What are Red Roses?

Red Roses are minimalist accounts, vignettes, of real consultations in general practice. Some are immediate and recent; some recount practice thirty years ago. First published in 2014 as chapter endings in The Good GP Training Guide – RCGP Publications, London, 2014; editors Matt Burkes and Alec Logan1.  The original authors are eight UK GPs – Matt Burkes, David Haslam, Dougal Jefferies, Helen Lester, Alec Logan, Faye  McCleery, Hans Peiper and Deborah Swinglehurst. 

Red Roses are also illustrated, specially commissioned linocuts by Helen Wilson.

Vignettes are anonymised and edited carefully to avoid risk to patient confidentiality. 

The articles published in TGGPTG were externally peer reviewed by senior editors at RCGP Publications. 

An exercise in filling white space has grown. “A collection of lovely anecdotes dotted around the book practically illustrating what it is to be a GP by immersing you in thought or laughter!”2

Red Roses are also an educational tool, to promote reflection on lessons learnt and insights gained. At Lisbon and Liverpool 2014, Istanbul 2015, Rio de Janiero 2016.

But time to take the next step.  The Red Roses Blog. Doctor-Patient stories on-line.

Why Red Roses? 

A story by the late great Helen Lester³ who died just a few months before publication.

What is Red Roses, the Blog?

Red Roses on-line, to allow access and comment, and submit new Red Roses. 

RedRosesgp.blogspot.co.uk

Please view.  Please reflect, share.  Please comment on-line. 

Then Submit Your Own. 

Together we build a repository of consultations, openly accessible.  An archive and research resource.

Who can submit a Red Rose?

Anyone! GPs and GPs in training, medical students, other doctors and health care professionals. And patients!

How can readers submit a Red Rose of their own?  Or comment?

Follow instructions on our Submit button.  You will be asked to register and supply an email address and mobile number.  Other contact details are encouraged but optional.  You will be required to declare that all descriptions of consultations are anonymised.  Worth repeating – ANONYMISED.

For all new stories CONSENT TO PUBLICATION should be obtained formally from patients or responsible others. Our Consent Form is a click away. Please use it whenever possible.

All submissions and comments will be moderated pre-posting.  We reserve the right to reject on whim, though will always try to supply constructive and graceful feedback.  

Formats - please submit as text.

Future formats – as audio and video files, guidance coming soon.

Red Roses – The Mystery of General Practice. 4

Alec Logan
General Practitioner

Wishaw, Lanarkshire, Scotland.

aleclogan@dial.pipex.com

+44 7515 340446

October 2015

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2            BJGP 10.3399/bjgp14X681925 Published 1 October 2014
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4

Immediate Discharge Letter

An elderly burnt-out schizophrenic discharged into the community after over 20 years in our local asylum, now thankfully closed. On shed loads of powerful drugs, complex multi-disciplinary arrangements for follow up, multiple co-morbidities. But none of this on the crumpled carbon copy of his Immediate Discharge Letter. No, a model of brevity, Less is More - no name, no address, no list of medication. And in the box for Diagnosis, "Dougie, the door has fallen off the tumble dryer."

Interesting Questions. Interesting Answers.

Question 1 - What do you do for a living?

Question 2 - For how long do you think you should take these tablets?

I started three very different patients on antidepressants this afternoon. For some reason I asked all three the same question. The three supplied exactly the same answer.

“For as short as time as possible.”

Question 3 - What is the percentage chance that you’ll have a heart attack or stroke in the next ten years?

In Scotland we score cardiovascular risk with a nifty tool called ASSIGN. Smoking and diabetic status, blood pressure, and lipid results are sensed by my computer and an ASSIGN score, my patient’s chance of having an MI or stroke in the next 10 years, appears bottom left corner of my monitor. It’s bold and red and expressed as a simple percentage. Even I can understand that. So can my patients. Ghoulish, like most computery things, but comprehensible.

Twice last week I discussed ASSIGN scores, one face to face, second by telephone. I explained the rules of the game. Didn’t let on that the answer was blinking at me. Then asked the question.

Patient 1 was 60 and a harassed electrician. “50%?” Nope, 15%. Phew!

Patient 2 was same age as me, 50, but a little overweight. Cholesterol 6.2, average in our regional gene pool. MI risk? “60%?” Well, actually, 3%. And of course, to put it another way, that’s 97% chance of not having an MI in the next 10 years. Have a good weekend.” I hear the sound of skipping over the phone. Great start to a Bank Holiday weekend. For both of us.   

Potassium supplements

Miss J’s Us & Es are on my desk and K is 3.4. A zealous younger partner has not ticked the Tell Patient Normal box and suggested telephone consultation.

Morning Miss J, about your blood test, your potassium level very slightly down, nothing to worry about... Probably your bendroflumethiazide, for blood pressure. Do you like bananas?

I love bananas!

Good. How many bananas do you eat per day?

One, usually.

