Puzzle

I get a bit tetchy when patients start moving the furniture. I've placed the main chair in a good position: close to me but not too close, next to the blood pressure machine, at an angle that allows eye contact to be maintained or dropped. Why do they feel the need to move it? Sometimes a male patient will lift the chair and rotate it through ninety degrees before sitting on it. Presumably that is something to do with staking his claim on the room. Then when I ask to take his blood pressure he will rotate it another ninety degrees so that he is sitting directly opposite the blood pressure machine. “What?!” as my daughter says, so eloquently. My first patient this morning pulled her chair forwards a good foot, so we were practically knee to knee. Madam, I hardly know you! True, she wanted to show me a lump on her arm, but it's customary to have a little conversation before getting down to physical contact. I do try to regard this as interesting sociological behaviour rather than an irritation. As a student I remember a consultant who tied the leg of the patient's chair to the leg of his desk in out-patients. Needless to say, he was an orthopaedic surgeon.

I may have mentioned before that I go to the waiting room to collect my patients. (If I repeat myself in this blog it's because I can't be bothered to go back through all the previous postings to check. And in any case, if a thing's worth saying it's worth saying twice.) There are a number of advantages to this. It gets me off my chair at regular intervals and gives me a little exercise (it's a long corridor), I can keep an eye on the waiting room in case of trouble or patients who have not been checked-in, and I can look the patient in the eye as I usher him or her through the “security” door into the corridor. This allows me to assess whether (s)he is sober, agitated, angry or possibly psychotic. It is easier to sort out dangerous situations while we are still close to the waiting room and the reception office, rather than alone in my room at the end of a long corridor. And I have a fond hope that someone who has been met with eye contact, a smile and a greeting is less likely to punch me. This morning I saw my university professor friend sitting there, waiting to see the nurse. I went out, took her hand, said I was feeling much better today and thanked her for her kindness on Tuesday. A small reward, but much deserved.

Yesterday evening I saw a man in his early thirties who comes from a cultural group that have a reputation for tolerating illness badly and seeing the doctor frequently. Looking back through his notes he has attended several times a year for many years, which is unusual for a man of his age without a chronic illness. He told me that his mother had wanted to call the doctor out but he had felt well enough to come in. His complaints didn't point to anything obvious, a bit of malaise, a little headache, some tummy ache, and some dizziness which was his worst symptom. On examination he looked more worried than unwell, normal pulse, no fever, no rash, no neck stiffness, throat maybe a bit red but otherwise nothing to find. I suggested that he took paracetamol and gave him some cinnarizine for the dizziness. This morning his name appeared on the “extras” list at the end of my surgery, but before I got that far his name disappeared and reappeared on the visits list with the comment “mother says he can't get out of bed”.

I certainly have mentioned before that we are reluctant to do home visits nowadays, and today his name was the only one on the list. I am particularly reluctant to visit in the area where he lives because parking is such a problem. Until a few years ago one could always squeeze the car in somewhere when visiting patients. Then the local authority took over control of parking, installed meter bays where parking was previously free, and they now patrol the area frequently to generate copious income from penalty tickets. The problem is largely in my head because there are plenty of free parking bays, I just don't want to buy a ticket. A reader recently pointed out that I earn a good income, and 50p in a meter every once in a while wouldn't hurt me. But my pride says that I am a doctor visiting a patient at home who is so seriously ill that he cannot attend surgery. Why do the Council insist that I pay them in order to carry out this duty? The last I heard they weren't issuing penalty tickets to ambulances. I prefer to park a quarter of a mile away and walk.

I was keen to avoid a visit if at all possible, so I wanted to ring the patient during surgery while there was still time for him to come down. Unfortunately the receptionist had forgotten to take a contact telephone number when his mother called, and the mobile phone number we had for him did not work. So I had no choice but to visit once I had finished my morning's work, and got there about 14.30. There was no reply to the door bell so I looked through the letter box. The light was on in the hall, the doors to the living room and bedroom of his flat were both closed. I shouted “hello there” but could hear nothing. If he was there then he was unconscious or at least so ill that he could not move or make any sound.

So gentle reader, what is your assessment of the situation? Was he suffering from incipient meningitis last night, and is he now lying semi-comatose and at death's door on his bed? Should I take prompt and life-saving action, summon the Police, break down the door and be crowned with glory and undying gratitude? Or has his anxious mother had her nerves stretched to breaking point, summoned an ambulance and taken him to hospital? Quick now! A patient's life is at stake!

Well, I reckoned it was going to be the latter. For me, the likely behaviour of anxious mothers from that cultural group outweighed the fact that the light was still on - it had no doubt been forgotten in the excitement of the emergency medical evacuation. I was very glad that I hadn't given the Council a 50p donation on this occasion. When I got back to the surgery I rang A&E. Oh yes, my patient had been brought in half an hour earlier. I shall report in due course whether he was suffering from an acute life-threatening illness or just had the flu and an overprotective mother. You may guess which I think is more likely.