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BRITISH BROADCASTING CORPORATION
RADIO SCIENCE UNIT
CHECK UP 6. - Chronic Resolutions
RADIO 4
THURSDAY 01/01/05 1400-1430
PRESENTER:
BARBARA MYERS
CONTRIBUTOR: KEITH HOPCROFT
PRODUCER:
ANNA BUCKLEY
NOT CHECKED AS BROADCAST
MYERS
Hello and a happy and a healthy New Year. I hope you're feeling well, despite the possible excesses of last night because with GPs' surgeries now firmly closed you may be regretting not seeing your doctor sooner. It's a long festive break if you've got those niggling aches and pains and maybe you've been worrying for some time now about what might be wrong with you. Perhaps you're putting off making an appointment because you're embarrassed about your problem or because you don't want to bother the doctor when of course they're overstretched at the best of times. Well whatever the reason that you haven't quite got round to seeing your GP the doctor will see you now, no appointment necessary. We've had a lot of calls and e-mails in advance for this special New Year's edition of Check Up and here to answer them all is Dr Keith Hopcroft. He's a family practitioner and a columnist for The Times, where he's often found to be taking a rather wry look at doctor/patient relations.
Keith, since it is New Year I wonder if you want to come up with any resolutions, perhaps on behalf of your patients?
HOPCROFT
Well yes I have a small number of resolutions I'd like to make for my patients. First of all, I would rather like them to stop bringing lists of symptoms - shopping lists are fine, symptom lists I'm afraid aren't.
MYERS
I thought you were supposed to, what's wrong with a list if you're a patient?
HOPCROFT
Yes, I mean on the one hand I can understand why patients who bring lists think they're using time properly and being organised and being thoughtful but I have to tell you - and I'm letting you into a secret here - that if you pull out your list we GPs say it's a declaration of war. The problem is we have 10 minutes and really that's not enough time to do more than one or two problems justice. So the truth of it is we're trying to be constructive, if you bring a lot of problems - and patients sometimes say look I don't come often, so I've brought a list - as though they're doing us a favour and I understand they're trying to do that but what it means is we're cramming a lot of problems into a short space of time and we end up doing justice to none. The technique men have is slightly different - they tend not to bring their list, what they'll do instead is they'll talk to you for about 10 minutes about their very interesting cold and you're wondering actually why on earth are you here but they're just sizing you up trying to get confidence and it's only when they're leaving - this is why we call it the "hand on knob consultation", they've got their hand on the door knob - that they'll suddenly spill the beans and say actually while I'm here could you do anything about my little problem down below. And the trouble is your 10 minutes has gone then so either you have a very rushed consultation or we try and bring you back and you may not come back. So just come straight out with it.
MYERS
Anything else?
HOPCROFT
Secondly, I'd like them just to think about being prepared - thinking what perhaps they might need to bring with them to the appointment, such as a urine specimen and so on. And finally I think I'd also like them to say or rather stop saying "while I'm here", which is one of those things we really don't like to hear. I realise all those things sound a bit negative ...
MYERS
Quite so.
HOPCROFT
... yes, I'd want to stress all I'm trying to do is point out that consultations are stressful, they're very time pressured and I think if they take note of these resolutions they're going to make the most of their consultation.
MYERS
And if they do bring a urine sample not to bring it in a whisky bottle...
HOPCROFT
Yeah it's very disappointing for GPs around Christmas and New Year to think they're getting a lovely bottle of whisky and find it's actually a quart of urine - it's a disappointment.
MYERS
Well we don't want to put anyone off going to the doctor because that's really the theme. When to go to the doctor, when it's worthwhile, when you're not really bothering the doctor, in fact he'd be happy to see you?
Well let's go to our first call now and it's someone who wishes to anonymous and I think I probably know why. What's the problem?
ANONYMOUS CALLER
Well I'm speaking on behalf of a friend of mine actually who has been to her GP regarding the problem and she suffers from wind and flatulence, which when I'm out with her also can be embarrassing for me, as well as her. Her GP has no answers at all and suggests she goes to see her pharmacist and the pharmacist suggested charcoal and she did try those and it helps a little bit but not completely.
MYERS
Well this must be one of those classic embarrassing problems that people don't like to tackle the doctor with. On the other hand I guess we all pass wind one way or the other, we don't like to think about it too much, it's not that social but then again these are the realities of life Keith.
