Tuesday 25 April 2017

No cure, no fee

 

Illustration: Eorna Walton
Illustration: Eorna Walton

Now that our legal profession is learning the meaning of that obscure phrase 'value for money', Maurice Gueret wonders aloud how medics might follow suit

Two for price of one

I glanced at the office window of a solicitor recently and was delighted to see that the winds of competition are, at last, blowing through our second oldest profession. A prominent notice offered a free will with every house purchase that was put his way. Clever thinking, because your biggest financial transaction provides an ideal opportunity to think about who to saddle with your debt. It set me thinking about whether doctors are doing enough to make their services affordable in this epoch of austerity. Medicine has quite strict rules about advertising services to patients so I'm not sure if 'Ear Syringing - Two for the Price of One' might be a runner. Perhaps ladies on the contraceptive pill could be offered every fifth check-up free by having their coffee card stamped each visit?

'No cure, No Fee' might cause problems down the road for a profession that knows time to be the best healer of all. And I'm still waiting for the first hospital consultant that will pay for your first two or three hours of parking outside their clinic. If it's good enough for cinemas, then it should be good enough for operating theatres, too.

Poisonous partners

One hopes it's an unhappy coincidence, but there seems to have been a rise in the reporting of men poisoning their partners. One case that received a lot of publicity was the partner of a well-known children's author. He was found guilty of her murder by surreptitiously feeding her sleeping tablets over a long time. Last month, a Scottish man described as a 'Walter Mitty-type' husband was jailed for three years for secretly plying his wife with laxatives. Thankfully she survived, though I expect prison visits will be few and far between.

Sore bottom

An envelope has been passed to me that was addressed to the Sunday Independent's 'Rude Health Adviser'. That's a title that makes me nervous. But it turns out to be a genuine plea for advice in this column about a sore bottom. I cannot give individual medical advice, but the topic of the complaint is worthy of a general response. The elderly male reader has a 30-minute soreness 'between the crevices of my bottom' every time he does a number two. The complaint has been there for some time and temporary relief was achieved using Canesten Blue, a tube combining an antifungal cream with a bit of hydrocortisone. A very sudden, sharp, constant pain in the bum often signifies a hard, clotted pile, or 'thrombosed haemorrhoid', to give it its medical title. A pain only after defecation would hint at a fissure-in-ano, which is the painful equivalent of badly chapped lips at the far end of the digestive tract. Either way, I'd always recommend diagnosis and ongoing treatment from the family doctor.

Between hard stools

General practice is a medical sector where the number of young male doctors is in sharp decline. Older men can find the going tough with intimate complaints, especially when their nether regions require closer examination. Not all are up for it. An anal fissure is a tear to the skin of the back passage. Constant defecation makes some of them resistant to healing, and they can become fibrous. They are more common in men and the severe pain can cause a reluctance 'to go'. This causes stools to harden which only makes things worse. There are many treatments, including the use of laxatives, local anaesthetics, cortisone and nitrate ointments.

Surgery after referral to a colorectal surgeon is sometimes required in refractory cases, but it's not a decision to be taken lightly. Some success has also been reported in colorectal circles using injections of Botulinum toxin to prevent spasms.

Where's our register?

In November we'll find out what last year's census discovered about the nation's health. I'm not holding my breath. The health questions were vague in the extreme. Asking an entire population whether they have an emotional condition, trouble going alone to the shops or difficulty with pain will not garner a scientific response. If we really wanted a census to do some good, we could ask the population to say yes or no to organ donation. A recent UK survey found that two-thirds of people want to donate organs, but only one-third are actually signed up on the register to do it. In Ireland, courtesy of a moribund Department of Health, we don't even have an organ donor register.

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