Peer review

Someone recently mentioned this blog on Doctors Net, a private website for UK doctors, and several of my colleagues have been over to take a look. Some of them liked it and some didn't.

One thought that it was “chick-lit”. I've read a few chick-lit novels and found them amusing, entertaining and well-written, so I'll take that as a positive comment. It's true that I haven't talked about sex much, but I daresay I could remedy that.

Another felt that the blog's title was a piece of hubris, and that I am comparing myself to the classic book “A Fortunate Man”. I don't think I have ever claimed that this blog is anything like as well-written or as profound as that book. Back in March 2007 I wrote:

The title of this blog is a homage to the classic book "A Fortunate Man: The Story of a Country Doctor" by John Berger and photographer Jean Mohr, published in 1968. It sketches the life and experience of John Sassall, a general practitioner in an economically depressed rural area of England. The book had a profound influence on me, and many other GPs of my generation. I cannot claim to be anything like as good a GP as Sassall, but we all need rôle models. Part of my task in this blog will be to reflect on whether GPs in the UK can still consider themselves to be fortunate men and women.

I hope it is possible to pay homage without claiming equality. I will amend the front page of the blog to make this clearer.

Another doctor, who works in Public Health, was frustrated by my recent posting about diagnosing Hepatitis A. He emailed me to say:

I have enjoyed your blog; thanks for posting it.

I'd just like to comment on your comment that "There is no doubt that she is in the early stages of Hepatitis A, and we made the diagnosis by inductive logic before the patient became jaundiced and without a serology result. I shall wait for serological confirmation before I notify the disease to the Proper Officer, but..."

Public health action may be required with respect to patients with hepatitis A. Contacts may need to be vaccinated or given immunoglobulin; and they need to be advised about food-handling etc. There is a window of opportunity for some of these actions. We tear our hair out in public health when we get late notifications, and are unable to prevent illnesses that could have been prevented if only the disease had been notified earlier; or when we have to give immunoglobulin to patients who could have had (cheaper, safer, better, less unpleasant) vaccine if we'd had the notification more promptly.

I should be so grateful if you could notify all patients - and especially those with suspected hepatitis A with notifiable disease on suspicion (as the law says you must), and not await laboratory confirmation; and if you could publish a follow-up blog about this.

I certainly understand his frustration. However, I was not quite as convinced by my logical deduction as I sounded in my posting. Despite my impeccable reasoning I was a little reluctant to notify Hepatitis A (or “infectious jaundice” as it used to be called) when my patient was not jaundiced. I had discussed the implications of the probable diagnosis of Hepatitis A with the microbiologist and subsequently with my patient, dealing with the points raised above, so I felt that I could reasonably wait until the serology result. It was perhaps as well that I did because this showed that she does not have Hepatitis A (or B or C). She has been referred to the clever doctors for further investigation.