HOPCROFT
Yeah I think we do all pass wind - that's absolutely true - and it is something that patients do bring along to their doctors, there's no reason for anyone with that problem to feel embarrassed. Of course I don't know how many people are out there suffering who don't come along to see me. But I'm almost ashamed to admit I'm a bit of a flatulence expert in my own way because I have written a couple of articles about this, so I ...
MYERS
What's your theme?
HOPCROFT
Well the theme was to look at where the research has led us and what's the effect of treatment. It's very, very interesting to look back and discover that in fact most of our knowledge about flatulence was derived from the NASA space programme - this is absolutely true - in the '60s because NASA was very, very worried about the build up of hydrogen in the spacecraft.
MYERS
Is hydrogen what we're talking about when we're talking about flatulence?
HOPCROFT
There's a mixture of things, the really nasty one is sulphur actually, if you really want to know, but that's ...
MYERS
That's the smelly one.
HOPCROFT
... that's the smelly one, but that's only present in small quantities but it only takes a little. But they were quite seriously worried, not only that there would be a pretty bad smell by the time the astronauts got back but there could be dangers in terms of explosions and so on and so forth. So there's been some very interesting research and information that's arisen from that. Another interesting fact is the fact that the average healthy male will actually pass wind 25 times a day, which I'm no mathematician but I think that works out about once an hour and I understand this programme's half an hour long, so we've got a 50/50 chance of a bit of a problem.
MYERS
We'll watch out for that.
HOPCROFT
But moving on to the medical side of this. I don't suppose you know if your friend has any other symptoms in terms of her bowel or in particular if she's on any medication at all?
ANONYMOUS CALLER
I think the only thing she's on is thyroxin but that's the only thing as far as I know.
HOPCROFT
The reason I mention that is it's very, very difficult usually to pin down a cause for this, it's nearly always dietary and we can talk a little bit about that. But sometimes people are caught out by the fact they don't realise medication can cause this as a side effect.
MYERS
What medication could cause it?
HOPCROFT
Any medication but there are one or two in particular that are notorious. There is some medication that diabetics are given which is notorious for causing the problem. And perhaps even more commonly you'll no doubt have heard of the treatment statins, which are becoming kind of de rigour, they're the new aspirin and they often can cause wind as well. So it's just worth bearing that in mind even if it means continuing with the medication, sometimes it's just nice to know what the explanation for the problem is.
MYERS
Now I think caller you mentioned charcoal has been suggested, I think - what the idea that that somehow absorbs the gases in the bowel so that you don't pass as much wind, does that help?
HOPCROFT
That's right, the evidence is pretty poor that it does, it seems to help in some people but actually 9 times out of 10 the key thing to get across to people is this is not a sign of disease. If there are no other symptoms, particularly diarrhoea or weight loss, then the chances of this being related to any serious illness are absolutely zilch. So that's reassuring and that's all that some people want to know. In terms of managing the problem there's no easy answer. Unfortunately it does boil down nearly always to issues about diet, which I know won't be that stunning to people but this is the answer in nearly all cases. What tends to happen is the carbohydrates in the diet that don't get absorbed go right down into the lower bowel where there are bacteria that live there, they live there normally, and they actually ferment and they release these gases. But it's a very idiosyncratic thing - different people can be affected by different foods. I mean we all know about the stories about beans and so on and that's absolutely true but it's a very much an individual thing. So at the end of the day what most patients actually have to do and it sounds a bit bizarre but is almost to keep a flatulence diary, so they keep a diary of the days that are particularly bad and they write down what foods they've eaten and they try and link up and it's just a bit of detective work. And virtually always that will actually lead to some resolution of the problem. It won't cure the problem because as I say we all have to do it and in fact in Holland a few years ago there was a campaign to encourage people to break wind because it was thought to be healthy. I'm not suggesting we necessarily go that far but I'm saying don't worry too much, take a look at the diet, keep a sort of food flatulence diary and a bit of detective work and she'll probably be able to piece together what's actually causing her the problem.
MYERS
So really there is a message there about lightening up about this, we needn't be sort of terminology embarrassed if you pass wind in company, I suppose you just say - oops pardon - or just sort of ignore it do you?
HOPCROFT
Absolutely, totally, utterly normal.
ANONYMOUS CALLER
Well apart from the utterly normal it's embarrassing for the other people though.
MYERS
They look at you do they, they think it's you?
ANONYMOUS CALLER
Exactly.
HOPCROFT
I always find blaming the dog sorts it out quite well.
