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power relations

In the UK government’s dystopian world patients told to ‘hang on’

9 Jul, 09 | by Deborah Kirklin

If you want to refresh your memory of the comings and goings in Geroge Eliot’s classic, Middlemarch, then look no further than Professor Rosin’s analysis in the June 2009 issue of Medical Humanities.

http://mh.bmj.com/cgi/content/short/35/1/43?q=w_mh_current_tab

If you want to follow a contemporary equivalent of medical marketplace machinations then you need look no further than what is currently happening to general practice in England and Wales. And specifically to the Orwellian world in which carers and cared for find themselves. A world where government announcements to the national news media of the universal introduction of Cognitive Behavioural Therapy are followed by the systematic reduction of mental health care services in primary care. In my own practice, in the past 6 months, first the PCT provided mental health care worker was removed and more recently the practice counsellor of 17 years standing was ‘let go’. But hey ho, never mind, NICE guidance has after all told us what to do: if a patient is suitable for CBT and it isn’t available (!) we can (and should) tell them to ‘hang on’. more…

A poetic license to practice (with thanks to Jenny Joseph)

15 Jun, 09 | by Deborah Kirklin

“Health Warning” by Deborah Kirklin

When I am a patient I will rarely take my medications

But will always want my script instantly filled.

And I shall spend hours reading all the health advice the Daily Mail has to offer

And be sure to share it with my doctor, in detail and backed up by internet references. more…

The beauty of the beast that is Australia: unforgiving and unforgettable

10 Jun, 09 | by Deborah Kirklin

Half a lifetime ago I went to Australia for my medical elective, a joyous interlude just before finals that allows doctors-to-be to savour, for one last time, the freedom of life as a student. Eight weeks is barely time to get over the jetlag let alone to adjust to the stark and breathtaking landscapes that unfurl in any journey across this large and mystifying country. Yet long enough to leave the lasting impression that no matter how impressive the delights of Sydney and Melbourne and Australia’s other cities and towns, this is a country only a blink away from submission to its own awesome forces of nature.

more…

Sick doctors, sick notes, and swine flu: why coroner’s reports are so yesterday

20 May, 09 | by Deborah Kirklin

A couple of weeks ago a doctor friend from California was visiting me in London. Shortly before her arrival date swine flu fever was gripping the world’s media, with California proving a hotbed for new cases. And, illogically I’ll admit, I felt a certain disquiet that a doctor from the first US State to suffer a swine flu death would shortly arrive in my already less than healthy home. more…

Wanted: 90 year old patient to look after ailing doctor

28 Feb, 09 | by Deborah Kirklin

I’ve been ill. For two whole days. Horribly, gut wrenchingly, toilet bowl huggingly, head piercingly ill. For two whole days. So now I know what my patient felt like, right? The one who ‘gave’ this to me a few days ago when I visited her at home. The one who, in her 90th year, whilst clearly overwhelmed by the practical challenges raised by the physical symptoms I am now so intimately acquainted with, didn’t want to fuss, to be a bother, to waste anyone’s time. more…

Manners maketh the doctor

24 Jan, 09 | by Deborah Kirklin

The other day I made a call to our local hospital to ask a colleague to see a patient of mine as a matter of urgency. I asked the switchboard operator to page the relevant on-call registrar who duly appeared on the other end of the line. Using “hello?” as his tense, inpatient, opening gambit wasn’t a good start. more…

When is dementia not dementia: a lesson in listening

14 Jan, 09 | by Deborah Kirklin

In the last few weeks, working as a GP, it seems like I’ve seen more pneumonia and bronchitis than at any time in the last 20 years. As a practice, we’ve also had a number of our elderly patients admitted as emergencies, sometimes after seeing one of us and sometimes when they’ve sought hospital care directly. On several occasions they were found collapsed or semi-conscious at home. Some, sadly, passed away whilst others spent several weeks recuperating in and out of hospital. more…

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