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At the heart of general practice since 1960

Nothing gets past the nose of an experienced GP

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‘Who’s got the air-freshener? My room smells like a corpse marinating in fox s*it!’

Nothing generates a colourful description quite the way the odour of a necrotic leg ulcer does. Medical school was superb at teaching us to use looking, listening and feeling in the diagnostic process, but I think they underplayed the importance of smell.

Working on the coal face of general practice our olfactory lobes are relentlessly bombarded by the full spectrum of human niffs

Working on the coal face of general practice our olfactory lobes are relentlessly bombarded by the full spectrum of human niffs. It’s not just the obvious odours, like the patient who insists he only has ‘a nip before bed’, yet somehow still manages to smell like George Best after an Irish wedding. Nor the ‘virtually given up’ smokers who leave your room smelling like a 1970s theme pub for the rest of the morning.

No, it’s the aromas that hint more subtly at lifestyles that are the important diagnostic clues.

The elderly lady who reeks of cat litter trays and isolation.The whiff of stale kebab assaulting your nasal passages from the obese who ‘live on lettuce’. The ‘moody‘ teenager who hums like a Dutch coffee shop (can his parents really not smell that?). The expensive niff of a posh perfume on a patient, who according to your records, has been living on disability benefits for the last ten years.

Home visits though are the crack cocaine of the olfactory experience (tip for trainees: never wear a woollen coat on a home visit, you’ll be reliving the experience through your nostrils for the next week). Like a finely tuned Bloodhound, the nose of the average GP can explain away the ailments of an entire household the second the door opens.

Dogs - older kid’s allergies. Fags - younger kid’s asthma. Chips - dad’s high cholesterol. Strong urine - grandad’s confusion.

No, not much gets past the keen nose of an experienced GP.

Health ministers would do well to bear that in mind-yes we can smell your bullsh*t before it leaves your mouth.

Dr David Turner is a GP in west London

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Readers' comments (9)

  • Reminds me of a home visit to a confused elderly lady , on arrival could smell the cannabis fumes permeating through the wall of her terraced house from the soon to be discovered cannabis farm next door !

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  • I recall two pieces of advice from an elderly GP when I was a medical student.

    1. Always wash your own thermometer (they were mercury in glass in those days), it will save you enough to pay for your pension.

    2. There are some houses where its best to avoid washing your hands, they will be dirtier afterwards than they were before.

    In those days one might still occasionally visit a house where not only was a clean white linen hand towel put out for the doctor but also a new piece of soap.

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  • Another piece of advice I would like to pass on; never sit on a chair in a confused person's home. I was arranging an admission and had sat on the 'telephone chair' in the hall whilst talking to the hospital. I became aware of a disturbing dampness seeping up from the chair - you can guess the rest. I now use my doctor's bag as a chair wherever possible.

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  • I really could not stop laughing having read this blog ............A visit from Dr Watson.

    I had to once to do to a home MUR review only to find out that there were literally boxes and boxes of med that was being hoarded to taken away on a long ''holiday.''

    That Tena pads and leg bags were being not used just in case, because they were not freely prescribed on the destination of choice and this was the decision of both the patient and her carers.

    Just from the olfactory element the risk of a UTI was considerable.

    I let the GP know and he went ''ballistic''.........totally unsafe hoarding of medication and she did end up with a UTI.

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  • Don't be visible from the waiting area while you weild the Febreze! This can lead to a complaint being made to the Practice Manager as 'discourteous and unacceptable' on your part!

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  • I have a standard measure of risk. It's visiting the patients where you wipe your feet on the way OUT and not on the way in!

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  • Dr Watson or Sherlock Holmes?

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  • "Health ministers would do well to bear that in mind-yes we can smell your bullsh*t before it leaves your mouth."

    Make sure u take a air freshner when near Mr Hunt

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  • I so enjoyed reading this, I have not laughed so much in a long time. I experience all this in my nurse led clinics. I'm sorry to say I only believe half of what my patient's say about their lifestyles.

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