A Family Doctor’s Casebook (part 1)

General practice partnerships are like marriage without the sex, muses Geoff as he installs himself at his consulting room desk.  He knows that kind of marriage. Shoving aside the piles of letters that need answering, he begins tending to the sick of North London.

Geoff is a GP from my novels One Night at the Jacaranda and Hampstead Fever.  Despite his problems and hang-ups, he’s everyone’s favourite. Geoff is a firm believer in the NHS, but the changes he’s seen in the 15 years since he qualified frustrate him immensely.

1 The first patient is a three-month old baby with the Lexus of pushchairs and a Yummy Mummy who reminds Geoff of his ex-wife.  She begins by complaining about the 20-minute wait, and the perennial parking problems within a mile of the health centre. All this is extremely inconvenient as she’ll now be late for her Pilates.

Geoff asks what he can do for her.

“It’s Alistair’s head,” she throws down like a gauntlet.

She’s right in thinking her baby’s skull is a tad asymmetrical. Plagiocephaly is common now that babies all sleep on their backs.  Geoff reassures her that it’ll right itself in time, once Alistair lifts his head and becomes more mobile.

FreeImages.com/Johan Graterol POSED BY MODEL

Yummy Mummy is sceptical. “Doesn’t he need one of those special helmets?”

Geoff explains that there’s no evidence they help.

The mother seems unconvinced. She’ll probably go and splash out thousands of pounds on a contraption that will only cause discomfort and inconvenient. Still, she’s now ready to move on to the next symptom. The practice has a new policy of one symptom per consultation, which Geoff routinely ignores. It’s demeaning to patients and wastes everyone’s time in the end.

The rash on Alistair’s buttocks looks like a common yeast infection which should soon respond to the cream Geoff recommends. This pleases the mother, until Geoff asks her not to leave Alistair’s dirty nappy in his consulting room bin.

“I don’t want to stink out the car,” says Yummy Mummy.

Geoff eventually persuades her to take the offending object away, even though he thinks she’s likely to dump it in the waiting room on her way out.

2 Next it’s Mr Legg in his nineties, with an aching left knee. Sometimes it’s his right knee, and sometimes it’s both, which is no wonder since both legs are badly deformed by arthritis. He attends the health centre every couple of weeks, yet refuses hospital treatment. As he puts it, “I don’t want to be a bother. There’s plenty of younger folks who need it more.” Mr Legg adds that he doubts it’s arthritis anyway.  “It’s probably just down to the shrapnel what got me during the war.”

Geoff asks where the shrapnel got him.

“In a little village near Germany, Doctor.”

doctor's bag

3 It’s a relief to see that young Mohammed’s eczema is improving. For a long while, his mother believed that a mild steroid was totally unsuitable for a three-year old, but the cream, along with emollients, has made a huge difference. Mohammed sleeps well now that he doesn’t scratch himself to ribbons. All in all, he’s a happy chappy, apart from a streaming cold that’s not a problem until he flings himself at Geoff and plonks a kiss on his cheek.

Geoff usually washes his hands between consultations. Today he washes his face as well.

FreeImages.com/Toni Mihailov

 

4 Now a young man sits before him. Unemployed, with a squat nose and tats up one arm. “Pain in me bollocks,” he says.

Might be a torsion. Uncommon in adults, Geoff knows, but, unless treated promptly, it can lead to gangrene of the testicle.

“Right. I need to take a look,” Geoff says, pulling the paper curtains across.

As he waits for the fellow to undress, he wipes the photo on his desk with a tissue. It’s Davey, aged four, at the beach in Norfolk. Happy days before the divorce.

“Ready yet?” Geoff calls out, increasingly aware of how late his clinic is running.

“Yeah. Course.”

Turns out the man is sitting fully clothed the other side of the drapes.

Patiently, Geoff explains what he needs to examine. Another three minutes pass while the man undresses.

On examination there’s nothing abnormal about the patient’s tackle, apart from the stink. Geoff peels off his gloves and flings them in the bin. “Hmm. All’s well there. When did you first get the pain?”

The man shrugs. “Maybe a week ago. But I ain’t got it no more, like. Not since I pulled that bird the other day.”

“Fair enough,” says Geoff, even though there’s nothing fair about it. The ugly, unemployed fucker gets laid just like that, while he, Geoff, has been celibate for ten months and counting.

***

Coming up soon, Geoff deals with a very personal problem. Meanwhile you may enjoy one of these posts:

How to Alienate Your Doctor in Ten Easy Steps

What Your Doctor is Really Saying

or, on a more serious note, an overview of sepsis in The Disease Nobody Knows About Until It’s Too Late.

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Mistakes to Avoid at the London Book Fair

The London Book Fair is now just days away. This year’s LBF takes place April 10-12. That’s three hectic days at Olympia, Kensington, with over 25,000 people attending.

This time around, the market focus is the Baltic Countries, but it’s an international fair bringing in exhibitors from over fifty countries, and some truisms apply every year. I’ve been going to the London Book Fair for a while now, so I’m confident in saying there are some things not to do (especially as some of them are mistakes I’ve made myself).

1 Thrust your manuscript into the hands of a publisher. Don’t even expect to speak to a publisher. The fair is still very much industry-led, and, if you don’t have an appointment, you won’t be able to see a publisher.

The last seven or eight years have seen the fair become more aware of authors, with the belated recognition of who it is that actually writes books. There’s a small area called Author HQ with a range of events relevant to writers, but LBF is still a trade exhibition, so it you can’t expect it to revolve around authors or would-be authors.

LBF 2016

2 Try to find an agent. I reckon you’re more likely to win the lottery, even if you didn’t buy a ticket. You’ll even be pushed to chat with your own agent, if you’re lucky enough to have one. Literary agents are usually holed up for days at a time in the International Rights Centre, for which an appointment is needed.

3 Try to sell books. It’s a non-starter unless you booked a stand, which, as you might guess, is an expensive option.

4 Expect to buy lots of books. Although it would be mind-blowingly wonderful to visit such a massive bookstore, LBF isn’t one of them.

LBF 2016

However, you may be able to buy one or two newly released paperbacks at one of the book launches at the fair. I’m looking forward to the latest novel from author Jane Davis.

5 Help yourself to books from the stands. There will be freebies like mints, keyrings, bookmarks, carrier bags, and the like, but the books on the various stands are there for show, to give visitors a view of a publisher’s range. So put that glossy tome back!

6 Ask a lot of stupid questions. Nobody expects you to know everything, but naivety has limits, and not every speaker is as patient or as courteous as romantic novelist Katie Fforde who, at one of her talks, was asked “How does one start to write a book?”

7 Wear high heels. Comfy shoes are the order of the week. Vertiginous heels may enable you to see over people’s heads, but they’ll soon become unbearable and LBF doesn’t sell foot plasters (is that a gap in the market?). 

8 Expect to sit down. There is some seating here and there, though not much. 

So why attend the fair at all if you’re an author?

Because of the insights you’ll gain into publishing, the chance to network or make new contacts, attending a few interesting talks, getting new marketing ideas, and the inspiration of hearing celebrated authors speak at Author of the Day events.

Julian Fellowes at LBF

Will I see you there?

***

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