A potentially life-saving Tweet

twitter_This is an old column (late 2013) that has been loitering in my drafts’ folder for ages. 

I was planning to post it when I had finally mastered the intricacies of Twitter… but I don’t think that is going to happen in the foreseeable future. Much as I can appreciate Twitter’s value, I’m still very much an occasional spectator.  

I owe my Twitter fumblings a debt though… they may have just saved my mother’s life….

November, 2013

I used to think Twitter was for twits – twits with short attention spans, an inability to construct proper sentences and the misguided impression that everyone else is interested in their mundane lives.

Despite my reservations, I tentatively dipped my toe into the Twitterverse earlier this year, and discovered, to my surprise, that there is no shortage of relevant and interesting tweets relating to medicine and medical education.  It’s just a matter of knowing where to look and whom to follow.

Twitter has also added whole new educational and networking dimensions to the conferences I’ve attended this year.  Where once I would’ve deliberately left my electronic devices behind to avoid distraction, I now not only carry my iPad and phone with me, but actively interact with them during presentations.

I’m still very much a novice tweeter, though.  I’m not yet quick or deft enough to always operate unobtrusively. I feel guilty about this, for as a presenter myself, I know how annoying it can be to have your audience seemingly so distracted.

And I confess to being distracted myself by incoming emails, like the one from my father in Canada, received while I was sending a tweet relating to the handy HANDI (Handbook of Non-Drug Interventions) being introduced by Professor Paul Glasziou at GP13.

My dad’s email was titled “Mum’s health”. It gave a detailed description of a very acute and severe systemic illness following a viral respiratory tract infection.  After describing a typical pneumonia +/- sepsis, Dad then went on to say that he’d given her a cold and flu tablet, and did I have “any further suggestions?”

Any further suggestions?!  I emailed back immediately with my provisional diagnosis and told him to get her to hospital ASAP, and to ignore any protests.  45 minutes later, when the session ended, I rang to check that he’d received my email.  “Yes,” he confirmed, “but your mother says she’s too sick to go anywhere.”

Despite her not wanting to talk to me (which was a worrying sign in itself), I got Dad to put me on speaker phone and I got very bossy with my seriously ill mother.   She could barely talk, which made it easier for me to ride roughshod over her objections.

And it was just as well I did.  She was admitted and treated immediately.  Hypoxic, tachycardic, febrile and dehydrated, with intractable hypotension (60/35!), altered mental state, elevated serum lactate and rip-roaring consolidation on chest X-ray, she had lobar pneumonia with sepsis, just as I’d predicted.

I can just imagine the scene in the Canadian ER that night.  An older Australian woman in septic shock is dragged in by her husband, the couple apologising for disturbing the staff after-hours and potentially wasting their time, saying the only reason they were there was that they have a bossy doctor-daughter who bullied them into coming.  On the plus side, my parents did their bit for perpetuating the “Tough Aussie” legend!

Mind you, this is not atypical for our family.  “Breed ’em tough” was my parents’ preferred parenting style.  Severe abdominal pain (appendicitis) was not enough of an excuse to get out of cleaning a bedroom; a swollen and deformed wrist (fractured radius and ulna) not a reason to cry. We were never short of love and attention, but whinging never got us kids far.

There is a time and a place for seeking help though, and very luckily, thanks to being inspired to tweet about a handbook of non-drug interventions (HANDI), I was able to step in to ensure that my mother got the lifesaving drug interventions she didn’t know she needed.

First published in Australian Doctor on 15th November, 2013 On Twitter

http://www.australiandoctor.com.au/opinions/the-last-word/the-last-word-on-twitter

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Keeping abreast of the situation

old-lady-in-bikiniLorraine and Frank Cooper were booked in for skin checks. I had previously met Frank a few times but Lorraine only once. Like many older Australians they had managed, with the assistance of unprotected fair skin and direct sunlight, to achieve decades of perfect skin-cancer-growing conditions, and their crops of lesions were maturing nicely. Frank in particular rarely escaped without donating a skin chunk or two to our friendly local pathologist.

I quickly scanned their charts then walked into the crowded waiting room.

“Frank and Lorraine please.”

Frank sauntered over from where he’d been standing. Lorraine closed the two year old New Idea, placed it back on the rack meticulously, and headed towards me. They met in the doorway. Frank beamed at Lorraine, she returned his smile with her mouth but frowned with her eyes.

“You want us to come in together?” Lorraine asked.

“Only if you’re comfortable doing so.”

“No worries, Doc!” Frank said without hesitation.

Lorraine shrugged, “I guess so.”

