Saturday, 16 May 2009

Quite so

Poor Dorothy became mentally ill and her behaviour was upsetting the other residents in the nursing home where she lived. Despite the best efforts of her community psychiatric nurse it was clear that she would have to be admitted to hospital for treatment. And so it was that an Approved Social Worker, a psychiatrist and I went to see her to carry out an assessment under the Mental Health Act.

There was no doubt in our minds that she needed admission, but when we told her what was going to happen she became indignant. "I'm not going to no hospital" she declared, "I'm not daft!" At which point the social worker leant forwards solicitously and reached out to hold Dorothy's hand. "We're not saying that you're daft for one minute, Dotty."

The Normal

The Brown household takes The Times, and at breakfast this morning I was reading an article by a woman who caught malaria on a holiday in Kenya. She said that her consultant at London's Hospital for Tropical Diseases was surprised because she had taken all the precautions, including Malarone tablets. Her symptoms had been vague, just headaches and falling asleep. Yet she had falciparum malaria.

The article is a useful reminder that you can catch malaria despite taking precautions, and that the diagnosis should always be considered when unexplained illness develops within six months of visiting a malarial area. That is advice which I give to patients when prescribing tablets for malarial prophylaxis, and the more widely it is known the better.

But how had she got to the hospital? In a throwaway line she reports that
my GP referred me "as a precaution".
No doubt her GP used those words in order not to alarm her. Also perhaps because he (or she) was far from certain about the diagnosis and felt a little embarrassed about acting "on a hunch". But that is what GPs try to do: spotting the possibly serious in a sea of headaches and tiredness. It is said that we are experts in what is Normal. We may not know exactly what the Abnormal is, that is for our specialist colleagues to determine, but we try hard to recognise it when it sits in front of us.

There is little glory or prestige in this task. When you succeed the specialist gets all the credit for making the diagnosis, if you fail you are castigated for missing it. But if we had wanted glory we wouldn't have gone into general practice.