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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

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Jeremy Corbyn faces a dilemma as Brexit solidifies: which half of his voters should he disappoint?

He comes from a tradition on the left that sees the EU as a capitalist club.

Imagine a man who voted to leave the European Economic Community in 1975. A man who spoke out against the Maastricht Treaty in 1993, saying that it “takes away from national parliaments the power to set economic policy and hands it over to an unelected set of bankers”. A man who voted against the Lisbon Treaty in 2008.

You don’t have to imagine very hard, because that man is Jeremy Corbyn. When campaigning for the Labour leadership in 2015, he told a GMB hustings, “I would ­advocate a No vote if we are going to get an imposition of free-market policies across Europe.”

When Labour’s Brexiteers gathered to launch their campaign in 2016, several seemed hurt that Corbyn and his shadow chancellor, John McDonnell, were not there with them. “It is surprising, when we voted against the advice of the chief whip on a number of European issues over the last decades, that Jeremy and John, who have always been in that lobby with us, that they would want to lead a campaign that isn’t even asking for a renegotiated position,” said the MP Graham Stringer.

I mention this because since the election campaign started in April, I keep having an odd experience – people insisting that Corbyn is not a Eurosceptic, and that he will use Labour’s new-found strength to argue for a softer Brexit. Others claim that Labour’s current position on freedom of movement (ending it) is the obvious, common-sense – even progressive – choice.

This matters. Look, if the evidence above doesn’t convince you that the Labour leader is intensely relaxed about exiting the European Union, I don’t know what else would. Yet it’s clear that some Labour activists strongly identify personally with Corbyn: they find it hard to believe that he holds different opinions from them.

The second factor is the remaking of Brexit as a culture war, where to say that someone is a Eurosceptic is seen as a kind of slur. Perhaps without realising it, some on the left do associate Euroscepticism with Little Englanderism or even flat-out racism, and see it as a moral failing rather than a political position.

But I’m not impugning Jeremy Corbyn’s character or morals by saying that he is an instinctive Brexiteer. He comes from a tradition on the left that sees the EU as a capitalist club. You can disagree with that premise but it’s a respectable line of reasoning.

Also, the Euroscepticism of Corbyn and his allies will undoubtedly give them an advantage in the months ahead; they are not consumed by fatalism, and the members of McDonnell’s shadow Treasury team feel that the removal of European state aid restrictions can help revive ailing bits of the British economy. They have a vision of what an ideal “Labour Brexit” would be – and it’s not just sobbing and begging Emmanuel Macron and Angela Merkel to take us back.

We do, however, need a reality check. Now that the necessary humble pie has been eaten, Labour’s unexpected revival at the ballot box means we can begin to treat Corbyn as a normal politician – with the emphasis on the second word. He’s not the Messiah, but he’s not a joke either. He is a charismatic campaigner who is willing to compromise on second-tier issues to achieve his main objectives.

From the general election, we can see just how good a campaigner Corbyn is: he can fire up a crowd, give disciplined answers to interviewers and chat amiably on a sofa. That throws into sharp relief just how limp his performances were last year.

He might have little else in common with Theresa May, but they both looked at the EU referendum and thought: yeah, I’m going to sit this one out. He called on activists to accept the EU “warts and all”; and said he was “seven, or seven and a half” out of ten in favour of staying in it.

For both leaders, this was a pragmatic decision. May did not want to be overtly disloyal to David Cameron, but neither did she wish to risk her career if the result went the other way.

Anyone in Labour would have been equally sane to look north of the border and back to 2014, and remember just how much credibility the party immolated by sharing stages with the Conservatives and allowing itself to be seen as the establishment. By limiting his involvement in the Remain campaign and whipping his MPs to trigger Article 50, Corbyn ended up with a fudge that gave Labour some cover in heavily pro-Brexit regions of the country.

That’s the politics, but what about the principle? I can’t shake the feeling that if Corbyn campaigned as hard for Remain in 2016 as he did for Labour in 2017, we would still be members of the European Union. And that matters to me, as much as left-wing policies or a change in the rhetoric around migrants and welfare claimants, because I think leaving the EU is going to make us poorer and meaner.

That’s why I worry that many of my friends, and the activists I talk to, are about to be disappointed, after waiting and waiting for Labour to start making the case for a softer Brexit and for the single market being more important than border controls. As Michael Chessum, a long-standing Momentum organiser, wrote on the New Statesman website, “Recognising the fact that immigration enriches society is all very well, but that narrative is inevitably undermined if you then choose to abolish the best policy for allowing immigration to happen.”

Labour’s success on 8 June was driven by its ambiguous stance on Brexit. To Leavers, it could wink at ending freedom of movement when they worried about immigration; to Remainers, it offered a critique of the immigrant-bashing rhetoric of recent times. But can that coalition hold as the true shape of Brexit solidifies? Over the next few months, Jeremy Corbyn’s biggest decision will be this: which half of my voters should I disappoint?

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.

This article first appeared in the 22 June 2017 issue of the New Statesman, The zombie PM

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