Long time no blog. But I'm still here.
It's been a bit up and down this week. Yesterday I went to an educational session on sexually transmitted diseases which was very helpful. It was well taught, and I ended up a lot clearer in my mind about an area that can be worrying. Today I tried to stay calm and unstressed but this was difficult as the work kept piling up. As I reached 7pm I saw my last patient of the day who was the fifth “emergency” added to the end of the evening session. I dealt with the presenting complaint, a relatively minor infection. She asked me a question about another matter which I could answer quickly, so no problem there. But she then wanted to discuss two other matters; each would have required a full ten-minutes to deal with adequately, and one would have required a vaginal examination. By this stage my nurse had gone home.
And the fact is that I was weary. After ten hours fairly continuous work and with another half hour's paperwork in prospect before I could go home for my tea, I really didn't want to have to think hard about two more problems. And I don't think it would have been in my patient's best interest to be dealt with by a tired grumpy and resentful doctor. So I gently asked her to make a routine appointment to see me again later.
It is at this point, ladies and gentlemen, that the Government wants me to do another ninety minutes of intensive “out-of-hours” consulting. Feel free to insert your own expletive.
On a different subject, it is now increasingly common for consultants to send copies of their clinic letters to the patient as well as to the referring GP. This often works well. Last week I reviewed a man whom I had referred to the lipid clinic with raised triglycerides. He had already received a copy of the consultant's very helpful letter and been able to consider it, so we were able to have an in-depth discussion straight away rather than me having to explain everything from scratch. But in the same day's postbag I came across a letter from a neurologist who had seen a rather nervous young patient with dystonia. It contained the sentence “I have reassured him that there is no more serious disease than dystonia”, and I wonder what the patient thought when he received his copy.
Being a bit old and fuddy-duddy I share my partner's sense of mild outrage that one local consultant, who pioneered sending copies to the patient a few years ago, now addresses his letter to the patient and sends a copy to the GP. Sometimes he adds a postscript “GP please do so-and-so”. We think this is bad manners. As the patient's regular doctor we have referred him or her to a colleague for advice, and gone to some trouble to write a helpful letter of referral. For the consultant not to reply directly to us seems improper. Perhaps we should invite the patient to write their own letter of referral to this consultant? To be honest it's the least of our worries at present, but I do think that it's another straw in the wind.