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1st of May

Back to the author's tour of the UK in search of the perfect job...

Still hell bent on a career in general surgery, getting the job in Bradford seemed like a real opportunity. Some seniority which meant more actual surgical procedures entrusted to me but still plenty of teaching and support. Back to reality with a bang - Bradford was a totally different environment after Orkney. I started with 2 months thoracic surgery. TB was prevalent, there were sad lung cancer cases and many many patients with swallowing difficulties who came in to have their gullets stretched. Who has seen a liquidised diet? Whatever it is to start with -chicken and chips, stew and dumplings, ham salad, liquidisation results in the same brown slop regardless. There is nothing less appetising to look at and no wonder the patients didn't want to eat it. The nurses, feeling sorry for them would sometimes add a sausage(!) but guess what, this would get stuck and have to be removed leaving one patient shame-faced, one consultant snorting fire and nurses busy looking the other way. I had one junior doctor working with me - I was registrar and there were two consultants. One old school, pin-striped suit, greying at the temples and one curly-haired crumpled one. The junior doctor had to go back to his home country because of a family crisis and I ended up being on call every day, every night for one month. I don't see that happening now. Then, well, you just got on and did it. Hard work and not complaining earned you respect. As a reward, when the junior doc returned, the crumpled consultant took me out for lunch and then let me go back to work. Generous eh?

I lived in the nurses' home. There was a hideous underground tunnel from there to the hospital where cockroaches scurried, some liquid dripped and the lighting was appalling. I think I held the record for being able to run down there quicker than anyone, especially at night (remember Rebecca Owen?)

Two months passed quickly and orthopaedics was approaching, horrifyingly rapidly. Having done no post-grad orthopaedics, I was terrified and trying to read up the subject in text books only made me feel worse. Now I was most definitely about to step into male -dominated territory.......to be continued


2nd  May

Bradford continued......

Orthopaedics was spread over two sites,the Royal Infirmary and St Lukes. As registrar I had to cover both but the on call rota was considerably easier as there were three other registrars, so it was an unaccustomed luxury to have a bit more spare time. My consultant was tall and imposing, initially scary but it turned out to be the best six months I could have hoped for. He and I ran the fracture clinics, the orthopaedic clinics and looked after the ward, plus of course operating. I didn't particularly relish the type of surgery -drills and nails and screws and plates- and never felt that this was a long term option but appreciated having the opportunity to try it. A lot of strength was needed and I missed the more subtle nuances of bowel surgery!

We saw many, many patients from the sublime to the ridiculous. One man used to come into clinic regularly ( I suspect because nobody knew what to do with him so kept asking him to come back in the hopes that he'd be seen by someone different next time). I remember him well. He would arrive in a wheelchair. He wore a neck brace, splints on his wrists and elbows. He had specially made shoes and a corset for his chronic low back pain. With the greatest difficulty, he would get out of the wheelchair and come into the consulting room with a zimmer frame, each step taking forever. None of his symptoms ever improved. He had endless investigations and was unable to work. His difficulty with the english language did not make consultations any easier. He came to see me and like everyone else, I hadn't a clue what to offer next and felt that I had been pretty useless.

The next day I saw him in the supermarket, walking round, carrying a basket, no neck brace, no other orthopaedic appliances, doing the shopping like everyone else!

I decided to leave it to the consultant to challenge him on this one.

I did fulfil one ambition however. I genuinely saw a lady called Mrs Kirton, and having established that she had a sense of humour, suggested that she pull herself together........

In theatre, we had to wear lead tabards under our surgical greens as Xrays were often required to check things were in the right position. Fine if you're 6ft 6ins tall, not so good when you're 5ft4 and fairly tiny. A good way to lose weight through sweat loss.

At the end of my attachment, my consultant took me to one side and announced that I was now allowed to call him by his Christian name. What an honour! And what a wonderful person he was


3rd May

Another word about Bradford before the surgery opens again after the Bank Holiday.....

Farewell orthopaedics, it was time to move on to general surgery and work for not one, but three consultants. I also moved accommodation, out of the nurses' home and into the little one up, one down cottage which was at the main gate. How lovely I thought, my own little house, until I realised that ambulances with sirens blaring and lights flashing hurtled past all day and most of the night. Not that I slept there very often, at least not for long.

The on call rota got worse. There were two surgical teams - one with the three consultants and one with two. The consultants on each team didn't speak to each other and communications were done via lowlier members along the lines of ' Mr Z says please could Mr X visit his patient who was admitted last night.' 'Mr Z says tell Mr X that he won't and it's his problem now.' Ah, the beauties of team work.