MYERS
We will leave that subject, quite enough for a Saturday lunchtime, thank you very much indeed for your call. Let's move to another caller who's waiting to speak to us. And Tracey is on the line from London, hello Tracey.
TRACEY
Hello Barbara.
MYERS
And your question please.
TRACEY
Well I generally don't like going to the doctor anyway and usually I just go for something very specific and usually the pain's gone by the time I get to the doctor. But this is one that I've had for a while and I'm loathe to go to the doctor, I'm generally more tired nowadays than I used to be when I was younger and I don't know whether it's because I'm middle aged really or whether I've got some serious thyroid disease.
MYERS
Now there's a bit of acronym isn't there for patients coming into surgery ...
HOPCROFT
Oh you know about that do you.
MYERS
... who are tired all the time.
HOPCROFT
I was just going to announce that to the nation. There is. We call it - it sounds terribly derogatory Tracey and it's not meant in that way at all but it looks a bit derogatory, it's called TATT - T A T T - tired all the time. And the point behind the fact that there's an acronym is that it's such a common complaint for GPs. This won't solve your problem but it might put it in a little bit of context. There's been studies done on the population where they've actually just randomly asked people do you feel that you have adequate energy or do you tend to feel tired and the interesting thing is one third of the population at any one time when asked will actually complain of feeling tired. Now that, as I say, is not to dismiss your symptom out of hand and it's something we can go into more but it does make the point that actually you're in good company and the more flippant amongst doctors sometimes suggest that if people don't feel tired they're probably not trying hard enough.
MYERS
Well I think after last night probably the one third would be three thirds of the population feeling rather tired. Is it simply a matter of not getting enough sleep Tracey?
TRACEY
I do sleep quite well actually. I mean what I find nowadays is that I'm capable of - I'm not tired all the time, I'm capable of working really, really hard but then when I stop working I'm just like dead really and I didn't used to be like that. So is it age?
HOPCROFT
Well I mean age can be one factor. I'm interested that you mentioned thyroid because one of the issues GPs have is obviously we have a fairly limited amount of time to try and sort out these problems and tiredness is terribly difficult. If I have student with me and I ask him to list the number of causes I'd expect him to come up with at least 30, if he's any good. So it's very, very difficult to actually sort out a definite answer, not least because often there's a number of factors - age can be one. But I'm interested you mention thyroid because one of the questions we GPs like to ask, which kinds of cuts to the chase a little bit, is what are you worried that might be causing your tiredness, so I'm interested you mention thyroid. What made you mention that?
TRACEY
Well I was hoping it wasn't age.
HOPCROFT
[Laughter] Is that right, so you'd have another thing to explain it away to.
TRACEY
I thought you might be able to cure it.
HOPCROFT
As I say, to sort it properly requires quite a long consultation but in essence when patients come along to the GP what we would be trying to do is categorise it into one of a few categories. Number one is, is this patient ill, i.e. do they have a disease? Now thankfully that's actually very unusual. Thyroid is a possibility and there are others that we'll know about such as diabetes and anaemia but they're very, very much the exception, particularly if the complaint is just tiredness with no other symptoms. If the person has lost weight or occasionally with thyroid gained weight, then that does raise other possibilities. But the patient who has just tiredness with no other physical symptoms and a normal weight very rarely has any physical disease. So that's the first kind of category. The second category, and again I'm talking more generally here now rather than about yourself specifically Tracey, is depression. Now the truth is that depression is very, very common, and patients will tend to come in and they don't sit down and say doctor I'm depressed, or at least not usually, they will usually say something along the lines of I'm feeling - I lack energy or I sleep easily and so on and so forth. So that's another fairly significant category. Probably the biggest category though for tiredness is simply - we call it multifactorial - lifestyle issues - in other words the various stresses and strains and issues around life that can actually drag us down and make us feel tired. So we're usually looking at things like rushing around, being a bit stressed, not having enough hours in the day to relax and to wind down properly, perhaps not doing enough exercise, maybe not sleeping terribly well, maybe not sleeping regularly, having what we call poor sleep hygiene, which means things like having a nap in the evening because you're so tired that you feel you can't do anything but have a nap, that then affects the quality of sleep that you have the next night, even it's not the quantity and then you feel exhausted the next day and so the cycle continues. So very often it's a number of factors here. It's a perfectly reasonable thing to take to your doctor but what I would suggest is it's very much the exception to walk in to see your doctor and then to walk out with a cure.
