Monday 9th February 2009

I have a hurty knee. It has caused me pain a couple of times after running, and the latest bout has crippled me since a huge snowball fight on Thursday, so I decided it was time to visit the quack.

My GP managed to fit me in only an hour after I rang. The NHS evidently works around here (that, or the icy conditions have caused the doctors’ favourite epidemic—one of cancellations). However, there was a catch: my appointment was to be with my doctor and…The Medical Student.

Given that my problem was a hurty knee, I was not very concerned by this. A pretty twentysomething taking notes, hanging off my every word as I recounted my manly snowballing and heroic battle through pain to ultimate victory could surely be no bad thing. She would flick through my medical records, find out just how healthy I have been all my life, and slip a note in with my prescription which would totally compromise our doctor–patient relationship. This course of treatment would almost certainly make me feel better.

I got to the surgery, and the receptionist clarified: ‘So, as I explained on the ‘phone, you’ll be seeing The Medical Student first’—she hadn’t explained this on the ’phone, but this was surely even better…a one-to-one exam would allow out-and-out flirtation, without having to hide behind double entendre and wry winks—‘and then you will get a second consultation from the doctor.’ I went to the waiting room upstairs with what would have been a spring in my step, but the knee injury transformed my anticipation into a slightly eccentric hobble.

Imagine my disappointment, then, when a male Australian chap called me through an office which wasn’t his own. A stethoscope was draped around his neck; his slightly uncertain manner gave the impression that he had spent the last five minutes positioning it in the most nonchalant way to give an air of casual, at-ease professionalism.

He took a history—I told him that my knee had started hurting—and then it was time to move to examination. I was wearing my moleskin trousers, special, rural-looking numbers designed with maximum warmth in mind. They are slightly tapered, and the material is very thick, and so hiking them up above the knee is somewhere between uncomfortable and impossible. ‘If you could just roll your trousers up so I can take a look at your knees?’ he said in the Australian question intonation.

Visual inspection turned up nothing, so I got onto the couch for some prodding, fondling and jabbing. I took my shoes and socks off, and rolled up my trousers again. The inconvenience was becoming pretty clear by this point, and I almost offered to take my trousers off. I managed to stop my tongue, however, since I didn’t want to lead the consultation…and one imagines that patients voluntarily stripping is one of the worst types of consultation-leading possible.

We fumbled our way through the physical (sadly not in the sense I had originally envisioned), and the appointment was kind-of tailing off. It was apparent that my knee was not suffering from any of the headline ailments which medical training concentrates on, and the poor bloke was flagging rather. However, mindful of his training, he realised that the focus of any given consultation in current GMC lore is ideas, concerns and expectations—patients who go away with what they hoped for from a consultation are happy patients, and happy patients is good, innit. The disarmingly cute way to find this out is to cut the crap and just ask. Paraphrased straight from your favourite medical textbook, he enquired of me ‘So, what were you hoping the outcome of this consultation would be?’

The time came to call the real doctor in. She was a no-nonsense, skirt-not-trousers character, somewhat like a headmistress. The Medical Student related my history to her, and then it was her go at diagnosis. None of this softly-softly trouser-rolling crap: wizened by years of general practice, she had the kecks straight off with an instruction that left you fearful of bed without supper if you failed to comply.

‘Gosh!’ she exclaimed as I stood up, legs together, feet pointing forward, ‘Your legs are quite muscley, aren’t they?!’

I assume that in her job she mostly sees knock-kneed pensioners and lepers, but the genuine astonishment from one who probably sees a lot of leg, amongst other things, was definitely as close as I got to being chatted up.

After a little umming and aahing, the final diagnosis was ‘anterior knee pain’—which, given that ‘anterior’ means ‘front’, I could probably have diagnosed myself. I came away with cards for a couple of sports physios, a recommendation of ibuprofen, and a sense of sympathy for medical students, who surely have one of the hardest jobs in the World. Not just because of the insane hours, the ludicrous quantities of rote learning, or the stress of having patients’ comfort and indeed lives depending on your competence: but remembering that you really are a doctor. Remembering that you’re a fucking doctor, that your friends and bosses are blagging just as hard as you are, that patients respect you and trust you, and that therefore it’s OK to ask someone your own age to get their trousers off (as long as it is in the context of a medical examination and not, say, during a church service) must be a bewildering and terrifying realisation.

I’m finding it hard enough being a grown-up, and all I have to do is fire muons at magnetic materials. Though actually, if I keep at it, one day I’ll have to come to terms with being a doctor too.

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Comments

  1. So what were you hoping the outcome of this consultation might be ? Perhaps a diagnosis, and a proposal for some treatment to cure the problem ? NHS failed on both counts. Sounds like you were written off (I assume the physios were private practises, and no offfer of any NHS funded treatment was made ?).

  2. I asked about NHS physiotherapy, but was told that, since the pain wasn’t stopping me working or keeping me awake, I would be put on a long waiting list, and that sports physios tend to be better on these kinds of injuries than their free counterparts.

    I realised with hindsight that I should have asked ‘So, if sports physios are better than NHS ones at bone, tendon or muscle injuries, what exactly are the NHS ones good at?’

    Though saying that would have only made me look like an anti-NHS right-wing nut-job anyway.

  3. I suppose a look at your records would show that you hardly ever visit the quack. Surely this would back up your need for treatment?

    It comes as something of a shock to me that they refer you privately. Does this help the NHS budgeting?

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