Well, lots of potassium in bananas, so I suggest two or three per day over the Christmas period. How do you fancy that?

That would be great!

Enjoy your bananas.

She laughs. I smile.

I press the Next Patient button.

Addendum. Just six weeks later Miss J’s potassium is 5.2. Yikes! Maybe she’ll have to cut back a little, maybe to single small free-trade banana bd. How shall I break the news?

The Good GP Training Guide, Introduction

A Day in the Life of... 

Morning, branch surgery, then a house call. Patient number 14. I'd put that one in our house call book. A sixty-something retired business lady, attitude of a thirty-something. In April she'd perforated her bowel at 40000 feet en route to Miami and a dream cruise. Imminent cruising alters pain perception, and after a torrid night in a Miami hotel room she felt a little better and joined the ship. First night at sea, high fever, collapse at dinner and so to sickbay. Airlifted to somewhere in Mexico and 38000 dollars' worth of emergency surgery for perforated colon secondary to large malignant tumour. Back home for general evisceration then heroic chemo. A hospice discharge letter earlier in the week suggested she might be at home, so I scribbled a note offering to say Hello. My visit the result. I was expecting a harrowing encounter. I rang the doorbell. Through the frosted glass I spotted my patient jinking sideways to hip-charge a black labrador into the kitchen. I didn't know she had a dog, such a good prognostic indicator. Door open, into front room, do have a seat doctor, so nice of you to visit. Hospice? Marvellous! Sorted the pain relief. And the incontinence. Partner appears, Labrador owner. Labrador appears and sits down to be patted, sniffing my trousers, I have Pointers. Can I help you with anything? How are things going? You are halfway through chemo, how is that? All fine. She radiates vivacity. Thank you so much for coming. I'll come again. I clasp hands. The bravest and most scintillating woman I've ever met.

Back at the Health Centre, soon to be razed, meeting with architects next week. We have a new one a'comin’. An inverted ziggurat, all glass and flying bridges, five storeys high.

Review results. One stands out. New patient registered a fortnight previously. Patient 16. Hypertension and microalbuminuria to an extent that would make a spoon stand upright. Quick phonecall, come and see me, just back off a rig. Receptionists, please chase blood results fast. Quick talk with younger partner who knows more about renal biochemistry than I do.

On call doctor early afternoon, two late calls, second, Patient 17. Elderly lady with breakthrough cancer pain. Her daughter-in-law used to play tennis with me when I was 10. Another Labrador! Adjust the dose of long-acting opiate. More clasping of hands, always an ordeal for Scots. Thankfully no kissing. Yet.

Afternoon surgery. Start with Proteinuria Man, Patient 16 Redux. He's doing a lot of training and body-building. On a high protein diet. The Byelorussian version with stacks of anabolic steroids. And he's jaundiced. Nope, I haven't sorted him yet. 

I finish almost on time. Patient 35. He is the perfect last patient on this particular Friday. Thirty-ish, with a tiny skin tag left upper eyelid and mild folliculitis. Hip Hop! Soon to go home.

"So, am I your last patient of the week?"

"Yes." I say, still marvelling at the simplicity of his lovely skin tag, the joyous absence of psychomorbidity.

We chat about football.

"You'll be glad to finish the week," he says. "You guys must be sick and tired of dealing with the same things all of the time."

Er... No!

Alec Logan

aleclogan@dial.pipex.com

GP, Wishaw, Scotland

The Gaelic? The Gaza

From Germany originally, I fell in love with the wild West of Scotland and did my trainee post on Mull. A few words of Gaelic went a long way. Fliuch (wet) gave you some street credibility and described the weather on an almost daily basis. Thawing out in front of the fire of a remote cottage with a hot cup of tea I realised that I must have been picking up the singing lilt of my native Gaelic speaking patient when he asked me: “Doctor, are you having the Gaelic?”  “No,” I replied, “but I am having the German!” “Aye, aye,” he nodded slowly, “that would do.”

Then I worked as an anaesthetist in Gaza. Arabic was a wee problem, but as my patients spent most of the time asleep, I could usually keep it very simple.

During recovery almost all problems could be solved with two commands:

Chud nefes! (Take a deep breath!)

Ifta tumak! (Open your mouth!)

On my first Chud nefes! nothing happened. I asked Mohammed, the anaesthetic nurse, for help. So he shouts CHUD NEFES! at a hundred decibels. What a big breath!

The British are right about foreign languages. If anyone doesn’t understand you, Shout Louder!!

Nurse!! Where’s my towel?

Danny Boy

I arrive at the nursing home to find a little old lady in a wheelchair, at the Crossing - we're talking a care home here, not Wells Cathedral, but still a stage of sorts.

She was singing. Danny Boy. And singing it very well, accurate soprano. Rather lovely.

"Mrs P," I said, "You have a lovely voice."

"YOU'RE A F****** LIAR!!" she replied. "JUST F*** O**!!"

Oh dear.