THE DANGERS OF AUTO-INFLATION

By Blair Smith
Contact the editor by e-mail at christopher.johnstone@ntlworld.com

Today was my big day! After surgery, I would hot-foot it south to honour my invitation to dinner with the biggest shots in medical academia, hosted in the grand lap of luxury. I had made it - at last, I would be on the inside, looking out (or down) at those not invited to this annual gathering and subsequent inclusion in the Big Time. I sensed the excitement early, as I selected my sharpest shirt and silkest tie, wearing these to the Health Centre, whence I would depart in my Limousine directly after seeing my last fortunate patient. As I arrived at work, I brushed off the admiring glances, aware that my well-groomed sartorial magnificence was not that to which our Peterhead clientele was habituated, but secretly absorbing this evidence of my new status. I wondered if there were any vacancies in Harley Street.

But that was for later. First I had a surgery to conduct, lives to improve, strokes to prevent, and QOF points to score. My second patient showed me two unusual lumps on his scalp, recurrences of previous swellings. Cystic, I thought, and worth aspirating for laboratory identification. Through with the nurse, my probing syringe filled with purulent fluid, and my hypothesis shifted to a more abscess-based diagnosis. The nurse responded to this change by handing me a scalpel and ethyl chloride spray. Summoning my surgical testosterone, I incised, both boldly and transversely, and then squeezed tentatively.

Alas, not tentatively enough! It was a blinding moment, like a flash of light, a blow to the head, or a slap about the chops with a crowbar. A sudden and unexpected fountain of pus had spurted profusely from the (now confirmed) abscess under my gloves, up the front of my oh-so-sharp shirt, the full length of my face and into my carefully coiffed hair. What a disaster! Desperately trying to maintain an air of undeserved competence in front of my patient, I finished draining the lesion, and washed my face. The nurse was physically incapable of applying a dressing, as she was combining the doubling up in laughter with professional poise - a remarkable series of contortions, and one for which I am unlikely to forgive her. I had to have a shower before seeing my next patient, and stop to buy a new shirt between house-calls. The only saving grace was that, somehow, the purulent cataract had missed my tie, which, tucked at an unlikely angle, served to conceal the track lines until the end of my surgery. My eventual appearance at dinner was bedraggled, my appetite was dulled, and my artificially inflated pride was flattened, incised and drained.

I concluded at least two lessons from this: (1) never exaggerate or imagine your self-importance - it's false and you'll only end up with pus in your face; and (2) always wear an apron.

Of course, there have been plenty of opportunities to learn the former lesson in the past - general practice is a rich source of such tuition. Incorrect diagnoses in the face of certainty, rebuffs from consultants after confident referral, curses from patients after strenuous clinical efforts. Despite our years of undergraduate and postgraduate training, and systematic collection of degrees and diplomas, we still spend much of our professional existence swilling around in containers filled with various body fluids. When we do a good job, it's unlikely to be noticed, but a bad job attracts more attention than an elephant dropping in a drosophila colony.

Which is probably why GPs themselves are so (a) difficult to impress, but (b) down to Earth. A colleague of mine was invited to Number 10 to receive an award from the Prime Minister in recognition of his services to primary care medicine. In a manner that would remind you of mine at the beginning of this page, he told his partners in the Practice. "But," they said, "how are you going to cover your duty-doctor session that afternoon?" Another colleague was late for a meeting at the House of Lords because his last patient had delayed him with a tirade of complaints and abuse at his perceived mis-treatment. "One minute I'm discussing policy with the intelligent ruling classes," he told me, "and the next I'm being told to f*** off by people who don't know what they're talking about". I'm still trying to work out whether he got this the wrong way around.

Similarly in Scotland, auto-inflation results in nothing other than ridicule. Scots are unfamiliar with pretension, tolerate it unwillingly in others, and favour in-comers by stripping them of theirs (isn't that right, darlings?). Scots rarely tell you they are excelling, just doing "nae bad". When the great operatic tenor, Luciano Pavarotti, was on tour across Europe and hailed in every city for the master that he was, we knew that he was loved in Glasgow by the fact that his soubriquet was Fat Pav. Whereas elsewhere this would have been an insult, this honorary leveller was as high a complement as he could have been given here.

When I was preparing for my first experience as an oral examination candidate, I was advised that a good way to feel less daunted was to imagine the examiners sitting on the toilet, because everyone does (except the Queen) despite the obvious indignity of the pose. Twenty or so years on, as I am ranked on the opposite side of the table, I need to remember that the candidate has probably been given similar advice. Therefore, while I may be basking in the presumed awe of the student, the image from the other side may be somewhat more lavatorial. The dangers of auto-inflation.

Again, I am reminded of the excellent advice given in the Royal Navy Leadership Handbook:. "Those who are truly great have no need to boast; those who are not have no right." Perhaps, if I'd recalled my rightful place in the latter category, I would have avoided the dishonourable discharge that sprayed my face in surgery today. Incidentally, the dinner was good, but the lesson in self-pride was more memorable. And Ashley, our laughing nurse, tells the story to anybody who will listen. Thanks!

Other hoolet online articles by Blair Smith can be found at:
hoolet edition 49 - Ethics and Repression in the Bloo Toon
hoolet edition 48 - May The Best Team Win
hoolet edition 47 - Hunting Pink Elephants
hoolet edition 46 - Predictive Texting
hoolet edition 45 - Role Models
hoolet edition 44 - Time To Go Killorglin'
hoolet edition 43 - Salt and Shake
hoolet edition 42 - Stepping up the Pace of Life
hoolet edition 41 - Smoking out the Irish Question
hoolet edition 40 - Not Cricket
hoolet edition 39 - Anniversaries and Predictions
hoolet edition 38 - Is There Life on Mars?
hoolet edition 36 - Onwards and Upwards
hoolet edition 35 - Goal of the Season‘s Greetings
hoolet edition 34 - Chickens and Eggs
hoolet edition 33 - On Shifting Goalposts
hoolet edition 32 - Period Zero
hoolet edition 30 - Annual Appraisal
hoolet edition 29 - Working Towards Scotland's Healthier Children For Us All 2020 and A Framework for Maternity Services in Scotland
hoolet edition 28 - In Memoriam Admiral Byng. A cautionary Tale

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.