What does the Doctor Think? September

Blancmange: Does anyone out there like blancmange? Answers on a postcard please. I love it and I have very fond memories of primary school Christmas parties circa 1950 to 1954 when each child would arrive with a pudding bowl full of jelly or blancmange with a strip of elastoplast on the bottom of the bowl bearing the name of the owner. I suppose we had other food, such as sandwiches and cake, but I can remember nothing but the joys of blancmange, either strawberry or chocolate. Those were austere days of school slates and knitted dusters where I was brought up and blancmange was a great treat. If I mention blancmange nowadays, anyone under 50 years of age thinks I am talking about Angel Delight, which is totally different, and anyone over 50 seems to hate the stuff and would rather eat gravel. We are going to be on holiday with some of our grandchildren during the Summer, one one of them will have his first birthday during that time. I have promised to provide blancmange for the party in the hope that I might be able to interest some children who are, as yet, not prejudiced against the stuff. Paracetamol: There has been much confusion recently following a few clinical trials which declared that paracetamol was virtually worthless. As the drug is one of the workhorses of General Practice, either alone or in combination with other drugs such as codeine, this caused consternation, especially as most of the trials concerned only young people. This week's British Medical Joural has looked at all the information and has reached the following conclusions:  Introduced into UK medical practice 1956, it is the most widely used and prescribed drug in the UK, generally considered to be safe and effective at the normal dose (up to 8 a day).  It is an effective mild analgesic (dental pain, headache, etc). Its effectiveness in the common cold is questionable; it may have a small benefit in hip and knee pain but it is of no use in back pain.  It can cause liver damage at doses of more that 8 tablets daily and, if given in pregnancy for more than a week or two, it can lead to the birth of a boy with tiny testicles.  The final conclusion in the article, which makes no reference to Paracetamol combinations such as Co-Codamol, is that, as Paracetamol is thought to be safe at the correct dose, we should try it first and move on to other drugs if it doesn't work - much what we have been doing for the past 60 years! Charging for missed appointments: There is always a lot of excitement about this topic; people work out the total number of missed appointments in general practice, multiply it by the total number of practices and conclude that donkeys of millions of pounds are wasted every year by people who cannot be bothered to cancel their appointment. I have always had really good patients and I have to say that this has never been much of a problem for me. Actually, I do not mind too much as there is always plenty to do at the desk and it gives me an opportunity to catch up. It is only irritating when appointments are in short supply and patients are clamouring to see the GP. Apparently, 79% of the general public think it would be a good idea to charge people for missing appointments. Many politicians agree but very few doctors, especially those like me who have been round the block a few times, will agree. Why? Because this is how it will go: GPs will be told to collect say £11.50 for each failed attendance Patients will bring out a variety of reasons for not attending, some reasonable, others fanciful. GPs may fall out with their patients and must pay extra admin staff to try to collect the fees (but all the money collected will go to the Government). Eventually, all GP appointments made will be reported centrally, the Government will deduct money for failed appointments from GPs at source and the onus will be on the GPs to collect the money to replace their lost income. Hence, mature GPs are not keen as it would cause endless hassle! In future, with technology, there will be other ways for patients to communicate with their GPs and this may help those who, for one reason or another, cannot always attend on time.

“What's the best thing about being 104 years old?” they asked. “No peer pressure” came the reply. I was getting a bit saggy so I joined a fitness class. I bent, twisted, gyrated, jumped up and down and perspired for an hour – By the time I had got my leotard on, the class had finished! I've had two coronary bypasses, a hip replacement, new knees, Diabetes, Prostate cancer and a mini stroke. My 40 pills a day make me quite woozy and subject to blackouts. My vision is OK but only if I look sideways. I have bouts of dementia and, at my age, I have lost most of my friends. Thank goodness I still have my driving licence. “Dad, I've been given a part in the school play. I'm playing a man who has been married for 25 years”. “Never mind, son, maybe next year they'll give you a speaking part”. Knock Knock “Who's there?” “Doorbell repair man”. An old lady was planning her funeral and had two requests. One, to be cremated and two, to have her ashes scattered in the local supermarket. Why? So that her daughter would visit her twice a week My memory's not as sharp as it used to be. Also, my memory's not as as sharp as it used to be. Best wishes to you all Ian Nisbet Best wishes to you all er..... er