Clearly she had had another bleed. For a moment I wondered whether any immediate action was necessary as the previous bleeds had not been amenable to treatment, but as Martha later pointed out you can't just send somebody home when they bring such symptoms to you. So I rang the neurology Registrar on call, was put through within a few minutes, and found him to be a charming man who remembered her from last year. He told me to send her up to the hospital and he would arrange an immediate scan "although it'll be hell on a Friday afternoon". Thank goodness there are still keen dedicated doctors training in our hospitals, doing their best for patients.
However there are not quite as many dedicated nurses as there used to be, due to the expert financial changes implemented by our excellent Secretary of State for Health. Today I saw an extremely distressed woman who has just been made redundant from her job as a Sister in a local hospital. It seems that the coup de grâce was a single day's sick leave which she took last year, which lost her five "redundancy points" and hence her job. Don't ever be ill if you want to keep your job in the modern dependable NHS. However they still expect her to go in and take charge of her ward tomorrow night (stiff upper lip, chaps!). You have to wonder whether patient safety will be compromised by such a reduction in trained staff. We shall find out whether there are enough resources in the system because the nurse due to take charge of that ward tomorrow night is currently deemed unfit for work by her GP.
I very much enjoyed reading an article by Michael O'Donnell in the Careers section of this week's BMJ. Dr O'Donnell, GP author and broadcaster, is one of those irritatingly wise and humorous doctors that the rest of us try in vain to imitate. In the article he recalls being asked what was the most difficult lesson he had to learn when moving from hospital medicine to general practice. His reply was "learning the difference between disease and illness". In hospital he had learned a lot about disease, as described in the textbooks, but:
"In general practice I discovered illness, the "customised" disease suffered by individuals whose physical and emotional states determine the way disease affects their lives, and can even determine the nature and severity of their symptoms. I'd encountered illness in hospital but hadn't the time to recognise it. In general practice I couldn't avoid it. GPs spend more time treating it than they spend treating disease. Some 40% of new disorders they see "do not evolve into conditions that meet accepted criteria for a diagnosis." And even when the diagnosis is clear, GPs need to understand the feelings of guilt, anger, fear, loneliness - indeed any of the perplexing emotions - that turn the same disease into a different illness in different people."He goes on to suggest that we need to look to literature and the creative arts to help us understand what is going on in our patients' lives, and to help us help them.
"Scientific medicine has brought great rewards. It has expanded doctors' ability to prevent disease, relieve pain, and extend people's lives. Yet most GPs still spend most of their time not in dramatic interventions but in helping people to survive the short time they spend on this planet in some sort of harmony with the world around them."When it comes to describing what a GP does, O'Donnell has once again hit the nail on the head.