Bill Harvey: Dry cleaning
Author: Bill Harvey
As fans of Dorothy L Sayers may know, the truth ‘is like a cow. If you stare at it long enough, it will go away.’ I’ve been doing a lot of in-practice assessments lately and have again noticed two familiar trends.
The first is a somewhat hazy relationship between some trainees and newly qualified ECPs and facts and evidence. The importance of giving out good, up-to-date advice is part and parcel of primary care practice. Knowing how to explain and reassure is essential, as is (with a nod to recently deceased Donald Rumsfeld) knowing what you don’t know but know who might. Problems arise when facts are assimilated verbatim and reiterated automaton-like, often irrespective of context. Classic examples include advising an elderly patient with dense yellow crystalline lenses that UV specs will stop damage to the macula. How does that work, then? Another is the giving of dietary advice with little reflection of clinical trial data. My favourite, however, has to be the preaching of why an asymptomatic patient must start using ‘lid hygiene’ and ‘lubricants’. Asymptomatic symptom relief. And where there are symptoms, drops tend to trump any suggestion to stop staring at a screen for hours on end without blinking.
The second thing I have noticed is the need by many, upon finding out a patient is over 70 years of age, to talk to them as if they are an idiot. Cognitive decline may be common, but many of our current elderly have stories and experiences from former years that would blow most young people’s minds. In fact, discussing past conquests and shady dealings without the need to patronise can be very effective when a patient’s short-term memory loss is a cause of frustration.
In the week where trials begin on an early cancer detection test, I wonder if we will see talk again of routine retinal screening for amyloid to detect dementia early. The point might not be to cure, but offer earlier and better planned support.