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Nothing gets past the nose of an experienced GP



‘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