You don’t need to look out of the window, assuming you have one, to know when the seasons are changing. As we slip in to what will hopefully be a long, hot summer, we can don our entomology capes and leave a gallon tub of factor 50 in the waiting room to prepare for the annual surprise that befalls our nation as the sun makes an appearance and biting bugs reappear.
It’s always a close call in my consulting room as to who is more surprised and perplexed at this time of year – the patient or me. I am sometimes looked upon as though I have proclaimed Meghan Markle to be an illegal love child of Donald Trump, when I suggest that it might be difficult to identify the perpetrator of a rapidly vanishing pinprick sized red spot on the victim’s beautifully glazed forearm.
‘What do you think did it doc?’ is the usual plea. This is where our years of training are at their most helpful, drawing on our experience, dealing with diagnostic uncertainty and living with the consequences…
This is a GP who knows his stuff and can distinguish an arachnid from a beetle
‘Could be a bite,’ I nod knowledgeably, ‘possibly a sting’, I frown with concern, or ‘maybe even a spot’, I add to the differential. I suck in my breath cautiously, weighing up the options – should I contact 111 and arrange for an immediate air ambulance, or are we safe to manage this in-house? I gently enquire: ‘Have you been in contact with any of our more dangerous native creatures such as the midge, money spider, or Coccinella septempunctata?’
This usually prompts them to shudder, averting their eyes from the offending limb to look at me in a new light. This is a GP who knows his stuff and can distinguish an arachnid from a beetle, a GP who didn’t come away from working down under without a comprehensive understanding of the dangers of little critters. I like to take my job seriously, and although others may not view this as a core GMS service, I would argue that a working knowledge of our crawling and flying friends is essential.
It strikes me at this point the common ladybird is not only part of the differential diagnosis, but also representative of the NHS as a whole. How so, I hear you ask?
Count the spots. Seven, you will find. Now look at the key principles that guide the NHS. Seven, no less.
This is no coincidence – the ladybird – beautiful, slightly functional, a bit flighty, scary at times and not overly efficient. This is the NHS in a nutshell. We love the organisation, and although we find it a bit cumbersome and inefficient we would be lost without it, or at least without its guiding principiis septem.
This is how my thoughts wander on a Tuesday summer’s morning; I suppose it keeps my mind off the occasional ludicrosity our job throws up, and helps me to maintain my sanity as I look out at the summer haze, dreaming of diethyltoluamide.
Can’t wait for Autumn.
Dr Richard Cook is a GP in west Sussex