Liam Farrell: Reflex response of no great value

In one of the Marx Brothers' movies - I forget which - Groucho is accidentally jostled by a lady.

'Excuse me,' she says politely.

'Why, what'd you do?' he fires back.

I saw this when I was young, and thought it to be the height of droll repartee. I am also very impressionable, so ever since, when anyone says 'Excuse me', I offer Groucho's reply.

However, I don't have the great man's comic timing, nor his disarming cheek, so I usually just sound rude and offensive. But, despite having earned a few thumps over the years, I cannot help myself; it has become a learned reflex, impossible to suppress.

It is curiously similar to another learned reflex of mine, which I suspect many of my colleagues share.

I cannot say 'FBC' without immediately following up with 'U&E'; the words simply trip off my tongue.

The U&E is not usually relevant, but I keep on ordering it just the same. I didn't understand electrolytes in college and I never will. Sodium comes in and potassium goes out, and then, apparently on a whim, potassium comes in and sodium goes out; the Loop of Henle was a veritable jamboree of incomprehensible and capricious ionic migrations.

I suspected the textbooks were making it up as they went along.

The only thing I remember actually understanding was that persistent vomiting may lead to a hypochloremic alkalosis. This little gem has, unfortunately, proved to be of no benefit in real life; when someone is vomiting I am usually more keen on keeping the puke off my shoes than correcting an errant acid-base balance.

Not that FBCs are much more helpful; let's be honest, a common rationale for ordering blood tests is to kick for touch. It keeps the patient happy and gives the feeling that Something Is Being Done; it buys us a little time until they get better on their own.

And all the little add-ons, are they really necessary? In all my years of practice I cannot recall many times when they were of any use in reaching a clinical decision. Memo to the NHS tsars; stop measuring red blood cell distribution width, platelet distribution width and basophil counts, save millions.

It will be tough, but we'll manage without them somehow.

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