MYERS
So when people say well there's no point going to the doctor, in some ways that's because they're pretty sure that they have perhaps some social or other problems that won't be solvable - you can't give an instant treatment for it. But actually should you go anyway if only to air it and to share it perhaps?
HOPCROFT
Yeah I think it depends on your agenda. If your aim is to go and be cured then I have some sympathy with the view there's no point going to the doctor, this is why the chemist actually stocks the shelves with vitamins and tonics, they don't do any good other than a placebo effect. If on the other hand it's crossed your mind that you knew someone who was tired and they turned out to have some illness so it's causing you a worry or people are saying that you seem down and there may be more to it than meets the eye then absolutely we're happy to see people. And we do say there's rarely a surgery goes by without me seeing a patient who complains predominantly of tiredness.
MYERS
Thanks for that Keith. A quick e-mail now, from a lady, doesn't want to be names, fair enough. She has, what she calls, an embarrassing growth on the end of her nose. What could it be? That's quite vague, is that the sort of vague symptom that people often mention? I guess if you saw her of course you would see what it was and that's a good reason for going.
HOPCROFT
Does she specify how long it's been there?
MYERS
Doesn't say anymore.
HOPCROFT
Okay, no yes I suppose that it's an interesting and important one because - do we have an age on the lady, I think ...
MYERS
She's in her middle age.
HOPCROFT
Yes that's right. I think the message here is just because something is in an embarrassing position and therefore you might deem it embarrassing, for goodness sake don't hesitate to take it to your GP.
MYERS
You might deem it cosmetic and therefore think well I'm only worried about it because it's on my nose and it's highly visible.
HOPCROFT
Absolutely right but that's one issue but the general rule is if you've got a skin problem, and a typical story we're hearing and sometimes you generally need to look up and see what's going on, but the story we hear - I've got this thing on my face, it just won't heal and it's been there and it's slowly getting bigger - that needs dealing with. Very often nothing too sinister - there are things called rodent ulcers that are very, very common on the face, can be dealt with very, very easily, it sounds like it could be, there's lots of other things it could be but it could be one of those. But the message is even if you think we're going to view it as purely a cosmetic problem you might be surprised, we might say actually that looks - you think that looks quite trivial, if we left that for years and years it may get bigger and may be a problem, best to deal with it. So that kind of story you go along to the GP, embarrassed or not.
MYERS
Another point on that is because this is something that's been there for a little while it's difficult to know when to go to the doctor because of course now you can't book an appointment with your doctor in advance for a routine check, you have to make your call in the morning and you get an appointment on the day, which of course is very good in many ways but people find it very off-putting because which day will they make their ...
HOPCROFT
Yeah and I acknowledge that totally and utterly, we doctors are terrible because if you come along within a few days of a symptom we'll say goodness me, you've come so early, it's impossible to say exactly what's wrong here, you've got to give this a bit of time to let it develop. And then of course if you give it too long to develop you'll come along and we'll tell you off for leaving it too late. So I accept that patients can't win, it's finding that happy medium.
MYERS
Let's go to another call, we've got Joe Finn. Hello Joe Finn, waiting to speak to us, what's your question please?
FINN
Hello there.
MYERS
Hello.
FINN
Yes, one of my problems is frequency - number of times going to the toilet, overnight, particularly.
MYERS
Is this to pass water?
FINN
To pass water yes.
MYERS
Right.
FINN
Sorry. And I've been treated by my GP with first of all a - to open up the tubes, I'll put it that way - I don't know which particular part it's working on - to increase the flow, although as far as I was concerned the flow wasn't particularly difficult. But the other thing that the GP has come up with is it's a sort of bladder syndrome. Now I've started off on one of these tablets and then increased it to two and whilst it seems to have had some effect it's still not very happy situation because I'm up something like five, six or even seven times in the night to go to the toilet, so to pass water.
MYERS
Well you'll be joining Tracey with tired all the time syndrome if you're not careful, if you're not getting a good night's sleep. Can I just ask roughly what age you are?
FINN
I'm 70.
MYERS
Okay. Keith what would you say, having to get up several times in the night to pass water?
HOPCROFT
Yes, hello Joe, sorry to hear about the trouble you're having. Can I just briefly ask you - it sounds to me as though your doctor is saying this is a prostate problem?
FINN
Well actually this is one of the things that I particularly - niggled me about the comments - the first thing that people say is it's a prostate problem. Well whilst there may be a minor blockage the problem is not the slowing down of the flow but it's the frequency of it.
