Thursday, July 11, 2013

Me, Me, Me

AD 1959. A quiet rural practice somewhere in the UK


Oh dear. Not Miss Rodgers again...week in, week out! She is always tired, always miserable! My heart truly sinks when I see her.  She is so introspective; it’s all about her ‘me me me’. Nothing I do for her works, mostly because there is nothing I can do for her. She has been tired for years.  Her head is fuzzed and tired and her muscles are sore and tired.  Everything feels sore and inflamed; she can’t work, she can’t do the housework, she wants to sleep all the time.  I could almost make a new disease out of her. “Me syndrome, she is so obsessed with her body and how it doesn’t work as she would like, she thinks of herself all the time. So much so that she must have inflamed the “me” in her and it has now grown to a big oedematous non functioning “ME”

“Ah Sit down Miss Rodgers; it’s always a pleasure to see you, so how can I help you today”. “So you are still tired and sore and yes, I know you don’t believe you are depressed, and you don’t like the diagnosis of chronic fatigue syndrome because it’s too woolly and makes your friends and family think you are just feigning your symptoms”...” oh well, I have some good news for you, I think I have a new diagnosis for you”. It’s called “ME”...”No, No, No... not me, but M.E.”

“What does that mean, well it’s a newly diagnosed condition, and the ME stands for myalgic encephalopathy”

“I know it’s bad news, but there is some good news. It responds much better to antidepressants than chronic fatigue syndrome and it is thought that with the right treatment you might get better much quicker”

“Yes I am sure your friends and family will not think you a fraud any more, and now we have a new diagnosis for you, it will mean we can try some of the treatments we have already tried, and these might just work now. Yes of course I can write it down so you can share the news with your husband”

“it’s my pleasure Miss Rodgers, sorry to be the one to give you the bad news and once you have given it...well let’s say a month or two for the diagnosis to sink in, then we can think about trying some medicines for it....good day to you too miss Rodgers”

What a blooming stroke of genius, ‘ME’ disease. Of course it really should be EM disease – encepholepathic myalgia...something wrong with the head meaning the muscles are always sore and tired. but it really doesn’t have the same ring to it. I wonder if it will take off. Still she seemed the happiest I have ever seen her now she has a “proper disease!”

Sunday, October 28, 2012

A little Nod

Sometimes it feels like the consulting room is an ark, with the patients coming in two by two.  Now of course I expect  some patients to come accompanied; its quite difficult to share management options with a screaming baby

But when full grown adults come in with their mum, dad, advocacy worker, friend or just some random person, the whole dynamic of the consultation changes. My opening gambit has to soften from my usual warm greeting of “what the hell do you want?” to something a little softer. Once I have lit the litmus paper I then find the best option is to go and get a cup of tea whilst they decide who is actually going to tell me why the patient is littering my consultation room. This not only is a good use of the time between my opening gambit and getting any useful information and it also helps hide my irritation that the second chair has been pulled around to encircle me like a shark  around its stranded prey

By subtle body language I try and actually engage the patient once the relative has embarked on their diatribe of whatever the patient has got the problem with.  This subtle clue of refusing to make eye contact with the relative and sharing my eye contact between “The  Guardian” and the patient with a ration of 3:1 respectively. A glance at the patient at the end of news article usually suffices.

Yet regardless of this approach, the relative is the most important person in the consultation.  If they leave content with the outcome of the consultation then it is usually a nicely rounded off consultation, but if they don’t, then is the little nagging voice in my ear telling me that I did not meet their expectations.  Sometimes the expectations are easy enough to meet such as referral to emotional crutches ‘r’ us counselling services or the panacea to having a shit life, fluoxetine. Other times it is just not reconcile what is possible with what responsibility the so called guardian of the patient is trying to palm off on me; For example, to re-house their offspring in a 10 bedded council funded mansion, or to wave my magic wand and suddenly cure the alcohol/drug/gambling addiction of the afflicted. The little voice of discontent usually takes the form of a torrent abuse and expletives.

It doesn't take long to get a barometer on the situation; a nodding head in the corner of my visual field and I get all warm and fuzzy inside. A cold icy stare boring into my temple, one which would make Medusa look like her gaze is a little flirting, usually alerts me to the fact that we are not on track and i either need to re-evaluate where i am going with the consultation or hold fast for a rocky ride ahead.

I have so much learned to enjoy the nodding in the corner of my eye that I now carry one of those nodding dogs in my black bag. You know the ones from the car insurance adverts. I have found that just positioning one of these in the corner of whatever consultation room i am working in makes me spend the whole surgery feel like at least someone, albeit it an inanimate object, has faith in me.