Thursday 26 April 2018

Rude health: The listening ear

Doctors at the end of stethoscopes are best in emergencies, writes Maurice Gueret, and not bosom pals on the phone

Medicine by mobile phone is not really medicine at all.
Medicine by mobile phone is not really medicine at all.
Dr Maurice Gueret

Around this time of the year, those of you who have not been priced out of the health-insurance market will be getting renewal notices by post, and phone calls from well-trained policy sellers. Irish hospital insurance is no longer cheap, but it is competitive. I call it hospital insurance advisedly. Despite all the bells and whistles added on to gather your attention, it doesn't cover everyday medicines, or, indeed, much health in the community at all. The latest wheeze is the 24-hour helpline. Once staffed by 'qualified' nurses, there is now a move to give you a 'qualified' doctor at the other end of the line. I think we can see where this is going. In a few years' time, you will be offered a choice of 24/7 'qualified' consultants in all sorts of specialities on the phone.

If the kids are hot, it will be a paediatrician. If Fido brings up his dinner, you'll get the telephone vet. But the elephant in the room is that medicine by mobile phone is not really medicine at all. Particularly when the person at the other end of the phone hasn't a clue who you are, or what your form is. First rule for practitioners offering telephone-based health advice is to cover the corporate gluteus maximus. Assuming they know it from their elbow. I'd rather switch my insurance to the company to come up with a granny line - a 24/7 wise old lady who has seen it all before. Or even a 'Trust Your Instincts' line which advises patients to go with their gut feeling and make their own choices. Much more useful than a clinical telephonist in mortal fear of a lawsuit.

The vineyards of Newry are gearing up for a bumper year whenever Leo's public health (alcohol) bill gets enacted. This new legislation will push your cheapest bottle of plonk up to almost €9, which will make very pleasant Sainsbury's own-label wines at £4.50 each seem like excellent value.

An old friend in County Clare has sent me another remedy, with plenty of recipes for creating your own wine.

It's a famous book called Wild and Free - A Guide To Foraging In Ireland. Encouraging the use of the ingredients that nature provides freely, it was written by Kit O Ceirin and her late husband Cyril, and was first published almost 30 years ago.

Wild and Free is now back in print, and it's available online from Home-made wines can be made using edible wild fruits and a few wild flowers, and the O Ceirins even describe how a group of nuns, who kept an old-folks home, used to brew Christmas wine using tea leaves. Beginners are advised to try traditional ingredients like apple, blackberry and elderflower. More advanced practitioners might try haw, furze and wild plums. Thirsty work, this book.

We were discussing the temperament required of a good surgeon recently, and I mentioned the fact that when I once needed delicate surgery as a student, I picked a surgeon who played the oboe. It is arguably the most difficult instrument in the orchestra, and anyone with the patience to play, tune and carve their own reeds for this contraption, is a person to be trusted in a storm. It has been said that oboe beginners have to develop a thick hide because it takes years to get any kind of pleasant sound from it. And families of young oboists survive the formative years by developing thicker skin in front of their eardrums.

Well, I had a letter from a nursing colleague asking whether the surgeon in question might have been the late Mr David Lane who passed away in October last. Indeed it was. She remembers him as a "great surgeon" who was very meticulous. Even when performing minor surgical procedures, he would always ask the patient if they had an allergy to iodine. She remembers hearing him playing the oboe at Sir Patrick Dun's Hospital in Dublin after his outpatient clinic had finished.

She said that he also had his own views on how to choose the best surgeon for your case. He told nurses once that if he ever needed back surgery, he would choose a neurosurgeon, because they were much more conscious of the importance of the spinal cord than other carvers. An obituary to Mr Lane paid him the ultimate tribute as the "surgeon's surgeon". He is missed by generations of patients and doctors, and by his fellow musicians in the Dublin Baroque Players and RTE Symphony Orchestra.

The nation is gearing up this year to remember 1916 with its Easter Rising and Battle of the Somme, but in our never-ending quest for military memories, other important anniversaries can be forgotten. One event took place in 1816 that had a profound effect on all diagnosis to this day. In that year, a young woman with heart disease was lying in bed at the Necker Hospital in Paris. She was so obese that neither placing a hand on her chest nor tapping out her ribs could elicit information about her heart. Her young doctor, Rene Laennec, felt a tad embarrassed about the prospect of placing his listening ear on her bosom, when he suddenly remembered a lecture on acoustics that described how the mere scratch of a pin could be heard distinctly at the other end of a tube.

Using a folded cylinder of paper, he gave birth to the stethoscope. In the early days, the tube was wooden and there was just one earpiece instead of the modern two. It revolutionised the diagnosis of heart and lung ailments, and later became essential to the monitoring of blood pressure too. Dr Laennec didn't live to see much of its success. Though he became a professor of medicine and subsequently went on to give the name cirrhosis to liver disease and melanoma to a skin cancer, he died of tuberculosis at the age of 45.

Dr Maurice Gueret is editor of the Irish Medical Directory

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