Photo: Getty
Show Hide image

Is your GP a buzzer or a meeter? Sometimes, a diagnosis starts in the waiting room

Sometimes, just going to greet a patient can make all the difference.

GPs can be divided into two distinct groups: “buzzers” and “meeters”. The former stay put in their consulting rooms, employing a variety of devices such as buzzers or intercoms to call their patients through. Meeters, on the other hand, walk along to collect each patient from the waiting room in person.

We’re meeters in my practice. I like the brief interlude of physical activity, which helps to clear the mind in readiness for the next consultation. Equally important is the opportunity to begin putting patients at ease, greeting them with a smile and making small talk as we walk down the corridor together. It helps the consultation get off to a good start, rather than the patient arriving “cold” at my consulting room door.

Meeting also provides valuable advance information. Musculoskeletal problems are the most obvious: back pain is instantly recognisable from the way someone gets out of a chair. Hip, knee and ankle pathologies produce characteristic gaits. Respiratory problems can be gauged by the degree of breathlessness with exertion. Eye contact, body posture and facial expression when crossing the waiting room give clues as to the patient’s state of mind; depression, acute anxiety or frustration and anger all transmit themselves clearly and one can prepare oneself for the consultation.

“Waiting-room diagnoses” are sometimes memorable, as in the case of Simon, a 45-year-old man I went to collect a little while ago. His notes showed he was an infrequent attender, which made it more likely that he had come about something significant. When I called his name, his wife got up to accompany him – often a sign of high levels of concern and occasionally indicative of a reluctant male being frogmarched to the doctor by a spouse who has decided that enough is enough. Their faces were taut with worry.

By the time Simon reached me, I had the full picture. He was noticeably out of breath after walking a dozen yards and strikingly pale – a sign of gross anaemia. The amount of the oxygen-carrying red pigment (haemoglobin) in his blood was very low.

As we made our way along the corridor, I thought ahead. There are several types of anaemia but by far the most common is iron deficiency. This arises because of inadequate iron in the diet (which is rare in the UK), or failure to absorb iron from food (coeliac disease is a frequent culprit), or – most often – sustained loss of blood.

Women of reproductive age quite commonly become anaemic from excessive menstrual bleeding. In a male of Simon’s age, however, a marked iron-deficiency anaemia is unusual and worrying – it is a typical presentation of gastrointestinal cancer, an otherwise unsuspected tumour leaking small amounts of blood into the bowel day after day until haemoglobin levels fall enough to cause symptoms.

By the time Simon, his wife and I had seated ourselves in my consulting room, I was braced for a delicate discussion. Once Simon had admitted that he had been keeping quiet about periodic blood in his stools for some months, the path ahead was clear.

Since 2000, GPs have been able to refer suspected cancer cases under the “two-week wait” rule, ensuring that investigations are undertaken speedily. The only proviso is that patients must be made aware that cancer is a distinct possibility, to ensure that they attend the appointment slot and to prepare the ground for any discussion that may be needed at the hospital. In Simon’s case, he required urgent “topping and tailing” – two separate endoscopies to allow direct inspection of his upper and lower digestive tracts. Gastroscopy is unpleasant: the patient has to swallow the camera and fibre-optic cable to allow examination of the stomach. Colonoscopy is even more so; endoscopic inspection of the lower bowel is only possible after a two-day purge with powerful laxatives.

There was a lot to explain and prepare Simon for, not least that, were bowel cancer to be discovered, there was a reasonable prospect of a cure. Survival rates in the UK have more than doubled over the past 30 years; at least half of patients are disease-free after ten years, rising to a 90 per cent cure rate if the tumour is detected at an early stage.

Though the outlook is far from gloomy, the uncertainty can be difficult to cope with. Simon and his wife were understandably anxious but I was impressed by the phlegmatic way they greeted each new piece of information. Simon’s comments stayed with me: he spoke of how they would remain calm and square up to whatever they needed to deal with.

A couple of weeks later, a fax brought the good news: Simon was clear of cancer. The bleeding was from an unusual blood vessel anomaly in the bowel wall, readily treatable by laser. He and his wife made an appointment a few days later to discuss the next steps. It was a pleasure to see the smiles on their faces as they came across the waiting room towards me, a sight I would have missed, were I a buzzer rather than a meeter. 

This article first appeared in the 11 June 2014 issue of the New Statesman, The last World Cup

Photo: Getty
Show Hide image

No, William Hague, there's nothing anti-democratic about opposing Brexit

The former Tory leader appears to be suffering from a bout of amnesia. 

William Hague just made an eyecatching claim in the House of Lords during the debate over Article 50. He attacked those Remainers still seeking to restore Britain’s European Union membership in general and Tony Blair in particular, saying that if he had called on voters to “rise up” against New Labour after he lost the election, Blair would have told him to listen to the voters.

To be fair to Hague, it has been sixteen years since he went down to crushing defeat to Blair, so he may have forgotten some of the details. Happily, the full text of his resignation speech the morning after is still online.

Here’s Hague, 2001:

"The people have spoken. And just as it is vital to encourage everyone to participate in our democracy, so it is important to understand and respect the result. The Labour party have won the election and I have already congratulated them on doing so. But they have done so without great public enthusiasm….It is therefore a vital task for the Conservative party in the coming parliament to hold the government to account for the promises they have made and the trust people have placed in it.”

And here’s Blair, 2017:

“I want to be explicit. Yes, the British people voted to leave Europe. And I agree the will of the people should prevail. I accept right now there is no widespread appetite to re-think. But the people voted without knowledge of the terms of Brexit. As these terms become clear, it is their right to change their mind. Our mission is to persuade them to do so.”

And here’s Blair’s last line which has so offended William Hague:

“This is not the time for retreat, indifference or despair; but the time to rise up in defence of what we believe – calmly, patiently, winning the argument by the force of argument; but without fear and with the conviction we act in the true interests of Britain.”

This is funny, because here’s William Hague’s last line in 2001:

"I wish I could have led you to victory but now we must all work for our victories in the future.”

 Here’s what the “you lost, get over it” crowd have to explain: what is the difference between these two speeches? Both acknowledge a defeat, acknowledge the mountain to climb for the defeated side, but resolve to work harder to secure a better result next time.

It’s particularly galling when you remember that taking Britain back in would not require a second referendum but a third: because the Brexiteers, far from losing in 1975 and getting over it, spent four decades gearing up to take Britain out of the European Union.

There’s a more valid criticism to be had of the value of a continuity Remain campaign which appears to hold many of the people who voted to Leave in distaste. Certainly, at present, the various pro-Remain forces look more like the unattractive fringe that lost in 1975 than the well-disciplined machine that won the replay in 2016. But the fact there was a replay in the first place shows that there’s nothing anti-democratic about continuing to hold on to your beliefs after a defeat. What is anti-democratic is trying to claim that the result of any electoral contest, however narrow or how large, means that everyone who disagreed with you has to shut up and pretend you were right all along. 

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.