It worked out that I was on call two nights out of three and although I wasn't first on call, I was rarely allowed any sleep. To make matters worse, when my opposite number was off, I had to cover both hospitals and still have nightmares of spending nights driving sleepily back and forth across Bradford. The one night I was so physically exhausted that I just gave advice over the phone resulted in a complete bollocking by the consultant the following morning. Misogyny ruled. I hated it.

On a ward round the entourage stopped at a weepy lady in bed, who had been admitted for a mastectomy for breast cancer the next day. With no regard for the fact that she actually had a name, the consultant bellowed at her -'you've cancer in your other breast so we're taking them both off' and walked on down the ward. I stopped to talk to her but was shouted at to take my place and continue with the ward round. Shocking but true.

It was becoming clearer and clearer to me that you got far more brownie points for who you sat and drank with in the doctors' mess than how good you were technically with your surgery. I realised too that, much as I liked performing the operations, I was gradually sitting and talking to the patients less and less and I missed that. I missed sitting on the edge of their beds, (sorry Sister Ellison) hearing about their pet cats, where they were going on holiday,what was worrying them, sharing their grapes and chocolates (only occasionally, of course) and slowly it dawned on me that that was what I liked best.

So I started to think about general practice..…


4th of  May

From the partners:-

We had been going to let the author write some more today but something has happened of the utmost importance.

Firstly, as usual we are indebted, this time to Mr Bill Wottle, lay chairman of the patient participation group for sending us these lovely snaps he took in his garden this afternoon. A sure sign that spring has sprung and summer is on its way.

Secondly, today, our page received its 1000th 'like'. From the bottom of our hearts, thank you to each and every one of you who reads our page and supports us.

Please, please, continue to do so. Please share with your friends and help spread the word about us. The third and fourth books in the series are written and the fifth is under way.

Signed -John Britton, Ellie Bonnington, Clare Jennings, Ed Diamond

Happy Bank Holiday. See a fair few of you, no doubt, tomorrow!


6th of May

Oh no, the author's rambling again...

Bradford - probably the hardest time of my life. All work, certainly no play and not much sleep either. I couldn't even sleep on my night's off. The irascible consultant continued in his blunt way - he threw a little boy out of the out-patient clinic because he was crying and repeatedly told me how there was no place for women in surgery. The senior registrars weren't much support either. One was too busy smoking and chewing nicotine gum at the same time, the other had dismissed me on sight.

As a 'reward' I was told that I could have my own operating list while the senior staff were away at a meeting and various patients were picked from the waiting list -herniae, varicose veins, odd lumps and bumps. Someone chose the people who'd been waiting longest and when they were admitted I realised why they'd been waiting longest. The worst varicose veins I'd ever seen, so bad I didn't know where to start. Bulging herniae in frail old men and nearly all the patients appalling anaesthetic risks. Call me suspicious but had this operating list been chosen specially for the unpopular female would-be surgeon? May I be struck down for my cynicism.

I dreaded having to assist the evil consultant. At the hospital the wards were in blocks, the operating theatre in one block but the paediatric ward in another. Quite often there would be children for circumcision or with undescended testes on the list but if it rained then there would be a delay as the kids had to be wheeled outdoors to the operating theatre, either someone had to find an umbrella or we had to wait for the rain to stop. Nothing was guaranteed to annoy the consultant more (apart from perhaps me). Technically, he wasn't the best and instruments regularly flew round the theatre as, like a bad workman, he blamed them for things going wrong.

Feeling a bit like a pit pony who rarely saw the light of day, it was rapidly becoming apparent to me that there was more to life than sleep deprivation, constantly having to prove myself and never having time to do anything for me. General practice was beckoning and fancying Harrogate as a base, I contacted the GP in charge of the GP training course, went for an interview and, for better or worse, was offered six months with him in a large, busy surgery and six months at another practice in Harrogate, much smaller and quieter.

My resignation letter gave my consultant a final opportunity to let rip and I suspect that he never ever worked with a woman ever again. Sad but true and we're talking only 30-ish years ago.

I hope things have changed


7 May at 15:45 ·

Memo to doctors from Elliott Douglas....

Subject: tidiness in consulting rooms.

The CQC (care quality commission for those of you who have forgotten) visit is due in 48 hours time. Certain changes MUST occur before they arrive if we are to achieve a good report. Remember that the staff and I have been working extremely hard in preparation for this visit and no matter how much you fundamentally disagree with this, it is vital that you toe the line.

Dr Britton -you must reduce the number of photographs on your walls. 53 is excessive and a dust trap. You must also clear your desk of all extraneous paraphernalia. This includes sweet wrappers and banana skins (yes, the cleaners found both of these last week). Please take home the towel that you have by the washbasin. This is not allowed.

