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Working as a boarding school doctor

Dr Fiona Cornish on the rewards and challenges of her sessions at a choral school

Dr Fiona Cornish on the rewards and challenges of her sessions at a choral school

"Could you bring an extra hepatitis jab?"

The message comes through just before I set off for my weekly visit to a local choir school, where I am the school doctor for the 40 boarders.

Matron produces a list of boys for me to see, and they whirl in from lunch or lessons.

I see an ear infection, an injured ankle, a headache: mostly the type of problem seen in an ordinary GP surgery.

Then it's a discussion with matron about other problems- the boys are going abroad on a choir tour and one has troublesome enuresis.

Sometimes one has to engage the brain at a higher level than autopilot.

An 11 year old boy presented a year ago with pain in his leg after sport.

As a mother of three boys, I am used to mud covered children with minor sports injuries, who usually recover quickly. However, in this case, he had returned twice with his leg pain and finally the penny dropped that he might have something more serious going on.

X rays of his hip showed Perthe's disease and he was referred to an orthopaedic surgeon. He was off games for several months but is now doing well and has returned to sport.

If the school specialises in singing or performing, one needs to become familiar with the occupational hazards.

The nightmare for choristers is to develop vocal cord nodules and be unable to sing in a service broadcast to millions worldwide.

Too much shouting, especially on the games field, is not good for the vocal cords, but normal boys like to shout. So when his voice becomes hoarse and high notes become impossible, it is off to the friendly local ENT consultant for a laryngoscopy.

If the verdict is nodules, then voice rest is essential until they have regressed.

Being a school doctor is a very interesting outside job to combine with general practice.

Experience of children, especially one's own, is essential.

Otherwise no specific qualifications are required apart from a practical approach, a sense of humour and good grasp of common sense.

The extent of the job is a variable feast, ranging from a weekly visit for 40 boys in my case to 12-15 hours a week for a doctor working in a large boarding school.

Other aspects of the job, apart from seeing the pupils, include advice on public health issues; outbreaks of nits and impetigo are an institutional nightmare.

There is also travel advice for choir tours or school trips abroad and dealing with the wider school community including all the staff.

The key to successful working is a good school nurse. She will deal with all minor illnesses and filter the significant problems through to the school GP. So teamwork is vital.

Diplomacy is a useful skill too, as there are the inevitable telephone calls to concerned parents beginning "Matron tells me that you said..."

Quite reasonably the parents need to be fully involved and informed about any medical treatment which is suggested or necessary.


Help at hand
If you are wondering how on earth you know what to do in those unexpected or unfamiliar situations, which inevitably arise in general practice or school doctoring, the usual answer is to turn to The Handbook of School Health.

This is the bible of school doctoring, published by the Medical Officers of Schools Association (MOSA).

The handbook is both an everyday source of reference and an up-to-date view on medical and administrative issues.

It covers adolescent problems, communicable diseases, sports injuries, as well as child protection and safety at school.

If, heaven forbid, you are ever asked about swimming pool disinfectants, the information is there. MOSA also has an excellent website, mosa.org.uk, and an interactive section where members can discuss current problems.

Topics can range from contraception in mixed sixth form boarding schools to management of meningitis outbreaks. MOSA holds regular meetings for school doctors and nurses.

It also gives guidelines on remuneration and specimen contracts for school doctors.

All pupils are registered as NHS patients with their school doctor.

For large schools, say with more than 400 pupils, the doctor may be paid on a sessional basis in line with the rates of pay appropriate for a part-time occupational physician.

These rates are available from the BMA and are revised annually. For smaller schools, MOSA and the BMA recommend a "per capita" fee and it is common practice in many schools for these charges to be passed onto the parents.

Obviously no fee can be charged for any duty which is covered by the NHS. The exact fee is a matter for negotiation by the medical officer and the school.

There are no obvious disadvantages to the job of being a school doctor.

Rising above embarrassing moments is what GPs do every day, so experiences such as the New Boy medicals are no different. Boarders in their first term, the boys assemble in their dressing gowns. There is much tittering and giggling as I arrive. "You know she has to look at your willy", one whispers to another.

We all survive and the occasional undescended testis is identified.

It is rewarding to build up rapport with the pupils over the five years at school, just like any other patients, and then one becomes more involved and informed about the school.

Building up rapport with the school nurse is another reward of the job.

An outbreak of impetigo might sound a disaster, but is certainly an opportunity to be seized and enjoyed by an efficient school nurse.

Boys are inspected, sheets and towels are boiled, boxes of tongue depressors are imported for controlled application of topical antibiotic. It is a joy to observe such high standards of proper nursing!

And my final patient of the weekly session is the caretaker, who has come for that hepatitis jab.

I try to look nonchalant as I struggle to find a pin prick sized area of skin which is not covered in a lurid multicoloured tattoo. And it's done. He hasn't even noticed!

Dr Fiona Cornish is a GP in Cambridge

Dr Fiona Cornish

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