@drgrumble are you going to 'come out' soon? :) I think you might!
So read the tweet from @amcunningham. Yes, Dr Grumble is on twitter. A waste of time? Not really. Teaches brevity you see. Only 140 characters. It's a good discipline. Could change the character of this blog.
Long ago Dr Grumble decided against posting anything about patients. It is a great shame. In his initial naivety, Grumble was hoping to post the odd clinical vignette based on real but anonymised cases. For a while he did. To preserve anonymity he changed the details of the cases he had seen to make them unrecognisable. Genders, ages, dates, places and ethnicity were all changed or randomly allocated. It didn't work. Sometimes the details were tweaked so much that comments would be made pointing out some inconsistency that didn't exist in real life but arose because of the disguise. Then there was always the possibility that while nobody could possibly recognise the patient, the GMC might think that the patient could be recognised from the information provided or, if the case was rare or had some unusual twist, the patient might recognise themselves. Dr Grumble's anonymity was a part of trying to keep his patients anonymous.
But there are other reasons for having a nom de plume. There are other people whose identity you might want to conceal: friends and acquaintances for example. Take yesterday. OK, it might not actually have been yesterday but let's say it was. Yesterday Dr Grumble had some friends around. One had not long ago had her 60th birthday and she regaled us with the tale of her pooh sample. For those of you without a 60-year-old in the family you may not have grasped what this is all about. Once you reach your sixtieth birthday, if you are lucky enough to live that long, you will receive a letter, not from the queen, but from the NHS. It will tell you that you are to be offered a pooh test to look for bowel cancer. Just as you have come to terms with this, a little pack will arrive in the post with the testing kit and instructions. The first challenge is to catch your pooh. You cannot let it plop into the loo. That's not allowed. Somehow you have to catch it. According to Grumble's friend an old ice cream container works well. Your poohs will turn out to be heavier than you expect. You crouch, do the business and catch your plops. Those of you familiar with German loos will know that this is a smelly experience. You then take the sticks, kindly supplied by the NHS, and spread your pooh in the appropriate cardboard window. Two spreads from different parts from each motion. And you do this three times. As Grumble's friend said, it makes a new meaning of the phrase Poohsticks. But the funniest thing of all, if any of this is funny, it that they give you an extra special envelope to send your sample back in and, just after you have sealed it up (no, you don't have to lick it), you will read on the outside "Business post".
After you have tested your pooh, you get an invitation to have some sort of a check-up at the GP's. It is done by a nurse. Just what the nurse does Grumble does not know. Probably she tells you to stop smoking and takes your blood pressure and things like that. In the case of Grumble's friend she discovered an irregular pulse. Good you might think. But it wasn't atrial fibrillation it was just the odd ectopic. This is something that Dr Grumble would have dutifully recorded and would not even have told the patient. But Grumble's friend was sent to the hospital where she had numerous tests paid for under payment by results and was then told there was nothing to worry about. Very costly one would think.
Since Dr Grumble has been tweeting he has had a few contacts with the great and the good, the powerful, the odd celebrity even. No less a person than Alan Maynard tweeted about how nurse practitioners could do some of the jobs of GPs. Mrs Grumble, who used to be a GP does not share this view. Clare Gerada concurs tweeting that there is no such thing as a trivial consultation - which, interestingly, was Mrs Grumble's exact point. It's annoying when management types claim to know more about a job than the people who do it. Many of us will know of some nurses doing doctors jobs who cost more than they save. The same has been shown of some GPs doing consultants' jobs. Dr Grumble generally avoids such anecdotes because he doesn't want to cause upset. In any case, Grumble is employed. He needs to keep his employer sweet. His employer wants more healthcare assistants to do nurses jobs, more nurses to do doctors jobs and more GPs doing consultant jobs. Pointing out that this is not always the right way forward is unwise. Nurses for nursing, doctors for doctoring, GPs for general practice, consultants for consulting and managers (not doctors) for managing is not the way you are allowed to think any more. But that is what Grumble thinks and that is just one reason why he is going to stick to his nom de plume.