Dr Bonnington - remove all those toys that you have in the box in the corner of your room. Remove all those papers that you have stored under your desk and examination couch. Remove the nice, friendly blanket that you have on the examination couch and replace it with horrible, cold, impersonal, uninviting paper towel which will ensure that patients feel as uncomfortable as possible when lying there.

Dr Diamond - the same applies to you about files which you have 'filed' on the floor. I know it's all your training paperwork but there must be nothing, repeat nothing on the floor. Your notice board needs tidying up too. Some of those posters are yellowed by the sun and frayed at the edges. This looks shabby.

Dr Jennings - there is not much to be done in your room as you tend to be compulsively tidy. Please take down some of your pictures on the wall as again these invite dust.

Dr Faber - why is there a large number of chocolate bar wrappers behind your desk? Please don't wear the boots you wear to muck out in, in two days time.

Remember, all of you. The minimalist look is the way forward. Also ensure hand sanitising gel is on your desk and that you are using it. We are counting the number of used paper towels at the end of the day to make sure there is evidence of plenty of hand washing. Remember to clean your stethoscope after each use and change ear pieces on your otoscopes.

I know this is hard for all of you to accept but we must be seen to be doing as we are told. We live in curious times. What evidence there is of infection being passed on from some lego in a box, I do not know but ours is not to question why, but simply do it.

I will be checking tomorrow. I hope I don't have to use the threat of an extra surgery for those who are slow to respond.

Elliott Douglas

PS -I am so sorry about this.


10 May at 16:55 ·

More from the author, with apologies for two days silence but small visitors have occupied my every waking hour - see my other blog Hector and Rufus for more details.

Where were we? Oh yes, I was bidding Bradford a not very tearful goodbye and moving to Harrogate to start general practice. I was glad to be going there because my mother was stationed there during the war and used to fire watch from the roof of the Grammar school, where she taught.

I vividly remember my first day. It was pouring with rain. I was wearing a green polo-necked jumper, a green sort of tweedy skirt (it looked better than it sounds) but -horror of horrors, no white coat, which I had always had as my security blanket. I was completely confused by meeting so many members of staff and doctors in one day. I thought the practice manager was one of the doctors for at least three weeks.

It was a large practice, 16000 patients but my male trainer was lovely - supportive, good fun, an excellent role model. A far cry from the men I had just been working with. The first thing I had to realise was that in general practice, most patients are not ill, or have only minor illnesses. A far cry from being in hospital where everyone (just about) is ill. I soon found that I was not only a doctor but also a confidante, friend, advisor, sympathetic ear. As I started to build up a bit of a following, I had a patient who brought her holiday photos to show me, one who told me how she had just committed adultery in a broom cupboard and had to tell someone, one who came in to show me her engagement ring and of course the wonderful two ladies who brought in their cats in a shopping trolley.

I felt part of a team for the first time and though it was a busy job, I relished this because in fact, it was such a relief from the crazy hours I was working in hospital, that it seemed easy. Gracious me! I had time to go home for lunch..... a meal that never used to feature in my day.

After six months, I moved to another training practice, one about half or a third of the size and I'll tell you about that next time..


11th of May

Being a Monday, it's been very busy at the practice and the partners have asked me if I would write today, so I agreed. It's always a good idea to stay on the right side of your characters. You have no idea how powerful they become when it comes to the plot and how everything is going to work out.

My second training practice was also in Harrogate. It was about a third of the size of the one I had just left and I really believed that I would like it better, having some rather naive views of small, country practices and cosy, chummy partners. Within a day, I knew that nothing could be further from the truth. The partners rarely communicated, except via a third party. The practice manager had a tiny dog that cocked its leg up against the filing cabinets and the receptionists, bar one gave new meaning to the word intimidating. There was no camaraderie in between surgeries and it was possible to go from one day to another without seeing another doctor. Had I not had the experience I had generally in medicine, I would have been terrified. Had I not been to the other practice first, I would have gone straight back into hospital medicine and left general practice behind me for ever.

I missed the slick organisation of the first practice, the back up, my motivational trainer. My new trainer was nice enough but very laid back and a very different personality to me. Think polar opposites....

It was a long six months. I had one particularly horrifying experience which haunts me to this day where I felt very lost and alone. Not good.

But one morning I had a telephone call from my first trainer, offering me a partnership -only part-time initially - back at his practice and suddenly, all was good again. I felt wanted and appreciated. I had become very fond of Harrogate and wanted to stay -it's a great town, loads going on, good shops (important) and wonderful countryside around.

A real milestone. My name on a brass plate. I'm not saying how many times I drove past to check it was real! Soft, or what?


12th of May

Memo from Elliott Douglas

To - the partners and doctors, practice nurses, receptionists and admin staff and cleaners

I am delighted to be able to report that we had excellent feedback after the CQC visit yesterday. There are one or two minor areas that we can improve on (Dr Britton -I did warn you about your surgery and your bow tie, and Dr Jennings, your engagement ring may well be a Victorian diamond of which you are very proud but again, you were warned wedding bands only) but overall, the inspectors were very satisfied with the standards of care we supply in all aspects of our work.

