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Fan mail: how one GP's extra legwork saved another from heartsink

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A couple of weeks ago, I was moved to write my first piece of fan mail to another doctor.

It wasn’t for a fancy diagnosis, but just for a wonderful piece of consideration for his patient and colleagues.As we all know, so much good medicine doesn’t hinge on remembering what different patterns of Anti-neutrophil cytoplasmic antibodies (ANCAs) mean, but on a bit of humanity. In my days as an A&E SHO, the most heartfelt compliment a senior doctor could pay wasn’t 'brilliant', or 'clever', but 'sensible'.

What happened was this. A lady had registered as a new patient, and I was the first doctor in the practice to see her.

She arrived with us halfway through being investigated for a collection of symptoms that could have had eight different causes, and she was able to tell me that her GP had already tried a few medicines.But she couldn’t recall the names of the medicines, or what her investigations had shown.

Usually this scenario could be the reference case for all future discussions of heartsink. The notes will have been sent via Birmingham, from where half of them will probably have been sent to landfill in Cardiff and the other half burnt in Exeter, and you’ll have to start again from scratch. You’ll also unwittingly try the same medicines her first GP did, and thrill her with the return of the ankle swelling/diarrhoea/rash that they caused the first time.

As I was preparing to trudge into this fetid quagmire, she remembered something. Her previous GP had posted her a letter when he heard she’d be moving out of his area. He’d said it might be helpful, would I take a look?

Opening the envelope, I didn’t know whether to fall off my chair, or grab her hands and do a little jig.

What I was holding was four pages long. The first two pages were handwritten, detailing what the presenting complaint had been, his initial thoughts, what investigations had been done (including a repeat potassium to confirm simple haemolysis in the first sample), and a couple of ideas of what he had been planning to do next. Attached were the lab results from all her bloods, and a printout of the radiology reports.

I’ve never known anything like it; I dictated a deeply thankful letter of reply, there and then. Twenty minutes of extra effort on his part had saved my new patient and I at least a fortnight’s frustration, as well as saving the NHS from having to shell out to duplicate his work.

So, fraternal greetings to that fantastic GP. Thanks again, and I promise to always do my best to emulate you. 

Dr Nick Ramscar is a GP in Bracknell, Berkshire

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