“So who wants to go first?” I asked after we were seated and the usual pleasantries exchanged.

“Ladies first,” Frank volunteered.

Lorraine looked mildly irritated. “It should indeed be me, but not because I’m a woman. I was booked in first.  I heard the receptionist saying that his spot was at 3:15. Mine was at 3.”

At that point, I recall wondering whether Frank had done something to really annoy her that particular morning, or whether her touchiness was simply a result of years of accumulated frustration.

Lorraine’s history-taking unfolded uneventfully, but I hit resistance when it came to her examination.  As is my habit, I asked her to undress down to her underwear behind the curtain and to cover herself with the provided sheet.

“Is he going to stay?” she inquired.

“Not if you don’t want him to,” I quickly countered, sensing her discomfort.

“It’s OK, Luv, you’re behind a curtain, and anyway, it’s not as if you’ve got anything I haven’t seen before.”

“But you haven’t seen mine!

An alarm bell rang. It didn’t seem like something a wife would say – at least not without a “for years” or “recently” tacked onto the end.

I glanced again at their charts: same surname, different phone numbers, different streets, different towns. Uh oh!

Taking a deep breath, I somewhat sheepishly inquired, “This may seem like a silly question, but you are married, aren’t you?”

“Married? I’ve never met him before in my life!”

Luckily for me, both were very understanding and forgiving, and could see the funny side.

Frank was relegated post-haste to the waiting room while Lorraine had her solar keratoses cryotherapied in private.

Later, Frank lamented, “I was hoping to get a peek at some live bosoms. It’s been a long time.”

I must have looked shocked.  He rushed to explain. “I’m no perv.  I just happen to love breasts. All of them: pancakes or melons, firm or dangly. The only complaint I’ve ever made about a pair of bosoms is that they’re too… clothed.”

When I sought their individual consent to write this column (I didn’t want to breach their privacy a second time!), Frank’s face fell when I explained that I would need to give him an alias.

“I’d quite fancy my name in print,” he lamented. “Well, at least use my ‘all breasts are beautiful’ line, OK? I want to do my bit to help all the ladies out there be proud of their assets. And hopefully, bare them more often. But not too much time in the sun, of course, Doc. There’s too much breast cancer around nowadays as it is!”

(names and identifying details have been changed)

First published in Medical Observer, 25th July 2014

Perspective. It’s a fascinating concept, any way you look at it.

job_interviewThe story sounded familiar, uncannily familiar. It had been a long day of interviewing applicants for GP training and the answers being given were having an increasingly ‘I’ve-heard-this-all-before’ flavour, but I’d definitely heard this particular example earlier in the day.

Both applicants described a specific hospital-based incident in which a lack of teamwork almost resulted in patient harm. The details were identical, until it came to the story’s climax.

Each applicant clearly and convincingly described how he unilaterally saved the day, despite being hampered by his colleague’s incompetence. I have no idea whose version of events was accurate. Maybe one (or perhaps both) was deliberately trying to mislead, but I got the impression each genuinely believed what he was saying.

Perspective. It’s a fascinating concept, any way you look at it.

I’m sure we’ve all had the experience of hearing two somewhat conflicting sides of a patient’s story, usually from different family members. They’re generally not too difficult to reconcile and/or the differences are inconsequential, but occasionally they throw up a real challenge.

I had an elderly patient with advanced dementia, who was cared for full-time by her daughter. Everything seemed to be rolling along happily enough until the other daughter visited from interstate. There were the usual familial disagreements about what should happen to Mum, but in this case the second daughter came to me with some pretty serious allegations of elder abuse.

The son, with a third version of events, got involved, as did a neighbour, whose story conflicted with everyone else’s. The relevant authority dipped its toe in and then hastily withdrew it, claiming there was “no clear case”. It was right — the case was anything but clear.

As it happened, in the midst of the bickering, claims and counter-claims, the matriarch at the centre of the drama conveniently brought the matter to a close by getting pneumonia and slipping away quietly and quickly in hospital.

Blessedly, she was without any significant assets for her offspring to contest, and they were civilised enough to not involve any lawyers in the division of her crocheted tea-cosy collection.

In my own family, differences in perspective are fodder for amusement rather than Grand Canyon-scale rifts. My 92-year-old paternal grandmother has always been a stoic, capable woman with a make-the-best-of-a-bad-situation attitude.

Over the years, the rose-coloured tint in her recollections has intensified to more resemble a bright scarlet, and her remembered role in past events has her firmly ensconced in the driver’s seat. Now in her twilight years, she happily sits with her increasingly positive memories and regales her fellow aged-care residents with her achievements (over and over again!), feeling progressively surer that she has lived the best and most heroic life possible. That some of her stories bear little relation to the facts as remembered by other family members is of no consequence.