However, this is no reason for complacency. We cannot be seen to be falling back into our previous ways. No clutter in consulting rooms or the nurses rooms, please. No paperwork under the desks (yes I do realise that a small child crawled under Dr Bonnington's desk as there was space, once she had tidied up, and bumped its head but that's just one of those things.) The child's parent has submitted a complaint about the surgery being a hazard, claiming that as they were in Dr Bonnington's room, Dr B was responsible for the child's care and safety, rather than the parent, but I hope to stop this one in its tracks, all being well.

Nurses, please remember the colour coding for the different bins you have. It is difficult to remember what the ten different colours mean but if you get into the habit of doing it regularly, then I am sure it will soon become second nature.

Receptionists and nurses -continue to use the protocols we have spent many hours writing for dealing with certain situations. Doctors, please be aware of these protocols and where to find them (on the practice intranet - ask me if any queries).

Sadly, I have to inform you that although technically we are not due for another visit for two years, the CQC retain the right to pop in with no notice and may send staff in, under cover, to act as patients and see how we respond.

Big brother is indeed watching us.

But credit where credit is due. We can all be very pleased with the report just received, the nicest aspect of this being that, by and large, this is how we practice on a daily basis.


13th of May

Dear Mr Douglas, practice manager

Re: complaint

I am writing to complain about the care I received, or rather lack of care when I came to the doctors the other day. I had my two children with me. I had to bring them with me as there was no one at home to look after them.

My appointment was with Dr Bonnington. I don't think I shall want to see her again.

My complaints are:

1) she did not spend enough time with me

2) she did not listen to me

3) she did not give me a prescription

4) she refused to see my children

5) she asked me to come back to another appointment about the pain in my back instead of dealing with it there and then, and I've more important things to do with my time. It might be something serious.

6) she gave me a piece of paper with exercises on for my elbow when I wanted referring to a physiotherapist

7) I had to wait over half an hour to see her

8) I didn't like the dress she was wearing

9) There were no toys for my kids to play with and she didn't have any treats for them either

10) She refused to refer me to a women's specialist as I can't get pregnant

11) It all took so long I got a parking ticket. I expect the practice to pay the fine for me

I look forward to hearing from you.

Yours sincerely

Mrs Smith(name changed to spare her blushes)

Elliott is composing his reply. It will be ready tomorrow..…


14th of May

Dear Mrs Smith (name changed to spare her blushes)

Mr Douglas the practice manager passed on your letter to me. I was very sorry to read that your visit to the practice and to me in particular was not a positive experience. We do strive at all times to provide a high quality service.

There were quite a few items raised in your letter, so I will answer each in turn.

1) You mentioned that I did not give you enough time. One consultation is only ten minutes. Just about all doctors that I know agree that this is not enough time but the sheer volume of work does not allow us the luxury of longer consultations. I do see, on checking the computer that in fact, you were in with me for 43 minutes.

2) You tell me that I did not listen. My notes suggest otherwise as I have documented carefully your thirteen problems that you wished to discuss and also how we decided which were the most important. I am sure you can appreciate that it is not possible to deal with everything in one visit, if you wish to have the best possible care.

3) I did not issue a prescription because there was no need for one. Not everyone leaves the surgery with a prescription. This has nothing to do with saving money. It is based on patient needs.

4) On account of the facts that I was indeed running late (see 7) and that your children were not acutely ill, I felt it quite reasonable to ask you to make a separate appointment for them. There were appointments available for later that day.

5) I asked you to come back to discuss your back pain for two reasons -a) you said it was the least of your worries and b) you said that you have had this for the last 5 years and it is not getting worse. I am still happy to discuss this at another appointment.

6) I gave you some exercises to do so that you can get started on improving you elbow condition (tennis elbow or lateral epicondylitis) immediately, rather than wait the 14-16 weeks which is currently the average time it takes for a physio to see a new patient.

7) I am aware that I was running late. As GPs we never know what is coming through our doors next. We do have to deal with emergencies. As you sat waiting to be seen, it will not have escaped your notice that the patient immediately before you had to be taken to hospital from my room on a stretcher, fighting for his breath.

8) I am sorry you didn't like my dress. I am rather fond of it. I could mention that I don't find leggings a particularly attractive outfit but that would be unprofessional.

9) We are no longer allowed toys in our consulting rooms, for fear of passing on infection.

10) I did not refer you to a women's specialist (gynaecologist) because you have only been trying to get pregnant for one month and had no problems conceiving with your other two children. This would have been inappropriate.

