Definitely not pregnant

Hi,

Had a flummoxed patient come in to see me today after she had been started on the progesterone only contraceptive pill (or mini-pill) three months ago. She had been asked to come back in to assess how she had been coming along with this medication and to prescribe her more. After talking about how things were going with the pill, I offered to prescribe her a years worth, so she didn't keep to have coming back

"Oh, don't worry about that doctor, I've got plenty"

Confused, I asked what she meant, as her three month period was almost up

"Oh, I have lots left thanks. They gave me all of the stock the pharmacy had - they even had to get me to come back later as there wasn't enough to give me. I have a whole bag of packets left"

I was confused as to what had happened, but on further probing it turned out that there had been confusion and the script which had been issued by us for 84 pills (3 lots of 28 = about 3 months) had been cashed in by the pharmacist for 84 packets.

~6.5 years worth of contraception.

Mammaries

Hi,

Awkward consultation today where a middle aged women wanted to have a breast reduction. This is something difficult to negotiate at the best of times, as it is all about finding where that line between health benefits and cosmetic lies, but it was made so much more difficult by the fact that when she wasn't referring to her breasts as 'the twins' she was referring to her 'mammoth mammaries'. Her pointed enunciation of the letter 'm' throughout  these words, and the serious note she was clearly trying to portray by using this clearly medical phrase made it difficult to complete the consultation with a straight face.

In the end we decided that it would be quicker and easier if her boyfriend paid for the surgery

The Great Cholesterol Con?

Hi,

Had a recurrent difficult consultation over the last few weeks - a lady had had routine blood tests done as part of her NHS health check which had shown a raised cholesterol. It is generally accepted (and pretty widely known) that high cholesterol levels lead to an increased risk of diseases such as heart attacks. This is based on a wide body of evidence from multiple studies and meta-studies backed up by government organisations such as NICE and mostly by the most important source of all - Wikipedia.

This lady had read a book called "The Great Cholesterol Con" which suggests that cholesterol is not linked to heart disease at all, and there is nothing to gain from lowering it at all. For this purpose she had started a "sausage diet" where she ate 1-2 sausages every meal, breakfast, lunch and dinner, along with the rest of her food. Predictably her cholesterol was crazy high. I tried to talk her through the evidence behind the ideas of lowering cholesterol, but I hadn't read the book so couldn't do this very effectively. I asked her to come back the next week so I could have some time to do some research. She was a little bit annoyed about this - she felt as a doctor I should know all this already, but agreed to return.

I read up on the arguments in the cholesterol book, which are based around inconsistencies in the Framingham Heart Study which suggested that as your cholesterol dropped, your risk of heart disease rose. It seemed as though this book was very selective in the data which it displayed to portray its arguments (well summed up by this review of a similar book) and ignored huge swathes of evidence which did indeed suggest high cholesterol levels (rather than just all cholesterol) are bad for you. You obviously need some cholesterol (and some salt, sugar, etc) but having too much can be a problem.

I collected up all of my research and information and bought it back to the next consultation with this lady. She was having none of it, and told me I had been taking backhanders from the statin producing pharmaceutical companies to peddle their wares. I tried to explain that as the patents on drugs such as Simvastatin had expired there would be no specific drugs company to try and pay me off, but the more I tried to disagree with her the more angry I made her. 

This was a loosing battle - I guess all we can do is display the evidence to the best of our ability and let people make decisions for their own health based on that. It was just upsetting that this wasn't a concious decision to damage her own health (like someone who smokes 40 a day, knowing full well it is bad for them) but a misinformed decision to try and help her own health, possibly guided by someone more interested in book sales than helping people. That said, she is coming back next week for another round of discussion, so wish me luck!

Mistakes

Hi,

Awkward moment with a patient on Friday. He had come in with a strange looking rash on his hands and face. It was strange looking and I wasn't too sure what it was, and told him it might be a non-specific viral rash and I wanted to get one of my seniors to look at it. He replied that he thought it was hand, foot and mouth disease after searching on the internet. I assured him that this was rare in adults, and went off to ask one of the GP partners to have a look. 

A cursory glance later, the GP told the patient that it was definitely hand, foot and mouth, a viral infection which will resolve itself, and isn't anything to worry about and left. The patient gave me a look of scorn and then followed the partner out of the door

I guess that makes us 1-1 Dr Google...

Nuclear war

Hi,

Today I saw a lady who had become obsessed with the fear that we might have a nuclear holocaust this year. What do you do with this situation? I tried to explain that it is unlikely, but I couldn't say that it certainly won't happen. What with all these problems in Ukraine and the Middle East, she told me that perhaps I should be more worried and left.

Perhaps she is right!

Fertility

Hi,

Really tough consultation today. A 44 year old lady had been coming to our practice for a few years trying to get pregnant. She had got a text asking her to make an appointment with a doctor about her recent blood test results, and came in to see me

Due to her age, she wasn't eligible for NHS assisted contraception during the last few years, and had been in and out of the surgery getting blood tests, trying to stop smoking and reduce her weight in order to improve her fertility. The blood results she had come in to hear about from me showed that she was going through the menopause and couldn't have children now. 

This was terrible news to break to her, as she really wanted a child. I think she had been in denial for some time, though, as she hadn't had a period in about 6 months. I spent over an hour talking with her while she alternated between crying and shouting at me - she felt that we had let her down and let her time run out. Being exposed to that raw emotion was scary, and I was aware that towards the end I had 5 people waiting to see me in the waiting room who could hear all the shouting and sobbing coming from the room. 

Being a GP can be emotionally draining, especially when you are questioning whether your team may be in the wrong...