HOPCROFT
Yes absolutely. Everything that sort of passes urine in the night is not necessarily prostate, in fact women suffer as much from getting up in the night ...
FINN
That's right, I realise that.
HOPCROFT
... as men and I've never met a woman yet who has a prostate, so clearly there's more to it than prostate. So one of the things doctors will do when a man comes along with this kind of symptom, absolutely prostate is there in the list but there are other things as well. So some of the tests that we tend to put people through - blood tests, the examination, urine tests - these are done not only to confirm prostate trouble but they're also done to exclude other problems because there are other issues that can cause this problem - bladder infections, stones, sometimes medication. So you're absolutely right, first of all, that there are number of other issues. Having said that, and I don't mean to be rude about your age, but in a gentleman of your age over half of men do suffer from prostate swelling - it's as normal, if you like, as going grey or losing one's hair.
MYERS
Can you say before you go on, both for me and for Joe, just a little bit more about the prostate then because you hear - you often hear it pronounced as the prostrate.
HOPCROFT
The prostrate - and the prostrate it ain't. Yes it's the prostate, with no extra r, the prostate it's a gland that sits at the base of the bladder, it produces various fluids but it sits at the base of the bladder, it's normally the size of a walnut and as I say in about half of men, as they get older, it enlarges, it swells and that has to effects and this is another thing I was going to come on with - to you with Joe. By swelling, yes it can block the tube and therefore cause a decrease in your flow but it can produce another completely different set of symptoms because by swelling it can press on the base of your bladder and by doing that it produces, what we call, irritative symptoms. Now the irritative symptoms are like irritable bladder, going much more frequently than usual, often passing small amounts and getting up at night as well. So an enlarged prostate doesn't just reduce your flow, it can produce exactly the symptoms you describe. And I'd also point out this is completely separate to prostate cancers - we're not talking about prostate cancers here, completely different issue.
MYERS
Joe, thanks very much and of course you're our first gentleman caller in the programme today, I wonder if that's a reflection of the fact that men are less willing generally to go forward to the doctor. Do you find that - what's the proportion in your own surgery Keith?
HOPCROFT
Well it's actually a really interesting question and I'm not sure that it isn't a bit of a myth actually because if you look at the - certainly at the extremes and children and elderly men there's really very little difference in terms of attendance. When you look at the sort of 15-50 age group there certainly is this discrepency but when you subtract out things like women coming along for smears and pills and breast checks and gynaecological problems and so on, you actually take that out of the equation, there's actually not such a huge difference as you think. So I think it's become a little bit of a cliché - this men avoiding the doctor. Some certainly do, there are certainly some individuals who should come along sooner and get themselves sorted out but I don't think they're quite as backward about it as we like to suggest.
MYERS
Right. I don't know if there's a quick one word answer to this one, let's try it, it's a message from - well someone who doesn't want to be named, fair enough: I suffer with itching in my bottom and inside the anus. Ointment soothes it for a while but it returns. Is there a better treatment?
HOPCROFT
Not in one word but in just one sentence perhaps. Really common problem, we see it loads and loads of times, don't feel embarrassed going to the doctor, it's never anything sinister, almost never anything sinister. The answer is some cream that your doctor or the chemist can provide and almost bizarrely - wet wipes - which is no reflection on this individual's hygiene but it's a vicious cycle of inflamed area getting sweaty and a bit mucky, particularly after going to the toilet - wet wipes, fantastic - you can carry them in a little plastic case for use after you go to the toilet, that plus cream will solve this problem. It tends to recur so you may need to go through that process again. But that will solve the problem. That was a long sentence.
MYERS
That was fine. Itchy bottoms now itchy feet - we go to Tim. Hello Tim.
TIM
Hello.
MYERS
And your problem is itchy feet I think.
TIM
Yes I think athletes foot long term.
MYERS
But you go to the doctor you get an ointment?
TIM
I kind of don't really like to bother with that. I've been to pharmacists, I've been through Mycota, Mycil, Meliculate [phon.] I got in South America, Daktarin was the last one...
MYERS
Oh any number of ...
TIM
... I'm self-treating with but nothing seems to work.
HOPCROFT
I think the pharmaceutical companies will love you Tim for what you're doing. Can you just tell me a little bit more about it - how long have you had the problem and is it on both feet?
TIM
Both feet, basically the little toe area between the little toes. Something like 40-ish years on and off.
HOPCROFT
Oh goodness me.