11) I am sorry you got a parking ticket. Perhaps if you had parked in the surgery car park, rather than the market square, then this could have been avoided.

I trust this answers your concerns in a reasonable fashion. I am happy to meet with you on a face to face basis if you wish to discuss things further.

May I assure you of my ongoing determination to provide the best health care to all my patients and am sorry that you were disappointed on this occasion.

Yours sincerely

Dr E Bonnington

cc E Douglas.


16th of May

The author's rambling again.....

A partnership! What every aspiring GP was aiming for ( in those days, anyway). A brass plate outside the door, my own consulting room, my own car parking space outside the building and a prescription pad with my name on the bottom. Gulp! Reality bites hard. Now the responsibility rested with me. Yes, I had colleagues to discuss problems with but the buck stopped with my decisions. If something went wrong then it was my head on the block. Very different from discussing things as a team on a ward round (usually in a huddle at the bottom of a bewildered patient's bed). And very scary.

The other big realisation was how much you are protected from as a training GP. Now, as a partner, I was experiencing general practice, warts and all. Suddenly I became aware of all the undercurrents between the partners, some more turbulent than others. Practice meetings, fuelled by large volumes of gin and tonic (one partner brought chopped up lemon in a plastic bag), went on until the early hours and we would go round and round in circles on the subject of boosting practice income (eg could we make a gymnasium in the basement and other such bizarre ideas).

It was and still is a huge practice, covering a huge area, not just in the town but the surrounding countryside too, which was nice to tootle through on your way to a home visit, if you had nothing else to do but this was rarely the case and rural visits were often the short straw. Plus there was no satnav to help you find where you were going.

When I first started there was a branch surgery in a small village just out of town, located in a partner's house and if you ever went to do that surgery, you'd find that patients, once they'd seen you, were then reviewed in the kitchen by the partner who lived there, over a cup of tea or something stronger.

That partner persuaded me to have a rabbit -Persil (well, he was white). Feeling sorry for Persil being all alone and having been assured that Persil was female, I bought Flora as a companion. So much for my knowledge of the sexual habits and contraceptive needs of rabbits -before I knew it I had ten rabbits, which I managed to find homes for with receptionists and even some patients.

Not a bad deal really - come for your pap smear and get a free rabbit. It could catch on. Yes, I was full of ideas all those years ago


17th of May

Someone's got to tell the author to stop....she's taking over

Let's start with a few facts and figures. We're talking about the late 1980s when I first became a partner.

Appointments were 5 minutes long.

Morning surgery lasted from 0800-1000, early afternoon surgery was 1430-1530 and late afternoon surgery 1600- 1730. Mostly the afternoons were a blur and that precious thirty minutes for a cuppa never happened.

On a good day you had less than 6 house visits (my worst was 13).

We did our own on call at night and weekends and if we'd been on call then we just worked the next day as usual. Driving round in the night trying to find addresses in the dark brought its own problems. No sat nav in those days. Just a map and a torch. No mobile phones. You got to know where all the public phone boxes were very quickly. Lots of nice patients put their outside lights on to help but some didn't. Why give your house a name but forget to put a sign up?

Early one morning I was called out to a patient with chest pain. Then, you went out to everything to make a decision. None of this dialling 999. Racing to the correct road, I saw a house with the front door open and a welcoming light shining from the hall. I ran in, clutching my bag, up the stairs only to be met by a lady in her dressing gown and curlers looking surprised! Wrong house! Oooops!

On a good night, you'd be called out three times, on a bad one, you'd be up all the time, visiting the serious and the trivial. It's hard getting an idea of what's going on from a phone call. People have a way of describing what's wrong that can be hopelessly unreliable. The terrible chest infection, possibly pneumonia would turn out to be a mild cough, children too ill to sleep would be snoring by the time I got there and then just when you weren't expecting it, someone feeling a little dizzy would turn out to be exsanguinating but playing down their symptoms because they didn't want to be a bother.

All part of the fascination. What will you see next? But the beauty of it was (and I write this at the risk of annoying younger members of the profession) more often than not, you knew the patient who was calling and they knew you, which brings me back to my favourite soapbox, which is the importance of continuity of care, an imperative aspect unique to general practice that is rapidly disappearing. Don't worry, I'm going to make the tea now.….


18th of May

Extract from the Teviotdale Telegraph, the newsletter produced by the practice for the patients.

Every six weeks the practice is closed for one afternoon. This is for staff training purposes and on the said day, the surgery will be closed from 1230 and reopen the next morning at 0800 as usual. You will not be able to collect repeat prescriptions during this time, nor will you be able to ring and make appointments.

Should you require urgent medical help, please dial the surgery number and you will be automatically transferred at no cost.

