It's a funny old world and GPs shouldn't be afraid of cracking a joke every now and then, says Dr Leon Piterman
It’s a funny old world and GPs shouldn’t be afraid of cracking a joke every now and then, writes Dr Leon Piterman
Patients often present with troubling problems, however, despite their suffering and undoubted fears, many are still able to crack a smile and see the funny side of things. The same applies to the GPs who care for them.
It is said that “comedy is tragedy plus time”. In the context of general practice, the time taken for that transition from can be quite short. It is also not uncommon for GPs and patients, particularly those we know well, to share jokes. Of course, there are times when GPs see the funny side of things with their patients left wondering. Those are the funny situations we share only with colleagues, and possibly with friends.
Laughter is thought to be therapeutic. In the course of a clinical encounter it helps if both parties can laugh together. The following two stories represent reflections on humorous encounters with my patients.
The specimen
Bill was a 23-year-old man applying for a job as a forklift driver in a local warehouse. He was tall, blond, solidly built and had nothing of note to reveal medically. This was the first time he had undergone a medical examination, perhaps not so unusual for a healthy young man.
Most of my questions were met with a simple “no doc”, “yes doc” response. Included in the examination is the need to test a urine specimen for sugar, protein, blood. Having requested patients to pass such a specimen in the toilet and return the container to me, I saw nothing unusual in asking Bill to do the same. I pointed him in the direction of the toilet and handed him the plastic container and asked him to return the “specimen ” to me.
Normally I would expect the patient to return within minutes even if attempts to pass urine have been unsuccessful. After five minutes, and no sign of Bill, I began to worry. After 10 minutes I felt compelled to enquire as to his welfare. I politely knocked on the toilet door and asked ” Bill are you OK?”. A tremulous voice replied: ” Nearly there, doc”.
A few minutes later, Bill, looking rather flushed and with somewhat glazed eyes, returned the plastic jar filled with milky fluid. He had produced a semen specimen and not a urine specimen.” Is that enough doc? ” he asked.
How was I to explain to him that fertility is not a prerequisite for forklift driving? That the company was more interested in knowing that he is not diabetic or suffering from chronic renal disease than knowing his sperm count? What could I possibly say to Bill without embarrassing him and at the same time subduing my sense of humour about the situation?
Professionalism dictated that I keep a straight face and politely request a further visit to the toilet.
Concussion
For a period of time in the early 1980s I was the doctor to one of our elite Aussie Rules football teams. The game was not as professional as it is now and this applied both to the training methods as well as the level of medical intervention.
This was particularly relevant to the assessment and management of concussion, a frequent accompaniment of body-contact sports.
As a GP with basic training in neurology I was accustomed to asking simple questions to assess one’s mental state: the so called mini-mental examination. Who is the prime minister? Who is the leader of the opposition? What is the name of the Queen? What is 100 minus seven? And so on.
I was politely informed on a previous occasion by the team coach that these questions might not be appropriate for elite footballers with no interest in politics and even less in the monarchy, and possibly the only question they might answer correctly would be naming the leader of the opposition, as long as that question was referring to the captain of the opposing team.
Armed with this vital information, I prepared myself for the next encounter with concussion.
I did not have long to wait. The following Saturday one of our players received a serious knock to the head and remained unconscious for five minutes. After attending to his immediate medical needs I arranged the ambulance to take him to hospital for further assessment and a CT scan.
Armed with a revised schedule for a mini-mental examination I confined my question to: “Name two days of the week starting with T?” In a flash he replied: “Today and tomorrow“.
I learned that the last thing to be erased in a footballer’s memory is his sense of humour.
Leon Piterman is Professor of General Practice at Monash University and has been in clinical practice for almost 40 years
