I treated Sam for minor complaints. I didn"t see the domestic violence victim

Sam* started attending my GP practice at the same time I joined. She had no extensive list of medical conditions yet she had frequent doctors’ appointments for minor complaints – in summer she would come with a cold, in winter with hay fever and all year round with tiredness.

She startled easily if someone spoke too loudly or the telephone rang. When she once arrived five minutes late for an appointment, she had volunteered that there were no clocks in her flat, since they were a reminder of time spent away from loved ones.

Sometimes Sam would roll her fingertips on the old scars that spanned her wrists. I asked about those scars (and traced their criss-crossed pattern with my eyes) but Sam would shake her head and hide her arms.

We went on in this fashion for some years. I was no longer the new doctor. I stopped looking for things that probably did not exist. Then one year a medical student came to us on a placement. He was in first year and this was his initial encounter with patients. He was given the task of researching and writing about a patient’s journey. He spent the day with me: we saw people with heart disease, diabetes, headaches, depression and dementia. Somewhere between these 10-minute appointments, there had also been Sam, who had come in with “not a particularly memorable” sore throat. To my surprise the student chose Sam.

Sam was taken aback that the young student doctor wanted to write about her but bit by bit she told him her story and with her permission he wrote it down. A while later Sam and I read it together.

Samia was brought up in a small village in the Indian subcontinent. Her life was busy yet carefree. She wished that time could stop there – she was happy. But her parents felt she had crossed a marriageable age and were worried – perhaps even more so because they had other children and dowries to provide for.

By a quirk of fate, in the nearby village a man had come from the UK in search of a bride. Samia’s parents hoped their daughter might be considered because she was beautiful and they belonged to the same caste as this man.

Samia was chosen and the date was fixed for the marriage – a few days before the groom was to fly back. Forms for her passport and visa were secured to start the process of her leaving for Britain. The procession came and the marriage ceremony was performed, with Samia’s father spending a substantial part of his savings on the wedding.

The groom returned to Britain and Samia to her parents. She was happy because she would travel by plane for the first time. She dreamt of a beautiful place where lambs grazed on lush green hills. Her only sadness was that she would move so far away from her family, friends and even her animals.

Her husband did not ring her, but Samia and her parents assumed he was busy in his job. Eventually, she got a plane ticket and all of the family arranged a van to go to the airport to see her off.

Her husband’s parents received Samia when she arrived in the UK – he was not there. Her father-in-law told her that he was at work. The days passed, with her seeing her husband rarely. It was a big family. Eventually she learned he was living with someone else.

She was soon introduced to the work she was to do, which included cooking and cleaning. Her life back home was tough, but here it was hundred times worse. When she complained it was decided that she should be sent back but Samia could not go back. She would not be the cause of pain and disgrace to her beloved family, no matter how much she needed them in her despair.

Her refusal made the situation worse. The hatred became visible. Her husband hit her sporadically. On one or two occasions other family members slapped her too. She was humiliated repeatedly with bitter remarks. Samia’s father-in-law had incurred business losses since her arrival and she was blamed for that too. In the end when there seemed to be no way out, Samia attempted suicide.

Someone took her to the local hospital. From there she had gone to a women’s refuge, and then moved from city to city, refuge to refuge until she had come to us.

Samia tried to put her life back together. She got a divorce, found a job, a place to live and even made a few friends. But home was still several thousand miles away. She longed to be with her family but lacked the courage to turn up alone, divorced and with nothing to show for her parents’ efforts.

Samia and I both finished reading. That is how the story would have ended – except that it didn’t.

Our student left but Samia had started talking and healing. She told me about her scars, her childhood, her siblings, her parents and even her pet goat. She told me of her aspirations for a better life when she had come here and her disappointment when her hopes had come to nothing. But after despair had come fortitude and courage. Then I did not see Samia for a while – she had gone to see her family. That had been her happy ending.

Samia had needed space and time to open up and heal. At the beginning I had asked the questions but she had been too traumatised to talk. I then focused on her medical problems and fixing only what was apparent. Samia’s story made me realise that sometimes we all need a fresh perspective on the same problem, perhaps even more so when some time has passed. It can occasionally lead us to question our initial diagnoses.