Some patients have questioned the wisdom behind closing the surgery when it could be open and attending to patients. For that reason, we thought you might be interested to read what plans we have for the next training half day, which is in fact on June 24th 2015.

The doctors will be attending formal teaching, which takes place at a venue in Northallerton. On the timetable for the next meeting is an update on urology, a fascinating talk from a highly respected new member of staff in the medical assessment unit, Dr Owen, who will be talking about seamless integration of primary and secondary care (with power point presentation and home made cakes) and then there will be a debate on the current situation with the out of hours service.

The nurses will be attending an update in resuscitation skills and childhood immunisations.

The receptionists will stay in house and, together with Elliott Douglas and an outside source, work on communication skills and dealing with aggression.

We hope that this enables you, as patients to understand how seriously we take this opportunity to hone our skills, which obviously helps us help you more effectively.

Inevitably however,appointments will be at a premium the following day. Please consider carefully, the need for you to be seen immediately. Many conditions do not need same day appointments and even more resolve with time. Please see our section on Handy Tips for Self-Care on page 17


20th of May

Memo from Elliott Douglas, practice manager to reception staff.

STRICTLY CONFIDENTIAL

As you know, doctors have to undergo a yearly appraisal and a five yearly revalidation. This is mandatory. Dr Jennings is now about to prepare her work for revalidation. As part of this, two satisfaction questionnaires have to be filled in. One will be sent to members of staff and her doctor colleagues, asking for feedback about her work, commitment, knowledge, how well she gets on with you all etc plus space for free text if needed. Please fill these in promptly and honestly.

The other questionnaire will go to thirty consecutive patients who are booked to see her (but not children). These will ask the patients how comfortable they felt during the consultation, how well the doctor performed, how much they understood, whether they felt empowered at the end and would they consult with this doctor again.

As you all know, Dr Jennings has had a prolonged absence from work with some mental health issues and she is extremely nervous about being assessed by colleagues and patients alike. I am sure we are all of one voice when we say that she will score highly in all aspects as we know how popular she is. However, please give support where you can, take her a cup of tea (milk, no sugar) mid-surgery and a biscuit (chocolate digestive -they are on the top shelf of the right hand cupboard in the staff room......unless someone has eaten them).

See if you can get them all done in one day, then she will be able to relax and not stress overnight. Since her return to work she has been remarkably buoyant and has been coping well but

I suspect that this sort of stress, plus her perfectionist nature is not a good mix.

With thanks

Elliott

Any comments, contact me in confidence.


21st of May

The author's stepped in again today....

In my early days as a GP, I had two other jobs as well. One was store doctor to a well known chain of shops and the other was police surgeon. Being a store doctor was interesting and you got a discount on your shopping, which was always nice. For half a day a week, most of the work was straightforward, making sure staff were fit to come back to work after prolonged sickness absence, advising management on ergonomic improvements and there was the space for staff members to make an appointment to come for a 'chat'. The staff were fabulously well looked after, offered breast screening and pap smears during work time, to encourage them to attend, plus general health checks. I remember one day - I went for the whole day specially - and spent eight hours doing one pap smear after another - forty if I remember correctly - an interesting way to spend a day to say the least. I went home with a bad back. I can't think why.....

Police surgeon work was fascinating. Despite the fact that it was almost inevitably in the wee small hours of the morning, police tea was very palatable, the officers delightfully welcoming as I arrived in a bleary state and I enjoyed it hugely. I met some unique and curious people (a lady, totally naked, standing on her head in a cell for example and a man demanding a bar of chocolate for medical reasons) and saw lots of very sad cases -sexual assault victims, a woman who had just murdered her baby and the devastation after a plane crash locally.

Most of the work was assessing if people were fit to be detained and interviewed, plus taking blood samples from drivers over the alcohol limit, which included a local consultant at the time, who did their best (notice how I'm not divulging if this person was male or female) to persuade me that a test wasn't necessary.

More about this later, I've lots of stories, all of which will be cleverly disguised to protect everyone!


24th of  May·

Being a police surgeon was fascinating, sad, hilarious. Much like seeing any other patient, it was important to ask permission to examine the prisoner. If they said no, then you were only allowed to make observations and record them but obviously this produced far less useful information for the police.

One night, I was called in to see a young prisoner. The police asked me specifically to examine his hands, because they believed that he had been involved in a burglary where the burglar had broken a window to enter a building and they suspected he would have wounds on his hands to corroborate this action.

He came in and sat down in front of me.

I explained that I had been asked to examine his hands and did I have his permission to do so.

He said no and put them quickly under the table.

Not really being able to do anything else, I started to call the police officer to have him taken back to the cell.

He stopped me and said, 'Doc, can I ask you something?'

'Of course,' I replied.

'It's about the eczema on my hands.'

