Covid has been a boon for bad GPS
The protestations by the Chairman of the Royal College of General Practitioners that family doctors “have been in the vanguard of the fight against Covid” is belied by the experiences to the contrary cited in correspondence to this column, including significant criticism from professional colleagues. “I have a neighbour who received two diagnoses for which he was prescribed treatment without ever seeing a GP,” writes Robin Jacoby, emeritus professor of psychiatry at Oxford University. Five days later, after his intervention, his neighbour was admitted to hospital “moribund with a lung abscess”.
Others, however, have written glowingly of the “exemplary service” they have received. So while one gentleman was advised last November over the phone that his swollen leg did not merit being examined or investigated, another with the same complaint had his deep vein thrombosis diagnosed and treated the same day.
What to make of this? Broadly speaking, there seem to be two types of family doctor – those who are committed and those who are bored or disillusioned. Covid has been a boon for this latter group, as behind the closed doors of the surgery they can get away with doing the minimum. This extends astonishingly to defaulting on the “follow-up” phone call. A friend seriously ill with Covid for 10 days was reassured by two doctors in her practice that they would call her back. Neither did.
Meanwhile, pharmacists, despite being exposed to a similar risk of infection as family doctors, have remained open throughout the past year, cheerfully providing frontline face-to-face advice and encouragement. What a contrast.
Underlying causes
Before taking a preventive daily antibiotic for recurrent urinary tract infections, the possibility of an underlying cause should be addressed. The story is as follows. The bladder, when full, holds 600ml of urine, voided by the simultaneous reflex contraction of its muscular wall and relaxation of the urinary sphincter. The functioning of this marvellously efficient mechanism can, however, be compromised by weakness or irritability of the bladder muscles (usually age related) or obstruction to the flow (by, for example, an enlarged prostate). The upshot is “incomplete emptying”, with retention of a residual amount of urine in which bacteria can flourish.
The solution is to pee and then pee again, coaxing the bladder to pass the residual urine with manoeuvres such as rocking from side to side or massaging the lower abdomen. Although not very elegant, standing up and straddling the lavatory bowl may do the trick – or it may be necessary to walk around the bathroom for a couple of minutes and then try again.
Hip, hip, hooray
When extolling the significance of the 60th anniversary of Sir John Charnley’s first hip replacement operation, the numbers cited unfortunately omitted the crucial word “annually”. The correct figure then for the past decade alone is one million in Britain and approximately 10million worldwide. It is impossible to begin to convey the impact of the procedure. One reader had both hips replaced in 1983, aged 45. Her pain-free life over the subsequent 38 years – working, bringing up her children and now actively retired – is, she notes, the most compelling testament to Sir John Charnley’s achievement.
The Blitz spirit
Finally, further to the older generation’s spirited response to the privations of the past year, a reader in her 80s attributes her resilience to the example of her parents in “getting on with it” in difficult times. Soon after her home was badly damaged during the Blitz, her father was posted abroad with almost no communication for the next three years. Her mother was thus left to bring up her two children, as well as to care for elderly grandparents. “Throughout all this time I don’t recall her ever seeming anxious or depressed,” she writes. No doubt, she acknowledges, her mother would have shielded her. Still, she “can’t help feeling there is too much emphasis nowadays on mental health problems”.
‘There are two types of doctor: those who are committed, and those who are bored or disillusioned’
Email medical questions confidentially to Dr James Le Fanu at drjames @telegraph.co.uk