*Sam is a composite of this GP’s experiences of patient care

• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here

If you would like to contribute to our Blood, sweat and tears series which is about memorable moments in a healthcare career, please read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more about issues like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

I treated Sam for minor complaints. I didn"t see the domestic violence victim

Why are people taking dental complaints to their GP?

Why are so many people going to see a GP rather than their dentist when they have problems with their teeth?

About 600,000 people a year in the UK who develop dental problems now visit a GP rather than going to a dentist, the British Dental Association revealed last week. That is roughly 11,000 people a week. The BDA, which represents dentists and dental students, blames the rising cost of dental treatment. It sees charges for dental treatment as “a tax on health”. It is also worried that such cases are adding to the growing pressures on already overstretched doctors and costing the NHS an estimated £26m.

In the last dental health survey, 26% of adults said the cost involved had been a factor in choosing the type of dental treatment they received, while 19% said they had delayed having treatment for the same reason.

Is this a new problem, perhaps caused by the NHS-wide financial squeeze?

Not exactly. In 2013, a Comres survey of 1,007 GPs across the UK found that “87% of GPs feel under increasing pressure from patients who are coming to them, rather than their dentists, for oral health-related issues”.

In addition, 96% of GPs want more to be done to discourage patients with dental problems seeking their help, Comres found.

Can GPs do anything to help?

Not really. People come with tooth pain, abscesses and other ailments. However, “GPs are neither trained nor equipped to deal with these problems, particularly those that require an operative intervention. GPs can offer pain relief or antibiotics, but will usually refer patients to a dentist”, says Henrik Overgaard-Nielsen, chair of the BDA’s general dental practice. “The overwhelming majority of these patients require root treatment or extraction, which GPs cannot provide. GPs can treat symptoms, not causes. Painkillers and antibiotics are never a solution to dental problems.”

For example, a patient with an abscess will often need the infection to be drained or the tooth taken out; GPs can do neither procedure.

Dr Maureen Baker, chair of the Royal College of GPs, agrees. “GPs are not dentists. Patients who are experiencing pain or discomfort with their teeth and/or gums should seek an appointment with their local dentist, not their family doctor. GPs are in no position, and shouldn’t be put in a position, to treat patients with dental problems,” she says.

How much are dental charges? Have they always existed?

Dental care was free when the NHS was created. However, that didn’t last long. In 1951, Clement Attlee’s Labour government, which had set up the service, brought in charges for dental treatment and glasses. That prompted Nye Bevan, who as the health minister had launched the NHS three years earlier, to resign because he felt that its key founding principle – that medical help should be free at the point of need – had been betrayed. In contrast, visits to GPs have always been free.

The BDA is worried that dental charges in England went up by 5% in April and are set to rise by another 5% next year. It claims the increases are designed to force patients to make up for diminishing amounts of government funding for dentistry – down £170m in England since 2010-11, from £2.2bn to £2.03bn.

Charges in England are much higher than in the rest of the UK. It costs £19.70 for an examination there, but only £13.50 in Wales, while such checks start at £6.68 in Northern Ireland and are free in Scotland. However, that £19.70 also includes diagnosis and X-rays or a scale and polish, if you need that.

One leading dentist refutes that this is too costly. “Twenty pounds for an appointment to sort out toothache? You need to decide where this sits in affordability.” But charges can go up quickly if you need fillings, root canal treatment or tooth removal (£53.90) or crowns, dentures or bridges (£233.70).

Many patients on low to moderate incomes get no exemption from dental charges.

How much do dentists earn?

Dentists’ average gross earnings in England and Wales were £155,100 a year in 2013-14. But that figure has been falling in recent years. After deducting their expenses, such as running their premises and buying equipment and supplies, their taxable income is about half that impressive-sounding sum – £74,400 a year. “I’m not saying we don’t make a reasonable living. But it’s no more than the average professional would be making,” the senior dentist says.

