Ah, the summer holidays! A time when you’d expect your GP to be less grumpy than usual. After all, there are no flu epidemics, no bed shortages and no excuses for asking for a home visit on the basis that the roads are too icy for you to drive on, which presumably means that you expect me to deal with your cough by air-ambulance. But, no. The holiday season brings its own pressures to Planet Primary Care, with the result that we’re grouchy as ever, but hotter.
For example, a standard part of the holiday preparation ritual, along with stocking up on sun cream, seems to be a trip to the GP. Hence the “I know it’s only a cold but we’re flying tomorrow” scenario, the implication being that a forthcoming week in Lanzarote rewrites the laws of physiology. Then there’s the “I just want to be sure that I won’t be ill on holiday” routine, which shows a misplaced faith in the value of the routine check. Besides, Murphy’s law dictates that your heart attack will strike the moment you step off the plane, resulting in frantic faxes from your insurance company followed by a complaint from you based on my inability to predict the future.
Worst of all, though, is the cheery declaration that you’re off to hug some Amazonian trees and want to sort out your jabs, the slight problem being that you leave tomorrow. An immunisation schedule such as this takes half an hour to devise and a month to administer. The best I can do in the ten minutes available is to explain that, in case of any problems, the rain forest unfortunately lies just outside my practice area.
The tension of these consultations is heightened because some of the services, such as signing travel insurance forms, are not covered by the NHS. Your indignation at having to fork out money to your GP obscures the fact that the amount represents a tiny fraction of what you’ve paid for your holiday. Helpfully pointing this out, as I do, provokes a reaction, which probably means that I won’t be on your postcard list.
But my biggest problems occur when you return. The usual morning surgery suspects — fever, cough, diarrhoea, rashes — become more significant when you point out that you’ve just got back from Papua New Guinea. Such symptoms open up important pathological doors, specifically those to your local hospital for tropical diseases.
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We GPs are used to floundering, but bung in the possibility of imported illness and we’re in real trouble. Schistosomiaisis, trypano- somiasis, leishmaniasis. Treat them? I can barely spell them. And, while the old “It’s probably just a virus” line is normally an acceptable way of playing for time, it isn’t when that virus could be ebola.
Your cavalier approach to illness prevention abroad compounds the problem. When I ask: “Did you take your antimalarials?” you’ll inevitably answer in the affirmative. Because you took them in the sense that you packed them. But you didn’t take them in the sense of removing them from the packet and swallowing them. It’s a matter of interpretation.
No wonder these consultations drive me mad. So, who am I going to call? The tropical medicine consultant, of course. Except that, with wonderfully ironic timing, he’s on holiday. Which inevitably means that I have to turn you over to the local hospital so you become their brain teaser rather than mine.
Unless, that is, you have the one tropical disease that I can treat: the delightful “cutaneous larva migrans”.
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We GPs are used to patients’ florid descriptions of their symptoms to snap us out of our stupor, such as “It’s like a pneumatic drill through my temples”. In this case, though, “It’s like a worm crawling under my skin” is acceptable, because that’s exactly what’s happening. Some magic cream and, bingo, end of Alien scenario and I’m an heroic, clever doctor. Such victories are rare, though.
So, want some pre-travel health advice? OK, I hear Bognor’s nice.
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Dr Copperfield is an Essex GP. He also writes for Doctor magazine