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After the ward round, one of the nurses wants a word with me in confidence. ‘My throat’s killing me’ she says. She does sound a bit hoarse. She’s having trouble eating because of the pain and she’s worried it’s her tonsils, but she doesn’t want to bother her GP unless she really needs to. ‘Can you take a quick look?’
I always feel a bit uncomfortable in these situations. It’s not that I begrudge doing a favour for a colleague. It’s just that, first of all, I know I’m probably not really supposed to. Friends, family and colleagues are not, as a rule, meant to become patients, even temporarily.
It feels a bit awkward, and even, potentially, a bit dubious on medico-legal grounds. Catastrophising, I picture being hauled up in front of the GMC or featuring in one of those terrifying cases that appear in the publications of medical indemnity organisations.
Secondly, I’m aware that I might not actually be very well equipped to give useful advice. I did a few months in general practice once upon a time, but these days I don’t look at many sore throats and it’s been a while since I was familiar with the guidelines on the indications for antibiotics (except that I remember they’re usually not recommended).
On previous occasions I have been asked to look at rashes, examine sore joints, explain a pain in the top of someone’s head, and even interpret what a colleague had been told about an abnormality on an antenatal scan (that one I firmly declined). I once had to advise a colleague with severe wheeze and tachycardia that she might actually be best to take a trip round to the A&E department.
The problem is, it always seems churlish to not to oblige these seemingly simple requests for informal advice.
Anyway in this case, I rationalise, it’s really not a big deal. It’s only a sore throat. It’s not likely to turn out to be a life-threatening illness, and looking at someone’s tonsils hardly constitutes an inappropriately intimate examination. She’s not asking me to prescribe anything. I’m really just triaging, helping my colleague decide whether to go and see her own GP.
So, having issued my disclaimers about not being much of an authority on sore throats, I follow her into the back of the store room (it seemed the most convenient available place for a bit of privacy) with a pen torch and a spatula.
There’s not much to see – as far as I can tell, no giant tonsils, no nasty exudate. I advise paracetamol and a trip to the GP if it doesn’t improve in a day or two. All very straightforward really. Assuming she doesn’t turn out to have throat cancer or any of the other very-unlikely-but-rather-serious causes of sore throats I read about afterwards when I decide to turn the experience into a learning opportunity.
By the Secret Doctor
Read the blog and follow @TheSecretDr on Twitter
Antonio, please go with your wife to see your GP again, your situation doesn't sound very safe.
Regarding informal consultations, along with the principle of 'do no harm', don't forget that we all joined the profession in order to help people, and it does not sit easily in my ethical and moral compass to deny anyone my expertise if they ask for it. However, treating people who you know in some other capacity is a skill and you must be conscious of this, and of course aware of any regulatory obstacles from the GMC etc.
Oh I know this only too well! As a consultant orthopod I wasn't asked to look at many nurses' throats, rather more odd aches and pains in limbs or joints. I used to at least have a discussion, and if there was anything sounding significant asked them to come to the end of my outpatients so that I could at least write notes. Very few did...
I get a lot of request for informal consults fortunately only in my field of specialty. I have a simple rule :you get me your records or appropriate paper and patient labels and I see you at lunch, record the consult and write to GP. .....or no comment. Works for me !
It's always sensible to have ground rules - though all Drs want to help
If we break professional boundaries, either as Drs or as Patients, then nobody wins, and important things might get missed
I am relieved that it is not just me who is in this situation but a common behavior of our colleagues. I do want to help and usually will listen and discuss it with the colleague and advise them of my opinion and the right path of going and see the GP with the possibilities. I must say I have saved a couple of lives with this kind of corridor consultations and urgent advice. which has made me easy going in this matter.This however may be due to the nature of my specialty. We should be kind to our colleagues who are suffering.
This is just one more example of the rubbish that causes us such unneccesary fear in our wonderful but PC crazy country run by the " elite". If I have an unexpected pimple on my back, just out of sight of two mirrors, I have to cancel a clinic, to the inconvenience of a number of patients, to visit my GP for diagnosis. In the old days I would have asked my friend in Dermatology to take a quick look thereby preventing further inconvenience to the patients and saving money. We can't even write a prescription for a colleague unless he/she has been referred by a GP. He/she has to go to their GP for one !! The mind boggles!! What do 'they' think we're going to prescribe? Diamorphine fritters for a party? !!! Nanny State at work!!. Will sanity and trust ever return ?
In spite of Brexit, I doubt it. Nevertheless, I suspect that many doctors will still respond to a plea. Isn't that what we signed up to when we qualified ?!
PS. OMG! Just read the story of Antonio and his wife. What a worry for the family. If this isn't a spoof letter then her GP could refer her to ENT or MaxFax for diagnosis and, if it's Sleep Apnoea, advice/treatment.
Quite awkward. There is an old orthopaedic joke: what can you see on an X-ray held up to the corridor light? A: a lawsuit.
Antonio's wife needs a Sleep apnea clinic referral asap. She needs CPAP. Tell your GP if her apnea is not treated and she dies, you can sue the NHS. That should get things moving. Why fob off this lady just because her husband is ignorant of the assistance she deserves to be offered?
Looking into someone's throat at their request should be viewed as such; a simple request. Any Doctor who cannot diagnose a sore throat if present should review their medical education. Mr Secret Doctor would you have all these issues if a member of your family had a sore throat and asked for your opinion? I think not.
I agree with previous b;kgs .I have made some real lifesaving diagnoses through these so called corridor consultation .Too much is made of those these days .We just need to act professionally and safety net .We should not be intimidated into not helping people.
The GMC, RCGP & BMA put people's lives & health at risk with their pompous, arrogant and unprofessional approach to such issues.
As a long in the tooth, now semi retired psychiatrist, it has been relatively straightforward to avoid these requests, although i did give in (ONCE) when the now defunct Chief Exec asked. It IS a hassle to see a GP (mine is excellent but it requires 30-40 mins on auto redial to get an appointment), but they are the people who can suss out what is routine and what requires a furhter look. I learnt many years ago never to treat anyone without making good notes and informing the treating team. We DO want to help but is can be seduced by colleagues. BEWARE!
Anonymous. As a retired GP most of my attempted consultations occur in Sainsbury's .
I wonder if GPs realise how much work we take off their hands with these informal consultations. If they really all did go to their GPs instead, I suspect they would be inundated
it is quite sad that we all become so 'scared of being prosecuted society', and human touch does not exist any longer, I understand the concerns and have exactly the same but feels like we lost a lot for last few decades as a proffesion
Disappointed with the anti-GP comment by the person who believes they are saving GP from countless unnecessary consultations.I hope it was written with tongue in cheek. Most " corridor patients" with minor self limiting illnesses will self treat and allow the problem to resolve. They are just taking advantage of a quick second opinion as reassurance.