Returning to general practice after a career break has been a bit like getting back on a bicycle. The bike’s had a lot more money spent on it and has a very complicated target-induced braking system but, paradoxically, it seems to run less smoothly. And it has to pull over every mile for an inspection. But the journey itself is pretty much as I remember it.
Indeed, I’ve been pleasantly surprised to find just how similar the case-load has been. In the run up to returning, I’d been slaving over the myriad new guidelines so I could hit the ground pedalling and offer even the most complex patients the best evidence-based care. And what did the first one pitch up with? You guessed it. Ear wax.
Not just any old ear wax, but ear wax with a clear indentation from where he’d forced it further up the ear canal with a cotton bud.
Before I could stop myself, I’d come straight out (in my best patronising doctor manner) with: “The smallest thing you should put in your ear is your elbow.” It was as if the needle had dropped back into the groove and I’d never been away.
These days you have to treat according to guidelines, and I did a speedy intranet search for the latest PRODIGY guidelines on ear wax. Zilch. So I went through the whole of Medline and eGuidelines.
No one has ever published anything on the benefits or otherwise of removing ear wax, so I shouldn’t really do it.
But the patients swear by it. It’s one of the few things we do that improves their quality of life (unless they’re in an unhappy marriage and find life easier with the wax in).
I was now half an hour behind, thanks to the Medline search and pondering this intractable dilemma, so I took the only course of action open to me. I bumped him on to the practice nurse.
I then made copious notes for my PLP (or PDP, whatever the difference is), in the hope of turning them into some PUNs (or even DENs). But even more importantly, I realised I could get a whole column out of this poor man and his ear wax, and perhaps even stretch it to five minutes of a new stand-up routine.
Something in my subconscious told me that the rules on this had changed, so I went onto the GMC website and discovered that “publication of any personal information about a patient requires the consent of the patient, even if identifying details are removed”. Bugger. I was going to have to get him back in.
But then I thought, how personal is ear wax? We’ve all got it, although only a few of us are foolish enough to go to the doctor with a cotton bud imprint on it.
I caught up with the patient in the car park and explained the situation. He seemed pretty amenable and I thought I’d swung it until he asked, “Do you get paid for these columns?” “Yes,” I said. “I want fifty pounds. Cash,” he replied.
After another ten minutes of wrangling, I’d got it down to forty, twenty up front and the rest on publication. The waiting room was now heaving and I was starting to wonder if this really was the right job for me.