“Dentists’ incomes have fallen by 25% in the past decade,” says Overgaard-Nielsen. Plus, surgery running costs are mounting, especially owing to difficulties in recruiting dental nurses.

Would the nation’s teeth be in better shape if all dentistry was NHS-funded?

Dentists complain that NHS dentistry is a “Cinderella service”, its low status confirmed by the gradual scaling-back of government funding. Maintaining charges that deter at least some people on lower incomes is “feeding a false economy”, says Overgaard-Nielsen. “It’s cheaper for dentists to keep healthy teeth in healthy mouths than for GPs to offer pain relief or for hospital surgeons to perform extractions under general anaesthetic.”

Why are people taking dental complaints to their GP?

Cauliflower & Fennel Seed Soup for Digestive Complaints

Modern medicine and society’s reliance on pharmaceutical medications means that the natural medical benefits of food compounds are often overlooked.

Fennel seeds provide vital nutrients such as folate, potassium, and vitamin C, but they have also long been used to help ease digestive disorders.

Although scientific studies on fennel are limited, it is known that fennel seeds contain a volatile oil that has a carminative effect¹. This means that fennel seeds help to prevent the formation of excessive gas, and aid its removal from the intestinal tract. The seeds also have an antispasmodic effect², making them effective in helping to ease stomach cramps and nausea.

One significant scientific study has shown that components in fennel seeds can ease infant colic³, and fennel seed extract is a common ingredient in gripe water.

The carminative and antispasmodic effect of fennel seeds make them an excellent choice of an ingredient in this soothing recipe. This dairy-free soup can be sipped to ease digestive discomfort, bloating, cramps, nausea and other types of abdominal pain.

Creamy Cauliflower & Fennel Soup

INGREDIENTS

• 1 tbsp coconut oil or olive oil


• 1 onion, diced


• 2 cloves garlic


• 2 tsp fennel seeds


• 1 cauliflower head


• 400 g tinned butter beans, drained


• 800 mls vegetable stock


• 200 mls coconut milk


• Salt


• Pepper

METHOD

1. Remove the outer leaves and tough inner stalk from the cauliflower and discard. Chop the cauliflower florets roughly.


2. In a large soup pan, gently sauté the onions in oil for 10 minutes, being careful not to allow them to brown.


3. Add the fennel seeds and garlic and continue to sauté gently for another 5 minutes.


4. Add the cauliflower, beans and vegetable stock to the soup pan. Bring the stock to the boil and then simmer for 30 minutes until the cauliflower is very soft.


5. Allow to cool slightly, then add the soup and the coconut milk to the blender. Blend until very smooth.


6. Return the soup to the pan and season to taste with salt and pepper.

About the author: 

Sonia Nicholas is a Biomedical Scientist and Freelance Clinical Science Writer & Editor. She has been working in the field of clinical science for fifteen years.

Sonia believes that everyone can improve their health by eating a clean diet (a diet of unprocessed, fresh, whole foods) – a claim that scientific research increasingly supports.

All of the articles on The Green Apple Club website are evidence-based and fully scientifically referenced. Follow The Green Apple Club on Facebook for daily recipes and articles on food as medicine.

References:

1. http://www.sciencedirect.com/science/article/pii/S1878535212000792


2. https://www.thieme-connect.com/DOI/DOI?10.1055/s-2008-1074977


3. http://www.ncbi.nlm.nih.gov/pubmed/12868253

Cauliflower & Fennel Seed Soup for Digestive Complaints

Social media driving rise in complaints to GMC: report

Social media, particularly Twitter and Facebook, meant communities produced exactly where individuals could discuss their therapy and very easily exchange data on how to complain.

But the majority of the complaints from the public to the GMC have been not about individual doctors and had been about standards of care a lot more typically. These ought to have been filed to the NHS organisation responsible or to the Care Quality Commission, the authors explained.

In close to 1300 cases the GMC referred the complaint back to the doctor’s employer to deal with and in three,750 circumstances the complaint was looked into and right away closed. In some circumstances no person physician could be identified at all.

Patients had been normally puzzled about where to complain to, the report said and because the GMC was seen an independent, sufferers may possibly be far more willing to seek support there rather than the organisation where they knowledgeable poor treatment method.

