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

Getty
Show Hide image

Theresa May’s stage-managed election campaign keeps the public at bay

Jeremy Corbyn’s approach may be chaotic, but at least it’s more authentic.

The worst part about running an election campaign for a politician? Having to meet the general public. Those ordinary folk can be a tricky lot, with their lack of regard for being on-message, and their pesky real-life concerns.

But it looks like Theresa May has decided to avoid this inconvenience altogether during this snap general election campaign, as it turns out her visit to Leeds last night was so stage-managed that she barely had to face the public.

Accusations have been whizzing around online that at a campaign event at the Shine building in Leeds, the Prime Minister spoke to a room full of guests invited by the party, rather than local people or people who work in the building’s office space.

The Telegraph’s Chris Hope tweeted a picture of the room in which May was addressing her audience yesterday evening a little before 7pm. He pointed out that, being in Leeds, she was in “Labour territory”:

But a few locals who spied this picture online claimed that the audience did not look like who you’d expect to see congregated at Shine – a grade II-listed Victorian school that has been renovated into a community project housing office space and meeting rooms.

“Ask why she didn’t meet any of the people at the business who work in that beautiful building. Everyone there was an invite-only Tory,” tweeted Rik Kendell, a Leeds-based developer and designer who says he works in the Shine building. “She didn’t arrive until we’d all left for the day. Everyone in the building past 6pm was invite-only . . . They seemed to seek out the most clinical corner for their PR photos. Such a beautiful building to work in.”

Other tweeters also found the snapshot jarring:

Shine’s founders have pointed out that they didn’t host or invite Theresa May – rather the party hired out the space for a private event: “All visitors pay for meeting space in Shine and we do not seek out, bid for, or otherwise host any political parties,” wrote managing director Dawn O'Keefe. The guestlist was not down to Shine, but to the Tory party.

The audience consisted of journalists and around 150 Tory activists, according to the Guardian. This was instead of employees from the 16 offices housed in the building. I have asked the Conservative Party for clarification of who was in the audience and whether it was invite-only and am awaiting its response.

Jeremy Corbyn accused May of “hiding from the public”, and local Labour MP Richard Burgon commented that, “like a medieval monarch, she simply briefly relocated her travelling court of admirers to town and then moved on without so much as a nod to the people she considers to be her lowly subjects”.

But it doesn’t look like the Tories’ painstaking stage-management is a fool-proof plan. Having uniform audiences of the party faithful on the campaign trail seems to be confusing the Prime Minister somewhat. During a visit to a (rather sparsely populated) factory in Clay Cross, Derbyshire, yesterday, she appeared to forget where exactly on the campaign trail she was:

The management of Corbyn’s campaign has also resulted in gaffes – but for opposite reasons. A slightly more chaotic approach has led to him facing the wrong way, with his back to the cameras.

Corbyn’s blunder is born out of his instinct to address the crowd rather than the cameras – May’s problem is the other way round. Both, however, seem far more comfortable talking to the party faithful, even if they are venturing out of safe seat territory.

Anoosh Chakelian is senior writer at the New Statesman.

0800 7318496