And he promptly put his hands out in front of me, firstly palms up, then palms down, perfectly showing me the wounds on his knuckles, and allowing me to make detailed notes.

Ooooops


25th of May

From the Lambdale Tourist Information Office (to be found just off the market square in between the pub and Alan Gough's pharmacy).

Bank Holiday in Lambdale!!!

Thank you to Mr Bill Wottle (patient at the Teviotdale Medical Centre) for these lovely photos he took, reminding us that the weekend includes market day. Like most small towns in the Dales, Lambdale has a traditional market twice a week and this attracts many visitors. Prices are very competitive as Mr Wottle reminds us as he bought a fine straw hat to keep the sun off his face for only £10.

Why not come and visit? Sit outside one of the local cafes, soak up the atmosphere, the sights and sounds of a thriving community and relax, leave all your stresses behind. Delicious, the popular deli have new ranges on their menu, including the monster burger, chocca mocha ice cream and strawberry and rhubarb crumble with a choice of custard, ice cream or cream ( or all three if you wish!) -all home made of course.

The Swindlehurst Castle Hotel is doing some excellent late booking deals. Two nights including breakfast and use of the spa facilities only £375 (dinner not included but remember they have a Michelin starred chef, so it's not cheap). The riding school attached to the hotel is offering some 2 hour treks out into the glorious countryside (and the weather forecast is excellent) for only £40. Hard hats provided.

The medical centre is closed but the pharmacy will be open on Bank Holiday Monday from 1000-1600 for emergencies. Alan Gough is more than qualified to help and advise on most problems, even those of an exquisitely personal nature.

Don't forget quiz night in the Town Hall, with proceeds going towards a new defibrillator. First question at 1930h precisely.


26th of May

The practice is indebted yet again to Mr Bill Wottle for his lovely shot of Lambdale from the well known river walk which comes to and end, skirting around the perimeter of local fields. Other than the evident beauty of the countryside, this photo raises useful issues.

The presence of two dogs in the photo is fortuitous as it gives us the perfect opportunity to remind patients that animals are not allowed in the medical centre building, not even small ones in bags and not even if your next port of call is the veterinary surgery down the road. The argument that humans are allowed in the vets' is not reciprocated and we are sure you will understand the reasons behind this.

Walking is an excellent way to keep fit, though dawdling is not, so you have to get up a bit of speed. As a result however, your heart and lungs will benefit and weight reduction can be aided. Stopping for tea and cake after your walk can negate these benefits. Please be vigilant and have proper footwear - flip-flops come with a host of potential ankle and foot injuries and stilettos really weren't designed for use in mud or uneven surfaces.

When the sun is shining, remember to use sunscreen to protect your skin from ultraviolet rays. A hat is a good idea too and placed at a jaunty angle on the head, can look very chic. You can buy them at little cost in the market (see yesterday's post).

Consider taking some water with you to avoid dehydration and wear loose fitting clothing to aid stepping out in style.

Who would have thought that a simple walk could be so fraught with danger?

If you are considering taking up any form of exercise, please do not hesitate to discuss first with your doctor if you have any doubts about its suitability for your fitness level. Dr Diamond has a particular interest in sports medicine.

Signed - the partners

27th of May

Memo from Elliott Douglas to all doctors and staff.

Well done to all who took part in the quiz night last night. In all fourteen teams of six people took part and the fantastic amount of money raised will buy a much needed defibrillator which will be kept at The Queen's Head, on the market square.

The overall winners were a team called Labracadabra, from nearby who had the astonishing total of 96 points. Second was the team made up of staff from Delicious, the deli and Mumbo Jumbo, the art and craft shop.The Teviotdale medical centre team (Drs Britton, Diamond, Faber, Jennings, Bonnington and Dr Bonnington's husband, Ian) narrowly missed out on third place, as they foolishly thought that Vertigo was a term relating to rotational dizziness, often associated with inner ear problems, whereas everyone else knew that it was a film produced by Alfred Hitchcock.

We have had several patients attending today who were present at the quiz night - which as most of you know, included a pie, peas and mint sauce supper - with stomach upsets. Please be vigilant about recording these as we may need to notify Public Health tomorrow if there are any more.

Dr Jennings hopes to be back in tomorrow if she has stopped vomiting.


The author's rambling again......

My father was coming to stay and I thought that I was doing well, surgery was running to time and I was on schedule to get to the railway station in Leeds to meet him. How foolish could I be? Lessons to be learned from your first day in general practice - 1) never, ever make arrangements that involve a specific time and 2) never, ever think things are going well.

In the space of one telephone call, everything was going wrong. Though not on call for the police that day (having swapped specially because of my important visitor), they were on the phone, asking for a female doctor to assess a young woman who was accused of infanticide. Was she mad? Was she bad?

