A lot of money is spent by health authorities to encourage people - women especially - to come forward for screening. Advertisements run regularly in the media extolling the benefits of presenting yourself for tests, even if you feel just fine.
The traffic seems to run in just one direction: it's good for you. But across the Irish Sea, members of parliament at Westminster have been calling for a more balanced presentation of the facts. Their important Science & Technology Committee (sorely lacking at Leinster House, where scientists and technologists are thin on the ground), has accused the National Health Service of poorly communicating the risks of screening. They want those responsible for testing to be completely honest about dangers, and for women to be given informed choices rather than simply being cajoled into line. Over-diagnosis is the major worry. One study suggests that for every life that is saved by breast screening, three women have to have treatment for a cancer that would not have proved fatal if untreated. To save the lives of a few people by screening, you may have to severely disrupt the lives of many more. A lot of women will accept that risk. But we are simply not making things clear in advance. Financial institutions have to include riders at the end of their advertisements explaining some measure of risk. Perhaps our health screeners could be encouraged to do the same.
The Medical Protection Society is a not-for profit organisation that insures a third of a million doctors worldwide against being sued. One of their medical advisers issued some interesting advice recently to Irish doctors about social media, and how doctors should conduct themselves on it. The main message was that doctors should never "friend a patient" on social media, and that if a doctor has an online relationship with a patient, then it should be "strictly professional". As I write, the sound of a hundred clicks on the 'Unfriend' buttons of Facebook ring in my ear. Doubtless the same finger-wagging moralists were around a century ago to advise doctors against frequenting public houses, playing golf with their patients, and having relationships with ladies from bordering counties. If Twitter is good enough for the Queen of England (@BritishMonarchy), and the Pope in Rome (@Pontifex) then what can be the harm of the odd doctor (@mauricegueret) taking good advantage?
Addictive clove sweets
Somebody left a jar of clove sweets in the house recently. I have been dipping in, and confess to finding them mildly addictive in middle age. Now I grew up not far from a dolly-mixture emporium called Mrs Byrne's in Rathfarnham. It was one of those old-fashioned newsagents with rows of sweeties in huge glass jars behind the proprietor, just above her cigarettes. On the counter, there was a silver weighing scales and an array of small brown-paper bags. The powder and sugar of a quarter pound of lemon sherbets filled my dental cavities at least once week. She had red clove drops, but I never liked them much.
They reminded me too much of the dentist. Last week, I found out why. While sucking on a clove rock, I decided to complete my education on this most exotic of boiled sweets. Cloves are the flower buds of a tree that is native to some unpronounceable islands in Indonesia. We know that cloves can be a bit spicy, and can be added to dinners, desserts and drinks to liven them up a bit. Bold boys around the world have also been caught smoking cloves for generations. Medicinal uses of clove oil have included the elimination of flatulence and the eradication of worms.
But its principal use has been dental. Cloves are a good source of a chemical called eugenol, which not only helps to seal root canals, but also has local-anaesthetic properties. This is why your mouth can feel numb or full of pins and needles as you suck on clove sweets. And is the very reason they remind me so unhappily of paediatric dentistry.
Many years ago, I did a one-day locum for an ageing lady doctor. I simply couldn't find anything, for it was the untidiest surgery I ever had the misfortune of working in. The mouldy contents of the surgery fridge would have provided enough penicillin to cure an army of pneumonia. It came as a shock to me, as I was brought up to believe that men were the messy creatures who needed to be kept tidy and in check by our betters from the opposite gender. But perhaps the lady doctor was simply unwell. She retired soon afterwards. I did ask recently for the waiting-room observations of patients, and one particularly shocking reply stood out. Eileen has a lady doctor in a county town, but has decided to move on. This is what she told me. "My GP's waiting area is small, with odd chairs - some leatherette, some cloth. Small children wipe their noses on them. There is a corner for toys that have never seen Milton. Cheap, small coffee table, piled nearly two-feet high with old magazines thumbed to death. Receptionist looks like a weekly showerer. It's a new building. Need I say more? I'm moving on." Poor Eileen. Things are unlikely to improve when under-sixes get free care from July. Dr Leo reads this column, so you can expect him to announce unannounced waiting-room visits from HIQA to all GPs in the very near future.
Waiting Room Survey
My annual Waiting Room Survey continues and I welcome all your observations, good or bad, to email@example.com or by post to me at PO Box 5049, Dublin 6w. We'll anonymise everything so no public naming and shaming. Yet!
Dr Maurice Gueret is editor of the 'Irish Medical Directory'
Sunday Indo Life Magazine