a thick orthopaedic collar around his neck. He had splints on both wrists and both elbows. Closer inspection revealed a lumbar support and two braces around his knees.

The pain was intolerable, his joints were awful, why did nobody help and no, there was absolutely no way he was able to work and could he have a sick note while he was in the clinic.

I can't remember what I did with him. Maybe changed his pain relief, maybe sent him for more xrays but he had had all sorts done and I was left with little choice. The consultant wasn't a lot of help and there was a feeling of failure when he was wheeled out. Hey, you can't win them all.

2 days later I was doing my shopping in the local supermarket. As I coasted down the aisle, probably looking at the chocolate, I thought to myself -oh where have I seen him before? You know that feeling where you just can't place someone for a moment?

Then I realised and yes, it was the patient from the clinic, walking quite normally, swinging a basket full of shopping, chatting to his wife..........

I leave you to draw your own conclusions..


16 June at 15:43 ·

Letter to Elliott Douglas, practice manager

Dear Mr Douglas,

Yesterday, I requested a home visit from Dr Bonnington as my arthritis was very bad and I could hardly move. I also needed a new lot of tablets and creams and some of that liquid for my indigestion and thought that she could do that while she was visiting to save me having to go to the chemists. I waited in all morning but she did not come. She did not phone to say why she wasn't coming.

This has never happened before and I am quite disgusted by the laisse-faire attitude of the doctors. When I first joined the practice, nothing was too much trouble but since you got those computers, things have gone to the dogs.

Please look into this.

Yours angrily

Celia Tonbridge (Mrs)

Dear Mrs Tonbridge,

I am in receipt of your letter and am sorry that you are displeased with the service. I shall speak to Dr Bonnington and write further.

Yours sincerely

E Douglas (pratice manager)

Dear Mrs Tonbridge,

Dr Bonnington informs me that she did visit you, as requested, at 1130 but there was no reply.

Yours sincerely

E Douglas

Dear Mr Douglas,

I had only popped out for an hour to the hairdresser's for my weekly shampoo and set. Why didn't she wait? I was back by 1215.

Yours still angrily

C Tonbridge (Mrs)

Dear Mrs Tonbridge,

As you well know, home visits are done between 1100 and 1330. Dr Bonnington is not psychic and also has more important things to do with her time.

Also your response raises the question - if you are able to go to the hairdresser's, could you not possibly come in to the surgery for an appointment?

Yours most sincerely

E Douglas (practice manager)


17 June at 18:49 ·

The author's been raking through the archives again.

Yes, it's good to be a doctor but it's important to remember that the role of the doctor is multi factorial. You're not just there to diagnose, initiate and follow up investigations and choose safe and correct treatment. Nor are you just there to monitor chronic disease and be vigilant to keep up to date.

No, let's think about the other roles I've had to play. There's no telling what's coming into the consulting room next and whether I'm going to be required to be doctor, friend, confidante, priest, advisor, teacher or a mixture of all of them. Old fashioned this may seem, it happens and there's a sense of privilege attached to it.

I have had patients make an appointment to see me to

1) show me their holiday photos

2) show me their engagement ring

3) introduce me to their potential fiancee and ask for my blessing

4) bring in their pet cats to see me

5) bring in cake because they thought I might be hungry

6) bring in carrots for my donkeys

7) confess to adulterous behaviour that they couldn't possibly tell anyone else about

To name but a few. Sometimes I couldn't believe what I was hearing and thought it must be a preamble to a more serious matter but no, it wasn't.

It was a complement, a testament to the fact patients knew they could trust me, they liked me and felt I was a part of their lives.

One of the joys of general practice. Has it got lost in the mists of time? I seriously hope not.


18 June at 17:55 ·

Email to Elliott Douglas from Dr Faith Faber

Hi Elliott, I'd be grateful if the receptionists could direct Mr Ptolemy Phillips to the male doctors in future. I have seen him several times, about trivial matters and on each occasion he has become increasingly 'touchy-feely' for want of a better description. His explanation that his wife 'does not understand him' is no excuse and his invasion of my body space makes me feel uncomfortable to say the least. His attempts to touch my thigh or kiss me good bye is totally inappropriate and though I have warned him that this behaviour is totally unacceptable, he pays no attention and is a little more familiar the next time he comes in.

Thanks,

Faith

Email from Elliott Douglas to Dr Faber

Sorry to hear this, Faith. Don't worry. Leave it to me.

Elliott

Two weeks later.....

Email from ED to Dr FF

Hi Faith. The practice has received a letter from Mr Ptolemy Phillips saying that he has noticed that he is not allowed to make an appointment to see you. He is very upset and is threatening to make a formal complaint. I wonder if you might make an exception in this case and continue to see him to avoid bad feeling and keep Mr P happy.

Elliott

Email from Dr FF to ED

Elliott- are you serious? Am I not allowed to have a say in this matter? How can I look after someone properly when I feel threatened and uncomfortable in his presence?

Reply from ED

Faith- give it a go. Keep careful contemporaneous notes. I'm sure it will be okay.

This is fictitious - I mean it'd never happen in real life......or would it?


