There are some things on the internet which are so marvellous that you wonder how you ever managed without them. One such is GP Notebook.
A few weeks ago I saw a gentleman with a funny thumb. The skin between the nail and the mid-thumb joint was reddened and thickened, the cuticle had come away from the nail, and the nail had faint transverse ridges. I described all this carefully in his notes, but didn't know what on earth it was. The best I could think of was that there must be some bacterial infection under the red skin, which felt a bit boggy. I send him away to try some antibiotic, and he returned this evening with his thumb completely unchanged. So I rooted around in the deepest and darkest recesses of what I am pleased to call my mind, and the phrase "chronic candidal paronychia" popped up to the surface. I typed in "candidal paronychia" into GP Notebook, and found myself looking at a page that described exactly the findings I had noted last time. It also told me that simple application of an antifungal cream (albeit for a few months) would probably be all that was needed. I don't recall seeing a case of candidal paronychia before, which is why it took me a little time to recognise it. But having thought of it, GP Notebook confirmed the diagnosis and told me all I needed to know, thus saving a phone call to a hard-pressed dermatology Registrar in our local Centre of Medical Excellence.
In GP educational jargon they talk of PUNs (patient's unmet needs) and DENs (doctor's educational needs). One of my partners was a teacher in an earlier life, and declined to get involved with GP training because he thought GP educational theory was a load of hogwash. I have some sympathy with that view, and reckon that the main Patient's Need is for a doctor who knows what he's talking about. However, we GPs we are constantly coming across things we don't know. In the old days we would have found out eventually by some laborious means, and jotted down the information in a little notebook to remind us the next time. GP Notebook is like a giant searchable compendium of many such little notebooks. I don't know how I ever managed without it!
And did my patient get value for money, or would he have been better looking it up on the internet himself? Well, at the first consultation I correctly identified that it was not serious and that it was some sort of infection. At the second the penny dropped, I identified the type of infection, and gave a confident diagnosis and the necessary treatment. And I will recognise the condition immediately the next time I see it. I feel that was probably OK. If you reckon that GPs ought to know everything and get everything right first time then this blog may be a little bit too sensational for you, dear reader.