One of my friends at university used to smoke weed enough that he had a regular dealer who he liked to refer to as “my guy”.
Seasonal affective disorder or SAD – my favourite of all the medical acronyms – is a common mental disorder characterised by a pervasive low mood, that recurs annually during the winter months in people living in the Northern hemisphere. Continue reading “Don’t be SAD: 5 things you can do this autumn to beat winter depression”
I never used to be able to touch my toes. It was just one of those things that I just assumed you could either do or you couldn’t.
Then last year my wife and I went to a local yoga class – after our free trial session we never went back – but I remember seeing some of the people who were there, some of the older people, and being amazed by their flexibility. I didn’t know that old people could bend like that! They always seemed stiff and fragile.
Surely if these old people could do touch their toes then so could I?
Without bothering to learn any more yoga I wanted to see if I could train my body to be able to do it. Using some of the basic principles I learned at the class, I started off standing tall and then slowly folded forward at the hip.
The key for me was sending my attention to the various parts of my body. I imagined my toes and the arches of my feet slackening, felt my ankles loosening and my knees relaxing. I consciously felt the stretch move up the back of my thighs, into my lower back and then spread to the rest of my back. I let the weight of my head pull my torso down further and as I did that I felt my neck lengthening. All the time I heard the instructors voice in my head softly guiding me through it.
Somehow, without forcing anything – without even really trying – my palms were resting, flat, on the tops of my feet. I felt no pain or discomfort. The longer I stayed in that position the more comfortable it seemed to become.
Practice makes perfect
Ever since that day I have done the same exercise every night before bed. It takes at most one minute of my time, but something about it seems to bring about a deep relaxation. Maybe it’s the rush of blood to the head?
None of my patients can touch their toes
When people come in to see me with back pain one of the things I get them to do to assess their range of movement is to try to touch their toes. None of them try very hard. Not because of pain – they often walk in and sit down without any problem – but because of the fear of pain.
When I ask them to touch their toes, almost all make a feeble attempt and most do not get far past their knees. They will make excuses or place a hand on their back even before they have started to move. When I ask them to do it more slowly and to let their body-weight do the work they will often go a few inches further.
Yes, you can!
Unless there is something physically stopping you, you can touch your toes. Maybe it won’t happen straight away like it did with me, but if you do it every day, religiously, you will soon be able to do it.
One of my grandmother’s biggest complaints about immigrants, aside from their big noses and swarthy skin, was their smell.
That is not because we worry about the rare diseases we learned at medical school (although this is a well-known problem seen in medical students), but because we don’t worry enough.
As doctors we see thousands of patients with tens of thousands of symptoms, many of which will not have an identifiable cause despite thorough investigation. We call these ‘medically unexplained symptoms’. They don’t worry us too much – we know there is no serious underlying cause, and we know they will not get any worse or threaten our patients’ lives.
So rather than worry that our symptoms are caused by cancer, like many of our patients (especially the ones who check Google before coming to see us), doctors have a tendency to think that our own symptoms will be nothing serious. There are countless stories of doctors who have put off going to see their own GP until it was almost too late.
One of my clinical supervisors had pain in his chest for months. It was not bad enough for him to think it was a heart attack, so he just put it down to stress, or maybe a bit of heartburn. Eventually after the pain worsened and he started to feel feverish, he went off to see his own GP and was diagnosed with pericarditis – inflammation of the sac that surrounds the heart. He was off work for two months after that.
My advice to everyone is to see your GP as soon as possible if any symptom is something which you notice regularly and it bothers you. Even if it doesn’t bother you but it just doesn’t seem quite normal, I would much rather see you early on and tell you that it is nothing serious, than be faced with something that is already well developed and therefore much harder to treat.
I should start by saying that I like my patients – even the ones that are difficult. I don’t want anyone to think that this is just another rant by an arrogant doctor complaining that his patients are hard work. The hardest patients are often the most rewarding.
But my job is busy. Today, for example, I saw 29 patients, visited one at home and had telephone consultations with 4 more. On top of that there were 23 letters, 26 prescription requests and 34 blood results waiting for me when I got into work this morning.
Each one of them takes time and concentration. Some are fairly quick but others take much longer; the number of patients with complex health needs is increasing. At one point this morning I was running half-an-hour behind.
Please don’t misunderstand me, I am not complaining about any of this. I love my job. But that doesn’t mean it isn’t hard.
So much to do, so little time…
In order to do my best for everyone I need to be organised and run roughly to time (a half-an-hour delay isn’t actually that bad).
In a 10-minute consultation, time is tight. Most patients will talk for at least a minute before I can ask any more questions. In the nine that remain, I need to understand the patient’s story, examine them, formulate a diagnosis and management plan, write a prescription and/or request some further investigations, like blood tests and x-rays. I must then communicate all of this with the patient and make sure they understand.
I only have time for one problem
I have lost count of the number of times patients have mentioned another problem, just as I had been about to say goodbye.
It is usually “just one more thing” or “there was something else as well, doctor” asked in a hopeful, sometimes pleading way. The one I can’t stand is “while I’m here” as if I exist entirely for their convenience.
However they say it, my heart sinks. At that point in the consultation I have already mentally moved on to the next patient. The cogs in my head take a second to adjust.
Just tell them to f*** off
I know that there are lots of GPs who will very firmly, even to the verge of rudeness, inform the patient that they can only deal with one problem per consultation, and that they will have to re-book.
There are three reasons that I don’t say that myself:
- I have a natural curiosity in people’s illnesses. Could these new symptoms be related to the ones we had just discussed? If so, then the new information could be the key to making a diagnosis
- On two occasions in my career a patient has said to me, “And another thing doctor: I’ve been getting this heavy pain in my chest that goes into my left arm”. Both patients were having heart attacks.
- I am far too polite for my own good.
So when you next see your GP stick to one problem, book a double appointment or tell them upfront that you have several issues, so at least you can decide together how to approach them. Write a list if that helps you remember.
Limiting the time you spend with your GP will mean that someone else can get a bit more. After all, there is always someone who needs help more than we do.