TIM
I mean I won't say it's never gone away, it goes away with Mediterranean sun and sand for a week but it's back the next week.
HOPCROFT
Okay and is it spreading right throughout the sole of your foot or ...?
TIM
No, no, no it's basically confined between the little toe and between the toes.
HOPCROFT
Okay that's fine. It does sound like athletes foot. Sometimes people get horrendous problems and it actually spreads to the whole sole of the foot and it has this remarkable appearance - we call it moccasin foot because it looks so dreadful, obviously doesn't sound like that's happening to you. But it can be an intractable problem, we don't fully understand why. It's a fungal infection, some individuals seem very, very prone to it, it does tend to recur. Most of the treatments you've suggested are effective but as you've noticed they recur. A couple of tricks that might help you are to continue with the treatment even when it seems to be better because the spores remains there for a good week or two and also to treat the groin area because the fungus tends to remain there as well and will spread from one place to another, even if you can't see a rash there. Failing that if it's driving you completely barmy there are other treatments that the GP can prescribe - there are tablet treatments - rarely necessary but if it is really causing you a problem then more powerful treatments can be the answer.
MYERS
So pharmacy is not a bad first stop for something like this but then to the doctor ...
HOPCROFT
Yeah, it depends how much it's bothering the person, if they just want advice and want to know it's nothing that they need to be concerned about, it's not going to cause any long term harm, the answer's no, no, no and no, everything's absolutely fine. But if it's driving them nuts and they want to see if there's any other option clearly after 40 years it's not going to be anything sinister but the GP may well be able to come up with something else, there are other treatments available.
MYERS
Hope that helps. We've got another question, hello are you there.
ANONYMOUS CALLER
Yes.
MYERS
I gather that you put off going to the doctor with your problem for some time, what was the problem?
ANONYMOUS CALLER
The problem was facial hair. It's something I've struggled with all my life, since my late teens and I never thought about going to a doctor because it's not an illness, until after I retired and I found a wonderful electrolysis practitioner and she said - have you ever talked to your doctor? And I thought oh. So I went along and she was very dismissive, she just said - oh well, it's too late, you're too old and there's nothing we can do. I felt rather foolish actually.
MYERS
Oh well that's very unfortunate - to go to the doctor and to be made to feel rather foolish when you've got a problem that you've been struggling with and maybe you haven't been able to do anything but is that fair?
HOPCROFT
Absolutely. I guess what's coming across here is the issue that the doctor will view it as a cosmetic problem. I mean as it happens the real specific treatment for your problem is the one that you're having, I'm a little surprised that your therapist sent you along to the GP, given that you've had the trouble for so long. But I am sorry that you felt that you had such a dismissive approach.
MYERS
Okay, well thank you very much for sharing that, it would be a real problem, wouldn't it, if people - we've been encouraging them to see their doctor appropriately and they go and they find that they're not really very welcome. Keith, why do you think it is that patients often don't go to see their doctor, they're almost worried about - I don't know - perhaps getting on his wrong side or somehow his opinion of them matters rather a lot?
HOPCROFT
Yes I understand that and I mean I'll come absolutely clean I'm probably giving more aware than I should here, that there are a tiny minuscule number of patients who we refer to as "heart sinks", they're very much the exception and there's only one of a number of reasons why patients may be labelled like that. But I tell you'd have to work extremely hard to become a heart sink patient. We're quite happy to deal with pretty much any kind of problem brought any number of times, particularly if it's getting worse and you will not get yourself a reputation nor worry that we're going to be judging you.
MYERS
Well you started Keith with some resolutions for patients, how about some New Year resolutions to end with on behalf of doctors?
HOPCROFT
Yeah I think it's only fair we should balance that out and I do have a brief number of resolutions for us GPs, to be fair to you all. One would be not to keep you waiting so long in reception, although of course that may well relate to the number of patients who bring us the lists. Another would be - and this applies I think to hospital specialists perhaps even more than GPs - is to use patient speak, rather than jargon, I think hospital doctors in particular are guilty of using words that really the average patient can't possibly understand and we're often in the role as GPs of being translators for these things. And finally I think we GPs should really make an effort to stop putting everything down to viruses, although most of the time it is.
MYERS
Thank you very much indeed. Surgery is now closed leaving me time just to thank our callers and e-mailers and to thank Dr Keith Hopcroft for his time and expertise today. I'll be back with Check Up at our more usual time - that's Thursday afternoon at 3 o'clock to take your questions about stomach ache and indigestion.
ENDS
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