All regulators had noticed an improve in circumstances, even so the rise was biggest at the GMC.

Dr Julian Archer, lead author of the report, stated: “The process of compiling this report has created some fascinating findings. They present that the forces behind a rise in complaints against medical doctors are hugely complex and reflect a blend of increased public awareness, media influence, the function of social media technology and wider adjustments in society.

“We found that while a much better awareness of the GMC has a part to perform in the improve in complaints, it did not automatically result in an improve in complaints the GMC were in a place to deal with.”

He additional: “The report also indicated that there is considerably to do to enhance the wider complaint-handling system, so that complaints manufactured by the common public about their medical doctors are directed to the acceptable authorities.”

Niall Dickson, chief executive of the GMC, explained: “We have no proof that the rise in complaints towards doctors reflects falling requirements – what this investigation underlines is that sufferers are more inclined to complain and discover it simpler to do so.

“Medical doctors also are much more inclined to increase issues about their colleagues. The challenge for the GMC and other organisations is to make positive that any person who has a concern or complaint can uncover their way to the right organisation to deal with it.

“For the vast majority of patients and relatives, that will suggest nearby resolution. The big variety of complaints we acquire that are not for us, suggests that the recent system is not functioning as properly as it ought to.”

Social media driving rise in complaints to GMC: report

NHS whistleblowers to air complaints with Jeremy Hunt

Mrs Chowdhury explained: “He says he supports whistleblowers but when it comes down to helping individuals like myself we find we are abandoned.

“We talk up for patient safety and we lose our jobs and often our careers.”

Mr Hunt has spoken in the past about the need to have for openness in the NHS and earlier this 12 months intervened in the situation of a whistleblower who was getting threatened with disciplinary action by Royal Wolverhampton Hospitals NHS Trust.

Mrs Chowdhury located in 2009 that consultants she managed at Ealing Hospital had been charging NHS sufferers for scans. They were also claiming for operating in their NHS posts when they were at their private practices.

But senior believe in managers shielded the consultants, accused Mrs Chowdhury of fraud and sacked her.

Mrs Chowdhury, who is now significantly ill with breast cancer, stated: “I am out of perform and may drop my property due to the fact I can no longer afford to shell out the mortgage loan. I require assist urgently.”

Others attending the meeting incorporate Professor Edwin Jesudason, forced out of his work as paediatric surgeon at Alder Hey Children’s Hospital, Liverpool soon after alleging that youngsters had died and suffered harm due to bad surgery.

Nurse Annabelle Blackburn, who was sacked soon after revealing that patient’s lives have been getting put at chance by a chaotically run GP practice in Oxford, and Dr David Drew, a paediatric advisor from Walsall, fired after exposing safety concerns on his wards, will also meet with the Health Secretary.

Joining them will also be Jenny Fecitt, sacked as a nurse manager for raising safety worries at an NHS stroll in centre in Manchester and Professor Narinderr Kapur consultant neuropsychologist and head of neuropsychology at Addenbrooke’s hospital in Cambridge, eliminated soon after voicing his concerns about patient safety.

A Division of Overall health spokesman stated: “The Health Secretary has agreed to meet a amount of whistleblowers to see how he can help.”

Fiona Bell of Remedy the NHS North East, who is assisting broker the meeting with the Overall health Secretary, explained: “Mr Hunt requirements to be observed to do anything concrete in addition to offering verbal support

“You cannot have a Secretary of State for Well being who says he supports whistleblowers and does nothing when they inquire him for support. Hopefully this meeting will lead to action.”

NHS whistleblowers to air complaints with Jeremy Hunt

Alcohol industry"s complaints about Television advert"s cancer hyperlink thrown out

The Globe Wellness Organisation classes alcohol as a Group one carcinogen, alongside tobacco. Photograph: Johnny Green/PA

Alcohol industry complaints that a tv advertisement linking consuming with an enhanced danger of cancer was misleading have been thrown out.

