In recent years we have suffered from a series of temporary (or not-so-temporary) shortages of medication. Barely a month goes by without us being asked to provide an alternative prescription for a patient whose usual treatment is temporarily unavailable. Often there is no exact alternative, and considerable thought is required to come up with something that will have a similar effect and not interfere with the other medication that the patient is taking. These scenes must take place in surgeries all over the country, and cause a large amount of extra work for doctors and potential hazard for patients. I'm not sure what causes these shortages, but I suspect that “can't be too careful” legislation is behind many of them.
Recently Retin-A, a gel for treating acne, disappeared from pharmacy shelves in this country. But one of my patients was not so easily discouraged. He is a student from China, and arranged for a supply to be sent from Beijing. If you had any doubts that China is in the ascendant and our country is drowning in a welter of well-intentioned legislation, bear this story in mind.
Boeing aircraft and British pilots still seem to be generally reliable, although the increasing reliance on computers is worrying.
As I get older I have a tendency to live in the past, and am bothered more by change. Sometimes I seem to recognise hardly any of the names that appear in my surgery lists, although it usually turns out that I have seen them before. This evening I was struck by how many of the names were not English. Counting up, I reckoned that over 50% of the patients were first or second generation immigrants: from Pakistan, Sri Lanka, China and Nigeria. Patients from foreign countries can be hard work. There may be communication problems, and it is as easy to fall into traps when the patient's English appears to be fairly good as when an interpreter is required. Cultural expectations can cause misconceptions: about illness, treatment, and what may reasonably be expected from medical and other services in this country. And sometimes you find you are sharing care of the patient with one or more doctors overseas. So it is because of laziness rather than xenophobia that I don't like to see too many foreign names on the list. Mind you, my worst and most demanding patients are invariably English!
I felt more-than-usually helpless this morning in the presence of a refugee from a war-torn country. She speaks almost no English and her key-worker arranged a translator using her mobile phone. I always feel more pressured when there is a third party in the room, as I will have to persuade two different people that my plans are good. Using an interpreter adds to the difficulty, especially when done by telephone. But I think most of my feelings of helplessness were due to transference from the patient who is clearly depressed, and for good reason. Her children remain in danger back home and she is powerless to help them, or even contact them. She has a range of symptoms, some of which are clearly psychosomatic while the others have a strong psychological component. I gave some explanations, made some suggestions and prescribed some drugs which I think will help. Unfortunately she has just moved out of our practice area and will not be seeing me again, so along with helplessness I also felt that I was letting her down. I discussed the consultation with Martha afterwards, and she pointed out that the patient is now living very close to a Health Centre with a set of very good GPs who are used to dealing with refugees. So I needn't feel too guilty, nor indeed too helpless.