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Haslam's view: Travel broadens GP presentations

Travel is, for me, one of the delights of life. I'm well aware that when you've paid for and enjoyed a holiday or journey you have nothing left except photographs and memories. But I'm also reassured by the research that says that, when it comes to happiness, you get much more pleasure out of spending your hard-earned cash on experiences than possessions. And when it comes to travel, I've certainly had some experiences.

But the flip side, apart from the environmental hazards, has to be the complexity of some of the cases that come through the consulting room door.

A young man was the last patient in my morning surgery. I've known him since he was a fetus, and saw him intermittently during his childhood with the traditional catalogue of problems, from the ear infections of toddlerhood through to the acne vulgaris of the teenage years. But it had been well over a year since I last saw him and I was taken back when this beanpole of a man was ushered into my consulting room by his mother.

As ever, it was his mum who did the talking. ‘I'm worried sick, doctor,' she said. ‘I collected him from the airport yesterday and just look at him: all skin and bone. It can't have done him any good at all, that year in the jungle.'

Right. So this is one of the facets of general practice in 2008. At any moment, someone can turn up who has just flown in from the most remote part of the world. The flattering, and, to be honest, rather extraordinary thing is that the patient's mum thought I would know what to do.

And the patient sat there, rolling his eyes, and eventually said that he thought his dear mother was making a dreadful fuss over nothing.

It all took me back to a consultation that happened nearly 32 years ago. I was taking the MRCGP examination, and the examiner – as was the trend in those days – was role-playing a patient who had come to the surgery having been bitten by a dog in India the previous day. I was tired, and I was fed up, and I knew that I had blown it. So, with a deep sigh, I said, ‘I know nothing at all about rabies. I would look it up.'

And at that, both examiners smiled broadly, and one said, ‘At last – we've been asking this question for five days, and you are the first person to give us the correct answer. No GP in their right mind would treat this case without looking it up.'

And so it still is today, made infinitely easier by the internet.

And the patient certainly looked ridiculously skinny, to use a technical term. And a few direct questions revealed that not only had he been eating very little, but also had become so used to passing frequent, very loose stools that he no longer recognised this as being unusual. This wasn't a case I was going to leave uninvestigated, and the patient ultimately agreed.

When a case is presented like this, it is exceedingly easy to start off down the right diagnostic road. After all, few of us will ignore the words ‘been in the jungle for a year' when collecting clues. But how many patients completely forget to mention their travels? A weekend break in Marrakech, a few days in Egypt or stopover in Dubai are no big deal – and may well not get mentioned when a patient presents with abdominal pain.

‘…and have you been anywhere overseas?' almost needs asking as a routine part of any history.


Professor David Haslam CBE
GP, Ramsey, Cambridgeshire; President, Royal College of General Practitioners; national clinical adviser to the Healthcare Commission; and Visiting Professor at de Montfort University, Leicester

Haslam's view The flattering, extraordinary thing is that the patient's mum thought I would know what to do

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