When I started working as a GP, one of the most difficult daily tasks was signing sick leave notes.
I had no training for this and the problem was not simply signing the form and establishing the diagnosis, but also judging how much rest time the patient needed before being able to work.
This wasn’t a big deal when a patient had suffered a clear and obvious problem, such as pneumonia or after a heart attack, where there is a fairly standard recovery period of a few weeks or months.
Sometimes one would feel there are other unspoken issues, including, it must be said, an inclination to make profits, writes Dr Martin Scurr.
The difficulty arose when the patient was not eager to go, was not desperate to return to work, or, it must be said, seemed inclined to continue receiving benefits (more on this below).
These patients would be in a state that would not slow most people down, and very often you would feel that there were other problems not mentioned.
All of this was even more difficult when the problem was poor mental health.
As doctors we have no diagnostic tests, much less criteria to assess the degree of a patient’s disability or suffering, or how long it might last.
The only guide is what the patient says he feels. And then add the fact that, as a primary care physician, you are on the patient’s side, you are his advocate, you care about him, and you hope, and even fight, to help him return to good health and function.
That’s why it’s hard to question what they say they feel, to say no, even when you know they could really go back to work.
For this reason, I understand how we could have ended up, as we are now, with an astonishing increase in the number of people without work due to long-term illnesses, with a record number of 2.8 million people, as doctors like me claim. I could have signed on the dotted line.
Some outside the profession might say it’s a box-ticking culture; It’s quite the opposite, it’s about doctors putting the patient first, and that means trusting them instead of judging them.
Proposed changes to sick leave outlined by the Government last week, which would see doctors no longer tasked with providing it, are therefore welcome.
This will now be a task for specialist work and health professionals who will not have to face the unpleasant challenge of judging whether those with anxiety or mood disorder – and without a formal diagnosis – are capable of working, without any emotion. involved.
But let’s return to the other issue, known to professionals as “plumbus oscillans”, the change of direction.
A few years ago, I was on a chairlift during a short ski vacation and found myself sitting next to a man younger than me, possibly in his 50s, with a wrist in a cast.
I told him that I thought it was pretty heroic to go up the mountain with a broken wrist, even if it was getting better, and he responded by telling me that six weeks earlier he had had a hip replacement.
I was surprised that he was thinking about skiing.
But he said he was fine and wanted to make the most of his time off, as he had a sick note for two months and was determined to enjoy the break (pardon the pun).
Couldn’t he have returned to his workplace?
I would have thought so. But if I had complained to him, I would have been seen as a spoilsport, and this supports, once again, the fact that patients need to see doctors as if we were on his side and not as his disciplinarians.
My relationships with my patients are highly valued and often hard-earned. I do not wish to threaten the warmth and trust in me as a doctor and counselor that would come from having to keep an eye on public finances.
It’s hard enough having to ration our medical research and prescription costs without having to think about the country’s welfare bill.
I prefer to leave the oversight of that to other experts.
I sweat so much after exercising that I’m soaked
I am a healthy woman, recently retired, who rarely gets sick. However, she was slightly overweight and now trains and swims about four times a week, but although her extra weight has disappeared, she sweats a lot during exercise; At the end of the workout I am soaked. It’s embarrassing and I’m also worried it may be related to a medical issue.
Julie Smith, Blackpool.
One of the most common triggers for sweating in an older woman is menopause, in the form of hot flashes.
Dr. Scurr responds: Congratulations on losing that extra weight – a lesson for others.
Excessive sweating or hyperhidrosis is common. The first step is to determine whether this is primary excessive sweating, when there is no obvious cause, or secondary sweating, when it is due to an underlying and potentially treatable condition.
One of the most common triggers for sweating in an older woman is menopause, in the form of hot flashes. Decreased estrogen levels affect the control mechanisms of the small blood vessels in the skin, causing random bouts of sweating, usually at night, but often also during the day, even when the woman is at rest.
Excessive sweating can also be related to anxiety, certain types of medications (such as steroids), and problems such as diabetes and an overactive thyroid.
But in your case this happens only after intense exercise. He also appears to be in good health, no longer overweight, exercising regularly, toned, and enjoying his exercise regimen.
I suspect that what you have is simply a normal physiological variant of sweating after exercise, and that perhaps this is new to you due to your recent increase in activity.
You’re not alone; I’ve been running with other people who experienced intense sweats, while some of us barely perspired.
As you say, it’s embarrassing; but since this is the only symptom,
It doesn’t seem to be due to an underlying diagnosis; rather, it seems to be part of their constitution.
Ten years ago I had a heart attack, after which I was prescribed numerous medications, including aspirin. But caused me gastric problems
They switched me to clopidogrel. Recently, I have been having difficulty swallowing dry foods (such as sandwiches or cakes) and was wondering if long-term use of clopidogrel could be the culprit.
Sylvia Honey, by email.
Dr. Scurr responds: Like low-dose aspirin, clopidogrel is prescribed to reduce the viscosity of blood cells called platelets. This improves blood flow and reduces the risk of clots forming in blood vessel walls that have already been damaged by the buildup of cholesterol deposits.
The atorvastatin he is also taking (mentioned in his longer letter) helps minimize further cholesterol buildup, and this drug combination has helped keep him free of further heart problems over the past decade.
But like aspirin, clopidogrel can have serious side effects (chief among them, bleeding from the stomach lining) and it is not unusual to experience blood loss when taking it, although it is usually too small to cause obvious changes in stool (heavy bleeding). , usually emergency, which causes black, tarry stools).
But over time this can lead to iron deficiency anemia and low levels of hemoglobin (a red blood cell protein vital for carrying oxygen around the body).
A consequence of this lack of iron is Plummer-Vinson syndrome, which affects the muscles involved in swallowing.
This syndrome creates a network of membranes that partially obstructs the upper part of the throat. One theory is that iron plays a key role in controlling the renewal of the cells that line the inner surface of the throat, and that without enough, this process goes haywire and excess tissue forms.
This reaction is more common in women and develops gradually over months or years, but can be reversed with intravenous or oral iron supplements.
Speak to your GP, who will be able to order blood tests and may also be able to suggest alternative anticoagulant treatment.