> From:          [log in to unmask]
> Date:          Mon, 16 Dec 1996 08:51:47 -0500
> To:            [log in to unmask]
> Subject:       Re: Quality??
> Reply-to:      [log in to unmask]

> In a message dated 15/12/96  00:05:37, Peter Johnson writes:
>
> >Suddenly I start to evaluate General Practice the way the rest of the
> >population does. This wasn't some inner city lock up practice - this is a
> >respected, rural teaching practice. The best??

The moral for all of us is examine first
> and tell off after.

> Trefor Roscoe                          E-mail;[log in to unmask]

I agree, mainly. My trainer taught me years ago always to lose my temper on my way
to a call. These days when they mostly come to me, thats OK,  but when
you are driving out to them it is not a good idea. Afterwards is
safer.

Why do we need to be persecutory though? In asking patients what they have done
so far, there must be some appropriate basics they have tried, to commence some
positive Pavlovian conditioning somewhere. Telling people off against the
messages from their  emotions and 6th senses simply confuses them.

I recently did an audit of night visits over the past 2 years in our
13,500 patient practice. The highest number by any single patient was 7. Among
the top 10 there was only one we felt we would lose our temper with
so we kicked her off the list as we felt the relationship was too
dysfunctional for her good as well as ours.

Finally we had a recent incident when the doctor on call, who is very
good clinically and rarely loses his temper, had to deal with a
problem child of  schizophrenic and alcoholic parentage. The child
would not stop crying, did so while examined, then bawled when
re-united with parents. The doctor was at the end of a very busy
shift and did not completely undress the child, but found nothing
obvious. They went home with a working diagnosis of non-coping
parents, who then phoned 999 an hour later to prove a point. The triage nurse
initially went ballistic when the ambulance crew wanted to bring the child
back. The new fresh doctor listened to the story and felt it was
important to rule out non-accidental injury in that sort of setting.
When the child was fully stripped it had a pretty obvious broken
forearm which the mother drew attention to herself! Old adages about
dealing with the basics first still apply.

Bern
Dr Bernard Bedford
Waterside Health Centre
Beaulieu Road
Hythe, Hampshire, SO45 5WX
email: [log in to unmask]


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