19 June at 16:44 ·

Here's a tale with a happy ending - just what we need on a Friday with the weekend ahead.

In the mid 1990s GPs no longer had to be on call from home for their patients. Instead they all grouped together to form a cooperative and had a drop in centre at the hospital. Though there were two cars to take docs out to the very immobile or ill, the revolutionary idea was to get the majority of patients to come to the doctor at the hospital. This was received with mixed emotions by the patients, who, like most of us and disliking change, were perfectly happy to have the doctor call on them at home.

Suggestions that patients came down to the hospital were sometimes met with decidedly aggressive reactions and comments. I can remember going out to see patients on several occasions simply for a quiet life.

One sunny evening, a man rang saying that his child was ill and needed to be seen. No problem, bring him down to the hospital, come in the main entrance, follow the red line, no, not A&E, and you will find us.

Cue long rant about laziness, new systems, not satisfactory, who could he complain to etc etc. But, in the end he capitulated and agreed to come down.

We waited with dread and trepidation, drawing lots as to who would see the child and be subjected to yet another tirade of abuse. We watched him come down the corridor. It had to be him, muscles, white tee-shirt, denim jeans, chiselled jaw, but not in a good way.

'Whose idea was this?' he bellowed.

We trembled.

'Well, it's effing brilliant because it means we don't have to tidy up at home before the doctor comes!'

It takes all sorts..........…


20th June at 14:50 ·

Still in a weekend mood, though the weather could be more cheerful and the market stall holders will be getting very wet in Lambdale.

Did anyone ever read Epaminondas when they were little? The stories of a little boy who always took everything literally? Well, read on....

We're talking a long time ago. A lady had chosen to come and see me to discuss a female matter, that of premenstrual tension syndrome (PMS or PMT). Clearly better to consult a female than a male doctor. We went through her notes after my taking a comprehensive history, which made me somewhat suspicious as her symptoms were not only pre-menstrual but most of the rest of the month as well.

She had tried all the usual treatments available at that time. The contraceptive pill, vitamin B6, creams made from yam (apparently full of natural progesterone), oil of evening primrose, tablets of progesterone and suppositories of progesterone.

Nothing had helped.

Doubting the diagnosis but not wanting to dismiss it altogether, I handed her a copy of a paperback book I had on the subject of PMS, for the sufferer, penned by a world expert and full of good advice.

'Here, take this. I think it might help you and then come back, tell me what you think and then I can help you better.'

Looking dubious because no prescription was involved (remember, a vast number of patients assume that the consultation ends with a prescription), she left.

A month or so later she returned and it went something like this -

'How did you get on with the book? Did it help?'

'No, not at all.'

'But when you were reading it, couldn't you identify with lots of the points and symptoms and advice?'

'Oh, I didn't realise I was supposed to read it..


21 June at 21.15

Last memory for the weekend.....

Mrs X was seriously depressed. Widowed, living alone, no family nearby, she appeared in my consulting room and wept and wept. A lengthy conversation followed and the conclusion reached that her comments about self harm and attempt at suicide were to be taken very seriously indeed.

I spoke to the consultant psychiatrist who agreed and arranged to see her that evening. Mrs X duly attended the hospital, was assessed and then sent home with the promise that the psychiatrist would visit her at home the following morning, whereupon decisions would be taken regarding her further care.

The next day, I was just finishing morning surgery. The phone rang. It was the psychiatrist. 'I've visited Mrs X but can't get any reply. She knew I was coming. Could you pop round and see if she'll answer the door to you?'

I went round. A huge house, surrounded by a huger garden. No nearby neighbours. Rang the bell, knocked and knocked. Peered through the windows. Rang her telephone. No reply. With the memory of how she had been yesterday I knew there was only one thing I could do. Call the police and have them break in. Sounds a bit dramatic but what if she'd taken an overdose or harmed herself in some other way?

Along came two burly officers who tried the door bell, knocked, bellowed through the letter box ( I admit I hadn't tried that technique) - no reply. Out came the battering ram! BOOM! BOOM! and the front door was nothing more than splinters.

In we went...... The house was cold, chilling. It felt unlived in and unloved. Curtains were closed making all the rooms dark and eerie. Together we went into each room, expecting to find her, jumping when the floorboards creaked, taking it in turns to go first.

But......nothing.

We scratched our heads and then pounced on the address book by the phone, working our way through numbers that looked hopeful. No joy, until the very last one.

We explained the reason for the call - watered down naturally.

'Of course she's here -we always play bridge on Thursdays. We're just having lunch.'

She saw the psychiatrist after her bridge game. She was mortified because she didn't realise that people cared.

The police replaced the front door.

I was late for afternoon surgery.....again


June 22nd

Thank you yet again to Mr Bill Wottle, who has popped into the medical centre this morning to see Dr Diamond about a personal matter and left some photos for us that he had taken over the weekend. Much as we would like to boast that the castle in our new cover photo is the medical centre, sadly we can't and maybe it's best as it would be a bit draughty waiting to see the doctor. However as everyone in Lambdale knows, this view is a stone's throw away from us and isn't it magnificent? It makes you want to take up more walking doesn't it? What a good form of exercise that is, the doctors would like to remind you.