Mind you, these ‘facts’ are all a bit wobbly anyway. My father is always right (according to him), my mother remembers the emotions attached with great clarity (but not always the event specifics), and my brother claims to have forgotten almost everything that happened to him before the age of 18.

And me? Born with the Pollyanna gene, I’m probably more like my grandmother than I care to admit. I’m certainly not at the believing-black-is-white stage yet, but I would quite like to be by the time I reach my 90s.

It strikes me as quite a pleasant way to see out my days: a legend in my own lunchbox, utterly convinced that my life has been near-perfect.

First Published in Australian Doctor on 30th August, 2013 On Perspective

http://www.australiandoctor.com.au/opinions/the-last-word/the-last-word-on-perspective

Political Correctness Gone Mad

I suspect that there are very few of you not familiar with the way police officers in New York NYPDCity describe suspects, thanks to endless seasons and repeats of shows such as Law and Order, CSI:NY and NYPD Blue.   A description like this might be broadcast on police radio…

“White male, short blond hair, late teens/early 20s, approximately 6ft, blue jeans, black T-shirt”

According to an article in The Australian (reprinted from The Times), police officers in New York are worried that a new bill being brought city council may mean the above description will have to be changed to:

“Person, approximately 6ft, blue jeans, black T-shirt”

They are concerned because the proposed changes would allow members of the public to launch a lawsuit against the NYPD if they are wrongly apprehended and detained on the basis of race, colour, creed, age, gender, sexual orientation or disability, amongst other things. The police union have launched a campaign featuring an advertisement depicting a blindfolded policemen standing in Times Square.

I was wondering what would happen if similar politically correct measures were brought in for us, as Australian GPs.  The item numbers for Aboriginal and Torres Strait Islander health checks and assessments for those with an intellectual disability would probably be the first to go. The checks which discriminate on age, such as the Health Assessment for those ages 75 and older, and the Healthy Kids Check may well soon follow. Maybe Chronic Disease Management Plans and Mental Health Care Plans could also be deemed discriminatory.

The loss of these Medicare item numbers would not call the sky to fall in – after all, 15 years ago we didn’t have any of these at our disposal and bumbled along OK – but what if such changes affected the way we were able to manage patients? The NYPD are concerned that without being to state and act on the obvious they will be unable to do their job effectively (i.e. catch the baddies).  Imagine trying to diagnose and manage disease if constrained by similar restrictions. We’d have to forget that different racial groups have different propensities to certain diseases. We certainly wouldn’t be able to have a lower threshold for testing for things like HIV and syphilis in men who have sex with men.  Skin colour would play no part in assessing risk of skin cancer.  And everyone gets offered a PAP smear: male or female, young or old – can’t use age or gender to decide who to target.

OK, so this is clearly ridiculous, but my point is, so is not being able to target and apprehend a suspect on the basis of gender.   I shouldn’t be surprised; gender neutrality in language has been a hot issue for years. Perhaps this is the next step? I read that more than half the states in the US have moved to gender-neutral language in all official documentation.  Changing personal pronouns from “he” to “he or she” seems reasonable, despite being a little clunky in places, but changing “penmanship” to “handwriting”, and “freshmen” to “first year students” appears to me to be a little over the top.  When hearing that words like “manhole” have been changed to “utility hole” or “maintenance hole”, however, my eyes roll so far, an observer may wrongly assume I’m an oculogyric crisis. That is, if they are not a police officer from New York. I’m pretty sure identifying someone on the basis of eye position would be in the “considered potentially offensive” list.

……………………..

First published in Australian Doctor on 2nd August, 2013 On Policital Correctness Gone Mad

http://www.australiandoctor.com.au/opinions/the-last-word/the-last-word-on-political-correctness-gone-mad

“So you are practising at being a doctor, generally?”

I had such fun on the phone tonight… with a cold calling scammer of all things… just had to write it down…

8:30pm, Friday 17th January. Phone rings

Me: Hello, Genevieve speaking

There is a 3 second delay, a slight crackle and then a heavily accented voice greets me.

Him: Hello madam, I am calling from Microsoft Customer Care.

I laugh loudly.

Him: Madam?  I said I was from Microsoft Customer Care

Me: (cheery) I know, I heard you.  So what are going to tell me is wrong with my computer this time?

Him:  Not your computer, madam, my computer. I have a problem and I was hoping that you could help me.

This is a new one to me, I thought.  Let’s see where this goes.  I’m intrigued.

