After two months of blogging it is time to take stock. On the whole I am enjoying it. According to StatCounter I have amassed a kind and gentle regular audience of around 30 souls. You are all most welcome, as are the more infrequent visitors. I note with alarm that a number of medical bloggers have shut up shop, including Fat Doctor who was most encouraging to me as I was starting. I hope to use sweetness and light to cloak my nefarious activities here.
However I am unable to keep up the pace of posting every day - there are other things going on in my life too, you know! Two or three times a week will have to do (most married couples manage on less than that). I also feel unable to make each posting a self-contained little story with a moral or well-defined teaching point. Life just isn't like that. Sometimes I can contrive such a story, but I don't want to distort reality too much. And general practice is stressful enough without feeling that I am obliged to weave the material of each day into a rattling good yarn. Sometimes stuff just happens, and if you don't mind I will just report it. After converting the Welsh miner into a genteel Yorkshire lady for the sake of preserving confidentiality, of course.
I may have mentioned before that GPs never discharge people. For better or for worse we are stuck with each other: unless the patient decides to move on, or moves out of the area, or dies, or takes a pop at one of us. I've been seeing Daphne, a genteel Yorkshire lady for some 19 years on and off (OK, I admit, he's a bloke of about my age). He suffers from intractable psychological problems and physical symptoms. When all this started many years ago I tried to get him to engage with the psychiatric services, but after a few years and a few tries the psychiatrist wrote "it seems impossible to help this genteel Yorkshire lady" and discharged her. I mean, him. Since then it's just been me. Sometimes I see him quite a lot, sometimes he stays away for up to a year. Sometimes he is better, sometimes he is worse. But we have stuck together (for better or worse) all this time. Should I be doing more for him? I don't know. From time to time we try different medication, but mostly I prescribe what Michael Balint referred to as "the drug doctor".
Daphne has certainly got better over the years, but I well remember a charming and lugubrious consultant advising me that "it is unwise to assume that any improvement in the patient is due to your efforts". (This consultant it was who had a heart attack, admitted himself to his own coronary care unit, and sat on the edge of the bed smoking and watching his cardiac monitor. They don't make them like that any more.) People are robust, life moves on, things get better, personality problems improve with age (like a good Bordeaux). Where I think I have been useful is just being there, accompanying him on his journey towards better health.
Is he a heartsink? Not really. To be honest, I quite like him although it can be hard going listening to his tirade of symptoms at times. Please don't get the impression that I am some kind of saint, listening patiently and bearing all things. That is one of the dangers of twisting these stories into an improving and moral tale where all ends happily. My patients frequently annoy me, bore me, frustrate me, anger me, and sometimes frighten me. I often feel I am getting nowhere. Yet sometimes looking back I can see that I have made things a bit better, or at least I have done no harm. That is one of the advantages of blogging.
So Daphne came to see me again on Friday and was not too bad, all things considered. One of his complaints was that an item had been missing from his wife's latest prescription. "I'll print that for you" I volunteered. "Would you doc?" he asked, "you're a good man". And he clearly meant it. I replied “there's good in a lot of people”. He thought about this, and then told me that he particularly likes the immigrants in our city. He finds them kind and unassuming. “My neighbours are Vietnamese”, he went on. “You've heard of the neighbours from hell? Well, they are the neighbours from heaven.”
Now there's something for us all to aim at!