Today I enjoyed a whiff of Americana when a jovial elderly lady from the Southern States came to see me. In an elegant drawl she complimented me on the decoration of my “office” (rather than my “surgery”) and on leaving said “thank you, doc!”, which is not an appellation I would have expected from an English woman of her mature years. I came across another transatlantic difference when it came to treating her. In the USA they treat cholesterol levels above 4 (total cholesterol) and 2 (HDL cholesterol) for maximum protective effect. In the UK our guidelines are to treat if the levels are above 5 (total) and 3 (HDL). The cost of getting the levels down that extra point is not thought to be worth it for the small number of additional British lives saved. Needless to say, her cholesterol levels fell right in the middle of this transatlantic gap. As she will be going back to the USA shortly I decided to treat her.
I was delighted by another foreigner, in fact two octogenarians from Eastern Europe who have lived here for many years. They made a cheerful and devoted couple. The husband was telling me about a little bit of sporting success he had had in his young days, when his wife chipped in. “Never mind that!” she said, “he was the best dancer in Urbs Beata!". His dancing days may be over, but his partner is still proud of him.
Another octogenarian thanked me for sending him up to the hospital urgently because of a little ulcer on the rim of his ear which he kept picking. It was of course a basal cell carcinoma. He told me about his first visit to outpatients. “The doctor said straight away 'that's a cancer', which scared me, but then he said it wasn't dangerous and he would remove it completely”. Then he proudly showed me the neat job that the surgeon had made of his ear. He was a very satisfied customer, and I was pleased at the way the hospital doctor had subtly implied that his GP was “on the ball” for referring straight away. These are difficult times in the NHS, the Government seems set on a policy of “divide and conquer”, and we should support our colleagues whenever we can.
Having said that I will finish with a little moan about our local hospital, although the problem was undoubtedly due to understaffing rather than incompetence. Last week an elderly man who lives alone was so incapacitated by diarrhoea that my partner had to send him into hospital. He stayed in four days, but I had to visit him again today because he still had diarrhoea after being discharged. Nowadays clostridium difficile is in the news, so I was keen to know whether he had this infection. And guess what? During his four day stay with diarrhoea the hospital staff had been unable to collect a stool sample to send to the laboratory. They had taken blood cultures but that's easy - you just send round a phlebotomist. To collect a stool sample requires a nurse with a bit of nous and the time to organise it. You would never get the hospital authorities to admit it, but there aren't enough nurses. So it is left to the trusty GP to arrange a stool culture that our well staffed hospital was unable to collect during a four day stay.