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At the heart of general practice since 1960

Life as a new principal

Dr Kate Kirkwood finds her decision to

re-enter the NHS system is not exactly the icing on the cake...

Patient and I both

have a bone to pick

Back at work the following day, I see a patient I know quite well. Since our last appointment, she has fallen and fractured her fifth metatarsal. Or is it her calcaneum? She has been told different things by different doctors, and is worried in case the cast that has been applied is the wrong one.

I spend what feels like hours tracking down the orthopaedic registrar who had seen her, to establish which bone she has broken ­ and whether it matters. The long and short of it: he's not sure.

Can he give us some advice regarding weight-bearing? 'Um, not really, it depends on which bone she's broken.'

The phone call is abandoned, and the patient elects to go private: 'I just want a chat with someone who's got a minute to spare and some idea of what's going on.'

I know what she means.

All aboard health care rollercoaster

Sitting in the waiting room, I am accosted by a woman with a child whose rolls of fat are impressive even by the standards of the current obesity epidemic. 'He's a bit small for his age, isn't he?' she bellows, barely a minute into our chat.

'She's a girl, she's doing fine, and ­ major bonus ­ she doesn't look like a pig' is of course what I should retort; in fact I smile apologetically, morale at low ebb.

Fortunately, the health visitor beckons me into her room at this point. Reassurance is doled out and gratefully received, lines are drawn on graphs, and heads (mum's and baby's) are patted. We both feel better.

Back at home, I revert to neurotic mode, unfortunately. What to tackle next ­ the developmental concerns? The failed hearing test? The latter seems the simpler issue, and I duly lift the phone. The audiology clinic reluctantly admits we are on their waiting list, and agrees that this has been the case for some months. 'But we've only got part-time doctors, and two of them have left suddenly.'

I point out that, had we lived a few miles to the west, we would have had a routine hearing test six months ago. 'But we don't do that in Leeds.' More equally pointless exchanges follow. Finally I extract the promise of an appointment later this month, having lost a stone in sweat and blood in the process.

No doubt my daughter's notes bear the inscription in red 'Nightmare mother: beware', but I'm beginning not to mind about minor details of this sort. Primary care versus secondary care: no contest, so far today!

A time of discovery and re-discovery

My daughter turned one recently, and had her first taste of chocolate cake. As she chewed, initial suspicion was replaced by incredulous joy, and she turned to her parents with an accusing expression as if to say: 'Oh my God! I had to wait until I was ONE to discover this?'

Our attention was being diverted, however, by her little chums, all of whom were busily comparing numbers of teeth, waving techniques, and walking prowess. I have consistently refused to allow developmental charts into the house, since our ex-prem is only really nine-and-a-half months old and is already growing up in an atmosphere of barely contained parental (okay, maternal) anxiety.

We rarely read the baby books, for similar reasons, but I did come across the following sentence in one: 'Of course, if your child was premature, she will be under frequent review by her paediatric team in order to detect possible problems with vision, hearing, lung development, motor skills etc.' No prizes for guessing this wasn't a British book.

An extended internal rant followed, during which I castigated the NHS and the haphazard nature of its follow-up arrangements.

Eventually, I remind myself that it did in fact save our child's life, and that I hadn't brought up any of my concerns with my GP, whom I rarely see, or with my health visitor, whose weekly baby clinic falls on one of my workdays. Perhaps it was time to re-enter the system, rather than criticise it. I decided to go to baby clinic.

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