‘Burnt-out’ GPS need a reality check

The prominent GP spokesperson Professor Martin Marshall protests too much that his colleagues are so now overworked, “they are burning out and being forced to leave the profession” – as anyone who qualified 30 or more years ago will tell you.

As a junior doctor at Basingstoke District Hospital back in the 1970s, heart specialist Andrew Mcleod recalls evenings punctuated by calls from family doctors on their rounds after surgery seeing patients on emergency home visits.

“From long experience, they knew those who needed urgent admission or could safely be reviewed the following morning,” he writes in his latest blog.

His comments are prompted by his being asked to visit a neighbour, drowsy and unable to swallow following a recent course of radiotherapy. “It took about a minute to assess him as being severely dehydrated.”

Over the next few hours Dr Mcleod spoke on the phone – after a longish wait each time – to, variously, an administrative person at the 111 emergency service, a nurse who agreed his neighbour needed hospital admission, ambulance control and the 111 service again when the promised ambulance failed to materialise. Finally, assisted by wife and son, they managed to get the neighbour into the car and drove him to casualty.

The contrast with the situation 40 years ago – when the family doctor would have visited and arranged prompt admission with a single phone call – could not be more telling. “The whole sorry episode indicates just how poor the primary care service has become,” Dr Mcleod observes.

A familiar lament, compounded by the recent revelation that the average GP now puts in a 40-hour week (down from 48 hours in 2001), just over half of which is spent in “direct patient care”. This is impossible to square with Prof Marshall’s contention of being so overburdened they “burn out”.

Dairy dilemma

The misfortune of the lady afflicted with a greasy and unpleasantly odoriferous scalp despite washing her hair daily has prompted some interesting insights. This might be, it is suggested, an idiosyncratic reaction to dairy foods. One woman reports that since cutting out

‘The excruciating pains resolved when she switched swimming styles’

cheddar cheese (to which she had been addicted since childhood), her husband no longer complains about her smelly scalp.

Next, it might be, if paradoxically, that her daily shampooing is causing the sweat glands of the scalp to generate excessive amounts of sebum. The solution here would be to wash the hair less frequently – preferably with water alone.

Dermatologist Dr Rashid Haye concurs that overzealous washing can increase the amount of sebum produced but notes this also provides an ideal culture medium for the proliferation of the fungus malassezia furfur to cause the unpleasant smell. This can be tested for in the usual way and if present, warrants treatment with the antifungal shampoo Nizoral.

Night vision worry

This week’s query comes courtesy of Mrs BE of Luton, whose entire field of vision on waking at night is filled with a stippled pattern like a

Splash down: front crawl helps ease problem of ‘whip kick’ in breaststroke

spider’s web. This is most marked when the level of light in the bedroom is low and against a white background (such as the ceiling or door). “The spider web persists for several minutes,” she writes – gradually fading as she becomes fully awake. What, she wonders, might account for it?

Splashing discovery

Finally, further to the recent comments on the merits of muscle strengthening and stretching exercises for those with painful knees, an enthusiastic swimmer reports her excruciating pains at night dramatically resolved when she switched her swimming style from (mostly) breaststroke to front and back crawl. This might seem odd but apparently the “whip kick” (as it is known) movement of the legs when thrusting forwards through the water can twist the knee in such a way as to put a considerable strain on its internal structures.

Please email your medical questions confidentially to Dr James Le Fanu at drjames@telegraph.co.uk