Me: Your computer?  I thought you said you were from Microsoft Customer Care.

Him: That’s right madam.

Me: And you’re ringing about a problem with your computer?

Him: Yes madam. My computer won’t let me log on. It keeps asking me for a password and then says my password is wrong.  Can you help me with this?

Me: Why?

Him: I don’t know why, that’s why I need your help.

Me: No.  Why are you asking me to fix it?

Him: I’ve heard you’re very good at fixing computers.

Me: From whom?

Him: Pardon?

Me: Who told you I was good at fixing computers?

Him: My colleague did.  He said you were the one to go to.

Me: Your colleague from Microsoft Customer Care?

Him: Yes madam.

Me: And where are you calling from?

Him: Umm…  from nearby to your home.

Me:  Nearby where exactly?

Him: Just one moment madam  (sound of frantic typing) … I’m in Ball-Leena

I presume he was mispronouncing “Ballina”, the town in which I live, in northern NSW

Me:  Oh, from the big Microsoft headquarters in Tamar St?

Which of course does not exist.

Him: (relief in voice)  Yes madam, that’s right

Me: And you’re calling from there now?

Him: Yes, madam.

Me: (as if making pleasant conversation) So how are you finding this weather we’re having?

Him: The weather is… umm…  very… nice?

Me: Nice?  You call sub –zero temperatures and blizzards nice?

It has been hot and sunny – we are in the middle of an Australian summer.  It has never snowed in Ballina – at least since the last Ice Age.

Him: (uncertain) Umm… yes.

Me: You must like the snow, then. You a skier?

Him: (with relief) Yes, yes, I like the snow on the ground because I like to ski, but I would like you to help me with my computer now.  I heard you were very clever to fix computers.

Me: So you said… from your colleague at Microsoft Customer Care.

Him: That’s right, madam.  My computer won’t accept my password and I…

Me: Sorry to interrupt you but I’m a little confused.  You work for Microsoft, right?

Him: Yes, madam.

Me: And the colleague you mentioned works for Microsoft?

Him: Yes madam

Me: And yet he recommended me to fix your Microsoft Windows problem. How interesting.

Him: (getting desperate) Please will you help me?  I really need to use my computer. It is very important for my work.

Me: Have you spoken with the IT support person at your workplace?

I idly wonder whether Microsoft have IT support staff for their own office computers.

Him: Umm… I’m working from home today and I need to get onto my computer to do work right away. That is why I’m calling you.  I’ve heard you are the best at computer problems.

Me: So you said. What are you typing on?

Him: Pardon?

Me: I can hear you typing.  If you can’t log on to your computer, what are you typing on?

Him: Umm… my laptop, madam. It is working very well.  My desktop is my problem.

This is just too much fun.

Me: OK, I’ll see what I can do to help.

Him: (with huge relief) Really?  Oh thank you madam.  If you would just go to your computer and…

Me: We don’t need my computer.  We can use yours.

Him: My computer is not working.  If you just…

Me: Not your desktop, your laptop.

Him: My laptop is fine. I need…

Me: Great.  Bring up Internet Explorer or Google Chrome

Him: (frustrated) But they are search engines for websites. I can get to any website I want. That’s not…

Me: Type in “Microsoft password problem” into your search engine of choice.

Him: (becoming increasingly frustrated but trying not to show it) They can’t help me. I’ve heard that you are the best computer expert, madam.

I thought it was time to cut him a break.

Me: I think you have the wrong “madam”. I’m only a doctor.

Him: (voice brightens) A doctor?  A person doctor?

Me: Yes, a person doctor. Not a computer doctor. We deal with different viruses.

Him: What kind of person doctor? A bone doctor? A nerve doctor?

Me: I’m in general practice.

Him: (in all seriousness) So you are practising at being a doctor, generally?

Me: No, I’m… never mind.  Sorry I can’t help you with your computer.  Good bye.

Him: Wait! Do you know about knees?

Me: Only those belonging to bees.

Him: I don’t understand madam.

Me: Forget it.  Have a nice…

Him: Wait!  I have a problem with my knee.

Me: I thought you had a problem with your computer.

Him: I do. And my knee.  It clicks when I bend it and hurts a lot when I…

Me: And you would like my advice?  As a doctor?

Him:  (eagerly) Yes please madam doctor. That would be very kind of you.

Me: No worries.   Go to your laptop.

Him: My laptop?

Me: Uh huh.  Bring up Internet Explorer or Google Chrome.  Type in “knee clicks when I bend” into your search engine of choice and then…. Hello?  Hello?  Anyone there?

……

Most fun I’ve had in ages… which probably suggests I should get out more.