View from the ground, by Dr Kim Grant

Grant kim

I don’t think you would disagree that life as a GP can feel pretty time-constrained, pressured, and exhausting, so to lighten the mood I thought I might share some amusing anecdotes on patient creativity.

I recall a certain Mrs M from a few years ago, a lovely elderly lady in her 80s who used to see me regularly for her chronic health issues. She was very polite, sweet, and well turned out—always with a full face on and hair done perfectly. On one occasion she came to see me with some pain passing urine and increased frequency. When I asked if she might provide a urine sample she proudly rummaged in her bag, smiling as she commented that she’d thought I might ask, and so had come prepared. She then proceeded to pull out a bulky paper bag and handed it to me as if offering up some boiled sweets. I tentatively took it from her. It was like a bad ‘pass the parcel’ with no one to pass it on to (if only I’d had a medical student sitting in!). Cautiously, I gloved up and began to unwrap the rather weighty paper bag, trying not to grimace or wince; inside I found a bundle of tissues, and within that was a porcelain egg cup with a Royal coat of arms on it. Perched proudly in the Royal egg cup was a plastic shot glass, covered in cling film. Sloshing about in said shot glass, I deduced, was either a wee dram of whisky (I work in Scotland), or her urine. I cautiously peeled back the cling film, trying not to spill the contents, and wondered how I might fit a dipstick into the tiny shot glass. I transferred it to a urine pot for testing. It definitely did not smell like whisky, and the tell-tale pink square flashed up positive—a UTI as suspected.

This made me reminisce about some of the more unusual ways that patients have transported their bodily samples to me and my colleagues over the years.

I remember once being brought a urine sample in one of those original plastic Kinder Surprise pots, the kind you have to squeeze the sides to open, you know? As a child I struggled to get them open without the plastic toy shooting across the room. The stakes felt higher when there was urine inside it; unfortunately I did not have much success, and had to send the patient to do another sample in a collection pot instead. Another urine sample arrived in a quart whisky bottle (clearly needs a CAGE assessment), and I also heard a rumour of someone receiving a urine sample in an empty Virgin Mary holy water bottle. Clearly it was of sentimental value, having come from a trip to Lourdes—the patient asked for the bottle back afterwards (as you would).

When I worked in a rather affluent area, on a particularly memorable home visit, the urine sample was provided to me in a champagne flute. I remember thinking you definitely would not want to get that sample muddled with refreshments, and I also marvelled at the accurate aim to get it in there in the first place.

And what of other specimen types? Tupperware seems a firm favourite among patients. I can understand its promising properties of sealing odours firmly away, but I will never understand why a patient who brought a stool sample wrapped in a napkin, tin foil, and then Tupperware would possibly want the Tupperware back. Surely no amount of sterilising would make that usable again.

Margarine tubs must come a close second to Tupperware. I have had urine, stool, and snot all delivered in tubs of various brand names. The funniest I heard of was a bronchiectasis patient who brought an entire ‘I Can’t Believe It’s Not Butter’ margarine tub filled with purulent sputum. It certainly was not butter.

Lice: we itch at the thought. Back in the 90s, a senior colleague talked of a particularly disturbing sample of pubic lice, transported in a clear plastic cassette case and scurrying around. I ponder whether the tape box was just close at hand when the person discovered their infestation, and lament how such opportunities are few in an age of online downloads and the loss of cassette cases.

Coming back to my original patient, Mrs M, I am left wondering why an 80-year-old might own plastic shot glasses? I really wish I had asked her at the time—now I’ll never know. She certainly did not seem like the partying tequila type, but maybe I just need to get out more?

(NB all patient details/stories have been altered to keep anonymity)

Dr Kim Grant

Sessional GP, Scotland