Tag Archives: arthritis

A Family Doctor’s Casebook (part 1)

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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.

Ham and Eggs with Mr Turner

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It was lovely to sit down for two and a half hours with my mobile turned off. On the minus side, I had to put up with caricatures that would have done Harry Enfield and Chums proud. In the lead role is an on-form Timothy Spall doing his best-ever impression of Timothy Spall’s rendition of Timothy Spall.

His gurning is magnificent, his grunts fit for a piggery at feeding time. It all helps establish JMW Turner’s origins: his father was a barber and his mother a lunatic (as it was termed in Victorian times). The artist’s inarticulacy is well portrayed, but I didn’t see the need to over-egg the pudding, turning him and his housekeeper into Wayne and Waynetta Slob. 

There is also much gasping, groaning, staggering and falling about, all of which sharpens the contrast between Turner and his colleagues at the Royal Academy (filmed at Wentworth Woodhouse near Rotherham, South Yorkshire). There we have John Carew, David Roberts, John Constable, John Singer Sargent, Sir John Soane and others. The more Turner grunts, the more they twirl, ponder, recoil, ponce about and generally over-act.

Then Mike Leigh takes the piss out of the Ruskin family who come across as unbearably pseud.

I can't show you a Turner. Go to the Tate Britain.

I can’t show you a Turner here. Go to the Tate Britain.

The film Mr Turner goes to huge lengths (or, as the Daily Mail puts it, ‘amazing tricks’) to make the film authentic in every detail. Doctors did house calls in those days, though I’m not sure how Leigh induces Dr Price to come to London all the way from Margate for a simple home visit, especially since, in the film, Margate has quietly slipped west to Cornwall.

Still, the stethoscope is spot on as the simple tube invented by Frenchman René Laënnec.  His name is pronounced ‘Le Neck’ though this isn’t where doctors wore it at the time. The binaural model used today only came into production in 1851, the year Turner died. 

HP Rapaport Sprague stethoscope, circa 1981

HP Rapaport Sprague stethoscope, circa 1981

I liked Turner’s last mistress Mrs Booth (played by Dorothy Atkinson) who bears more than a passing resemblance to my ex-husband’s new wife. And Marion Bailey is a superb depiction of loyal housekeeper Hannah Danby, not least for the evolution of her psoriasis. First we see her scratching her neck, but later her scaly skin turns rampant. As the years pass, she becomes increasingly stooped and rigid, probably from psoriatic arthropathy which affects some 10% of people with psoriasis.

Turner’s eccentricity and talent come across well, as does the progression of his style of painting. Many of the images are genuinely beautiful. But the acting? More ham than a Bavarian market.

This is just my opinion. In no way does it represent the views of my husband (who thought we had booked to see Teenage Mutant Ninja Turtles), let alone the rest of the movie world. I’m sure everyone else will absolutely love the film to bits, darling.