Rus in urbe

I enjoyed myself during morning surgery. One patient came in on a very flimsy excuse (he had lost his repeat prescription order form and needed some more tablets) but really he just wanted to tell his doctor about the stress he has been under over the past six months, with his father having complications following a coronary artery bypass (see "Clerk"). None of the patients were difficult to deal with, and one woman was extremely pleased. Three months ago I had changed her contraceptive pill from Marvelon to Femodene, which has completely cured the breakthrough bleeding she was getting.

Talking to Martha at lunchtime she said that she was enjoying reading my blog (you can see why I find her congenial), but wondered how long I would be able to find things to write about. On the basis of this morning's surgery I thought she might be right, but things looked up for the aspiring blogger during the visit I did in the afternoon.

This was to a man who came to this country quite a few years ago as a refugee from Eastern Europe. He has had several troublesome symptoms which have defied close analysis due to communication problems. He speaks almost no English. Sometimes a translator is available, sometimes we use Language Line, sometimes we mime. Appointment letters from the hospital do not seem to reach him, and it has been almost impossible to arrange hospital investigation of his symptoms.

There is some controversy at the moment about the provision of translators in the NHS. On the one hand, it seems ethically wrong to jeopardise the care of non-English speaking patients when translators are available. On the other hand, one could argue that patients who move here have a duty to learn English so that they can access services without incurring extra costs for the NHS. This applies particularly to patients who have been here for many years. But the barrier is more than linguistic, for as Martha perceptively pointed out he is an unsophisticated person whose expectations are different.

I had never visited him at home before, and the flat was rather chaotic and grubby. The floor looked dirty, though I did not inspect it too closely as I looked for a safe place to put my bag down. The windows were all tightly closed and there was a strange musty smell in the air. As we talked I could hear a strange chirruping noise behind his bed, and then I saw a pigeon standing on top of a wardrobe. On closer inspection the floor was spattered with feathers and pigeon droppings. By introducing these birds into his flat he has created the atmosphere of a remote Eastern European farmhouse in a very urban environment. I wonder whether they are purely for ornament, or whether pigeon pie appears on the menu at times.

I'm off on my holidays next week, so there will be no more posts until after Easter. See you then.