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Close encounters

Phil Peverley

Columnist of the year

He's back from holiday – and finding that the humble ophthalmoscope can cement the doctor-patient relationship in uncomfortable ways

Personal space is a strange thing. It is that area around our bodies in which we feel uncomfortable if another person encroaches unbidden.

Being English, my personal space is probably bigger than average. About a yard is the norm, but on a bad day, my personal space extends to around 18 feet in every direction.

Other nations are different.

I remember queuing to buy a ticket in Cairo railway station. It was 4am, and the enormous place was practically empty. As I stood a respectful six feet away from the only ticket window that was open, an Egyptian gentleman came and joined the queue behind me, making the queue two people long. Without a word, he fitted himself snugly against my buttocks and back, and calmly rested his chin on my shoulder. We made a strange tableau, to my mind, in that cavernous space.

I have never been more uncomfortable in my life.

In my consulting room, I like to keep the punters at a distance. I'm not one of those old school GPs that have the desk as a barrier between myself and the patient – but that's only because the desk is fixed to the wall. I have the patient at 90 degrees, on the short end of the desk.

For the most part, patients are happy to sit where I put them.

But I have one lady who, every time she visits, makes me want to nail her chair to the floor. As soon as she sits down, for reasons that are beyond me, she starts edging the chair closer and closer round the corner of the desk. If the consultation lasts longer than five minutes or so (and it invariably does), she ends up sitting next to me, hip to hip. By the end of the appointment we are sitting there like a couple of vaudevillians about to launch into a piano duet.

I want to scream with embarrassment. She seems to enjoy the intimacy.

I own an ophthalmoscope, I don't know why. It's just one of those things that GPs are supposed to have. I can never see anything through it, but every now and again, when patients think there is something wrong with their eyes, I feel constrained to get it out and pretend to use it.

I don't like it at all. When you're using an ophthalmoscope there's no way of avoiding getting right in the patient's face.

'You'll have to excuse me,' I tell them. 'I've got to get pretty close to use this.'

'That's all right, doctor,' they

tell me, and we line up like a couple of boxers waiting for the

ref to start the bout.

Examining the right eye is not too bad. At least we are offset a bit, but I can't see too well out of my left eye, so when examining the left side I still have to use my right eye.

We would only have to pucker up a bit and the GMC would be down on me like a ton of bricks.

I should be trying to examine the fundus, but I spend all my time holding my breath and trying to remember if I had garlic last night. Before I go blue, I give up and exhale mightily.

'Looks OK to me!' I tell them, breathlessly.

'What were you looking for?'

they might ask.

'You know. Eye stuff,' I say, informing and educating.

'I don't know. What?'

'It's technical!'

The first person to invent an ophthalmoscope that works from

a yard away gets a great big hug from me.

Actually, come to think of it, they won't. They'll have to take the word for the deed.

Dr Phil Peverley is a GP in Sunderland and PPA Columnist of the Year 2006

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