I apologised and said that I really couldn't but they pleaded with me so I told them why, to which their prompt response was that nothing was too much trouble and they would meet my father and bring him back home to Harrogate. After that I could hardly say no.

So while I was having a very uncomfortable chat with a most unfortunate woman, my father was stopped by the railway police at the ticket barrier, much to his amazement and doubtless to the intrigue of all those travelling with him who must have been wondering what an innocent looking elderly gentleman with a copy of The Times and a large suitcase had done to deserve such a welcome.

He was accompanied (I hasten to add he went without a struggle and handcuffs were not required!) to the station cafe and plied with tea and buns (apparently very good), where he waited until a police car screeched to a halt outside the window and a burly officer came in and marched him to the car. Passengers partaking of refreshments were left open-mouthed. They sped back to Harrogate.

When I got home, he was having a cuppa and watching TV, absolutely entranced by his adventure. He had loved every minute of it (after a momentary panic that something awful had happened to me).

It was his favourite part of that, and probably any other visit he had to us. He loved to tell this tale to people and it's one of my favourite memories of him too. I said earlier that the police were great people to work with - I think this says it all.

And as for the poor woman. She wasn't mad - she was just very very very sad. Never underestimate postnatal depression


30th of May

From the partners:-

Yes, Mr Bill Wottle has been out again with his camera. The practice never fail to be amazed at his ability to capture the image of Lambdale and surrounding countryside and are always grateful that he sends us copies for us to enliven our newsletter.

Today we have photographs of the bow topped caravans parked on the grass by the river, resting and meeting up with each other on their way to the nearby horse fair which starts next week.

Such pastoral views provide a timely reminder that bathing in the river is not advised. There are severe and strong undercurrents ( as there are with many aspects of life) which can whisk you away in an uncontrollable fashion before you know it.

The water is also extremely cold and the risk of hypothermia is high.

The river bed is made up of small sharp stones which might cause foot lacerations, and these risk being infected. Remember Weil's disease(leptospirosis) too as rats lurk in large numbers near the banks of the river, especially as the warmer weather comes. Pregnant women should avoid handling cat and dog faeces and contact with lambs in lambing season.

Make sure you are up to date with your tetanus immunisations. Ask at the practice if you have any doubt.

Be wary of sandwiches made with cold meats and eggs. Campylobacter is one of the commonest forms of food poisoning. Enjoying a chilled glass of wine is most pleasant (please remember the recommended limits for men and women) but make sure you are in a fit state to drive home.

So it's not just a country stroll that is full of danger (see a few days ago), a day on the river bank with a picnic can be equally so. But all of these horrors are avoidable.

Why not pick up one of our leaflets entitled 'How To Enjoy A Day Out' from reception or the practice nurses?


 May 31st at 15:40 ·

The author's in a reflective mood......

Once I was at a meeting and overheard another general practitioner say 'you've really got to do something bad to get a complaint.'

How far from the truth is that? You can do your best, perform by the book but things will still go wrong. A few years into my partnership, I had a complaint against me regarding the way I had looked after a lady, who had subsequently died. In those days, a hearing was held in York, where you went and faced a room full of stern and terrifying people who were sitting around the table, some doctors, some lay members. I remember my senior partner coming with me and one of my other partners, both to give me support and speak on my behalf as well. A lovely hospital consultant came too but despite this fabulous backup I sat and shook all the way there.

The hearing was held in what was then the psychiatric hospital. We went into the meeting room and the hearing proceeded. I shook throughout.

Half way through the meeting, the phone rang and we were told that there was tea and coffee which had been left outside the room for us. Little did we know that in fact, a well meaning patient had passed by the room, seen us all in there and locked us in.

Cue the meeting going from the serious to the surreal. The chairman of the committee had to shout out of the window to passers-by that we were locked in and someone needed to generate some help. If it hadn't been so awful, it would have been so funny. Despite this, I couldn't drink my cuppa when it was offered to me - my gullet was in knots.

The hearing ended and I shook all the way home. A phone call that evening assured me that I had not been found in breach of my contract and the matter was at an end. Huge relief but I can honestly say that from that day onwards, the way I practised changed and I did my best to learn the art of defensive medicine. Not what I wanted but the horror of that day and the run up to it had such an impact on my psyche that I knew I would spend the rest of my career dreading complaints. And so I did - though I was lucky and did not have many. The blame culture has so much to answer for. Communication, communication at all times combined with honesty all the way. There is nothing wrong with saying 'I don't know but I'll find out' and equally nothing wrong with saying 'sorry, I'm not perfect and I got it wrong.' Being brave enough to admit these things is something else.

You never know, it might have helped me writing this down. Off for a cuppa now, which I can drink. Thank you for listening.

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