Thursday, July 07, 2005

Schindler's List 2

Before going on I'd like to make the point that I am, I think, a pretty competent and caring GP, but I'm only human and affected by the pressures of keeping to deadlines just like anyone else. What follows is a true account....

Mrs Schindler is a list-maker, and like many of her breed she has deceptively thin case notes. This is because, although she doesn't come to see you very often, when she does come she presents such a list of symptoms that you don't have time to record them all.

Her first problem the other day was vaginal discharge: not my favourite topic, but described in such graphic detail that I felt a bit queasy right from the start. Fortunately, she had a history of bacterial vaginosis, and an empirical trial of the antibiotic metronidazole without the need for examination seemed justified.

Her next little cluster of symptoms comprised rectal bleeding, pain, and itch. These sounded most probably to be related to piles, and she then went on to describe, ad nauseam, the haemorrhoids she had had after both her pregnancies. Examination revealed perianal skin tags, and I decided to refer her to the surgeons for further assessment.

She next moved further south to her athlete's foot and probable fungal nail infection. I asked her to provide us with some nail clippings to try and confirm this, but she still insisted on giving me a blow-by-blow account of her adventures with Canesten Cream.

Meanwhile the rising aggression of the patients waiting, appropriately, in the waiting room could almost be felt radiating through the wall....

Her coup de gras was to direct my attention to the most revolting coated tongue that I have ever seen. I asked her if she'd tried a mouth wash, and she replied that she'd even tried to remove the offending (and offensive) material with a brush! For want of something better to do, I took a swab and reserved judgement as to diagnosis.

Towards the end all this, I wasn't sure how long the list was going to be, and my mind drifted off visualising images such as one of her husband parcelling her in a plastic bag and labelling her with a bio-hazard sticker before they both entered the marital bed. As she exhausted the possibilities of her major orifices, I wondered if she was going to describe some noxious discharge from a nostril, or an external auditory meatus (ear hole to you). Perhaps a boil on her backside the size of St Paul's Cathedral would be revealed, or the subcutaneous bulging of a creature ready to burst from her chest like that of John Hurt in "Alien"? But just before I lost the will to live she finally came to the end of her list.

She stood up and calmly left the room. Frankly, I felt like I needed a lie down!