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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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From war and slavery to prison – life inside an immigration detention centre

David spent five years locked in a house in Britain. Then he spent two years in immigration detention centres. 

Visitors at the immigration detention centre are met by Sid the Sloth, balancing an acorn just as he does in the family film Ice Age. The picture is one of the brightly coloured murals adorning the otherwise bare walls of the visitor's entrance. The lurid paintwork sits in stark juxtaposition to the barbed wire outside, and the metal detector and eight sets of doors which visitors must pass through.

It is a thin veneer which fails to mask a system containing institutionalised abuse from top to bottom. It isn't surprising, then, that one of the conditions of my visit was not to identify the centre - the volunteers I joined fear having visiting rights withdrawn by the company in charge.

Once inside I met Sivan, a 32-year-old Kurdish asylum seeker who came to Britain clinging to the underside of a lorry. He had been tortured by the Turkish authorities. For Sivan the children’s cartoons in the visitor’s entrance held a particularly cruel irony. Detainees at the centre are not allowed smartphones, and with no access to email Sivan’s wife, also a Kurdish asylum seeker, is unable to send her husband pictures of their first child. The couple have not seen each other in the two months since Sivan was detained. That day, in the visitor’s lounge, Sivan saw his son for the first time. Holding photographs of the little boy in his hands, Sivan’s face momentarily lit up as it split with joy and then sorrow.

Sivan does not know when he will be able to see his young family - or if they will ever be able to be together.

Across Britain more than 3,000 people, many fleeing war and torture, are locked up indefinitely in immigration centres. They arrive in Britain seeking refuge. But are shut away in privately-run prisons before being forcibly removed. Often with little or no English, detainees rely on volunteers to help them navigate Britain’s complex immigration system.

At the volunteer hub, which helps 80 of the 500 men in the centre each week, I met former detainees who all had one thing in common: the mental torture that indefinite detention inflicts. Like David, a quiet Ghanaian who has never really been free. He was kept as a slave on a plantation until traffickers brought him to Britain aged 13. Here he spent five years locked in a house, when not being forced to work 14-hour days in a warehouse. He finally escaped only to spend 11 years waiting for his asylum application to be processed - still ongoing despite clear medical evidence of his torture during imprisonment. He has spent two years in immigration detention centres. And as he waits he now has to register his presence with the authorities every Tuesday. He is terrified that when he does he won’t return to his four-year-old daughter, but instead be returned to captivity by the Home Office, without explanation.

Another former detainee Daniel, a tailor from Iran who fled five years ago, spent five months in detention when he first arrived in Britain. He describes being locked up with no time limit as "one of the worst times of my life", and still needs anti-depressants. “It really damaged my mind,” Daniel told me. “You don’t know when the process will be finished and you’re just waiting, waiting. You don’t know what’s going on.”

I heard from detainees who have had medical appointments they have waited months for cancelled because the centre wouldn’t pay for transport. Some kept three in a room with a toilet between the beds. Others woken in the middle of the night to see their friend dragged from their bed and assaulted by guards before being taken for deportation. Detainees employed to clean the centre for an exploitative £3 a day, just to afford necessities like toiletries. Or they stay trapped by fear in their rooms because they are afraid of the ex-prisoners, many who have committed serious crimes, locked up around them. I heard too of solitary confinement used routinely as a punishment for those considered not to be compliant. More than one detainee said immigration centres are worse than prisons. And they are right.

Britain is the only place in Europe which still locks people up with no time limit. Despite the government’s promise to reduce both the numbers - and the time spent there - progress is still far too slow. Last year 27,819 people entered detention. Some have been there more than five years.

Barely a week passes without a new report of violence or suicide or rape or abuse, inflicted on those who came to our country for help. The government should hang its head in shame. The Home Office must stop turning a blind eye to what it must know what is happening to those in its care. It’s clear that this is a broken and barbaric system. After seeing it for myself, I’m more convinced than ever that the use of indefinite detention has to end.

Names have been changed to protect the identities of those interviewed for this article.

Jon Bartley is the co-leader of the Green Party.