We'd also like to take this opportunity to let you all know that all our blogs are on the author's website - www.carolmtetlow.co.uk - so if you've only just joined us or you simply want to revisit some of them, then they're there for you to enjoy and are updated regularly. Plus there are all the stories about a unique couple called Hector and Rufus..…


June 23rd

House calls, home visits, refer to them how you will but they are an essential part of general practice. Not everyone can get to the medical centre, the very ill, those with no transport (that's a controversial point- should they be made to get a taxi?), the frail elderly.

Call me nosey but there's something about house calls that gives you loads more information about your patient than seeing them in your consulting room.

How can you tell who needs a visit? The details from the patient or their representative can be vague.....

Here are some examples....

1) A call to one of the hotels for an elderly man feeling a bit dizzy. On my arrival he was exsanguinating before my eyes. Blood everywhere! Off to hospital, where he survived.

2) A 'seriously' ill child with high fever who had to be called in from the garden where she was playing energetically to be examined.

3) A colony of chinchillas living in the china display cabinet -with the china - well that's not going to last long!

4) Snakes in the living room - eeek!

5) A pile of letters waiting to go to the post and a bag of rubbish waiting to be taken out -left for the doctor to deal with on his/her visit.

6) A full blown afternoon tea, with sandwiches and cake so the doc can stop for a chat and cuppa!

7) The man with crippling back pain engaged in energetic sex on the living room floor......

8) the biggest Great Dane dog in the world which growled ominously the entire time I was there, more loudly when I got my stethoscope out.

9) the horrible man who kicked a puppy across the room while I was there (don't worry - the RSPCA sorted him out)

10) And sad, but true - a call to a nursing home to see an agitated patient. When I got there I was told he was much quieter. He was because, sadly, he was dead.

 

June 26th

The weather forecast might be a little dodgy but even if it rains, it's going to be warm.... so who cares? There's plenty going on in and around Lambdale to keep everyone amused.

As usual the market will be taking up all of the square. A visit to all the stalls is advised, you never know when you might find a bargain. There are over 58 varieties of cheese on Clive's cheese stall, with free taster samples and the new plant stall is going down a storm.

There is to be a gymkhana down by the Dog and Duck. Dr Bonnington is going with her husband Ian and their twins, Lydia and Virginia, who will be competing on their rather unpredictable ponies, Smudge and Jester. Lots of classes including show jumping. Medical cover will be provided by the Teviotdale Medical Centre

A beer festival is being held in the Town Hall and there will be various musicians to entertain visitors. A swing band is promised, a ukulele band, a folk duo and the local brass band. The atmosphere should be electric! So relax with a beer and enjoy!

Maurice's morris men will be dancing at 1215, 1515 and 1815, so please support them. Inbetween their performances, there will be an opportunity for you to meet the dancers and learn some of the steps and find out more! They are keen for new recruits!

And if that's not enough, also at the Town Hall, there is a display of flower arranging by the local women's group and a home baking stall.


June 28th

Wow! It's hot this afternoon. Not complaining but an hour's gardening is enough for now (any excuse to stop.)

The other day, I wrote about naughty patients. It's only fair that I also write about some naughty doctors. Not me - I hasten to write before you leap to conclusions.

A gentleman came to see me with an ingrowing toenail. Yuk. He wanted a referral, on a private basis, specifying that he wanted to see Mr X. Mr X was notorious for the short shrift he gave his NHS patients and his obsequious, nothing's-too-much-trouble approach towards his private patients. You may howl with horror, but that's how it used to be - I'm sure it isn't, these days. Well, I hope it isn't. Off he went and complained to Mr X about his problem.

Quick as a flash, Mr X removed his own shoe and sock, put his foot on the consulting desk and said,

'You think you've got problems, look at my b***** toenail.'

Bedside manner at its best.

A lady was due for a follow up appointment with her consultant. She complained bitterly of unremitting bellyache and many other symptoms, none of which were sorted to her satisfaction. This was maybe the fourth or fifth consultant she had seen about her pain, having asked for other opinions when one doctor ran out of ideas. Notorious for her dissatisfaction, verbosity and ability to speak for ten minutes without drawing breath, she was waiting to be seen in the out patient department. After a considerable wait, the nurse came up to her and said that Mr Y had been called away on an emergency and he would not be able to see her. Purple with rage, she marched out of the hospital only to bump into Mr Y who was climbing out of the clinic window to avoid her! He ended up seeing her and spending twice as long as normal with her as she wasn't going to let him get away with that.

I was on a course one day. It was particularly dull with an uninspiring speaker, a hot room with no windows and not very nice sandwiches. Returning to the room after lunch, I was one of three doctors waiting for the afternoon session to begin. We agreed on how we'd been on better courses. One of them jumped up and put the clock on the wall forward by 2 hours. The speaker resumed. We dozed. He looked at the time after a little while and thought that it was 1700h rather than 1500h, shrieked and wound up his talk in 5 minutes, which meant we all went home very early and very happy.....

Of course, the author was always perfect....(and if you believe that.......)



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