The Advertising Specifications Authority rejected soon after being presented with some of the big physique of evidence about alcohol and cancer danger. The British Beer and Pub Association and Campaign for Actual Ale were among 7 groups that alleged the ad breached the UK’s code on broadcast promoting.

The ad, which was broadcast in the north-east of England and developed by nearby alcohol campaign group Stability, showed a man in his kitchen preparing a meal. Right after taking a bottle of beer from the fridge and beginning to drink it, a small tumour was witnessed in the bottom of the glass. It grew with each and every sip he took, before sliding down the glass in the direction of his mouth.

Balance had spoken to medical professionals to make sure the commercial was not misleading or alarmist. It highlighted the reality that the Planet Overall health Organisation courses alcohol as a Group one carcinogen, alongside tobacco.

Colin Shevils, Balance’s director, stated the elements of the alcohol business that objected had been “highly irresponsible” in attempting to quit the public finding out that alcohol intake can enhance the risk of cancers this kind of as those affecting breast, liver and mouth. Surveys have shown that few individuals know that alcohol can be carinogenic, and not just for those that drink heavily.

Alcohol industry"s complaints about Television advert"s cancer hyperlink thrown out

Good public providers "poisoned" by poor dealing with of complaints, say MPs

Tory MP Bernard Jenkin, chair of the Commons public administration decide on committee. Photograph: Michael Stephens/PA

Good public solutions ranging from the NHS to regional government are also often currently being “poisoned” by inadequate managing of complaints, a cross-party group of MPs has found.

In a report commissioned right after the Mid-Staffordshire NHS scandal, the Commons public administration committee said many elements of the government have to get better at listening to complaints. It said the government total fails to conform to ideal practice on handling the public’s issues.

The report suggests that a Cabinet Office minister get charge of how complaints are dealt with across the government and there should be a single level of get in touch with for citizens to raise considerations about public services.

It said ministers should personally deal with complaints brought to their attention by MPs rather than delegate them.

Bernard Jenkin, the chairman of the committee, said: “As factors are, most folks feel there is no stage in complaining.

“Unless of course and till we have a culture of leadership in public providers that listens to, values and responds to complaints, from support consumers and staff, there will always be the prospective for tragedies like Mid-Staffs, and opportunities to enhance providers and public self-confidence will be missed yet again and once more.”

Good public providers "poisoned" by poor dealing with of complaints, say MPs

Pancreatic cancer charity"s ad could face investigation after 118 complaints

Kerry Harvey, the 24-year-outdated female who appeared in the Pancreatic Cancer Action, has because died

A controversial advert by a pancreatic cancer charity that showed patients wishing they had less a deadly kind of the illness could face an investigation after acquiring far more than a hundred complaints.

The Marketing Standards Authority will choose later on this week regardless of whether to launch an investigation into Pancreatic Cancer Action’s campaign right after criticism that it is in negative taste.

In the ad, a guy and lady, both with pancreatic cancer, are shown saying they wish they had testicular or breast cancer rather. Given that the campaign first aired at the start off of February, Kerry Harvey, the 24-yr-previous lady who appeared in the campaign, has died.

To date, the ASA has obtained 118 complaints about the advert.

The ASA will now judge regardless of whether the ad – which ran in regional press and online – has breached its promoting code on the grounds that it brought on the public “harm” and “offence”.

The damaging reaction to the ad is component of a expanding trend of complaints about charity adverts.

According to the ASA’s latest yearly report, the number of complaints about “non-business” advertising – the class in which charity adverts fall – grew 61% to 2,058 yr-on-12 months in between 2011 and 2012.

1 of the most complained about charity advertisements in current years, with 144 complaints, was a St John’s Ambulance advert that followed the journey of a guy diagnosed with cancer who underwent treatment method and survived, only to die due to the fact no one particular knew simple very first help.

Responding to the likelihood of dealing with a ban, Pancreatic Cancer Action stated the campaign had now completed and that it had no ideas at the minute to run it yet again in potential.

Ali Stunt, the founder and chief executive of the charity, mentioned the backlash to the advert had been “little in contrast to the constructive feedback we have been obtaining”.

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Pancreatic cancer charity"s ad could face investigation after 118 complaints