A whirling dervish at dispensing care

My chickens had fleas. Well actually they had mites, but it makes little practical difference. Eight legs or six, it's still too small for a serious argument and you need to treat it.

Saturday saw me reading the instructions on a drum of mite powder while 21 suspicious chickens eyed me cautiously. Possibly their hidden agenda was the worry about bird flu, but they didn't say.

'Apply powder to chickens one at a time,' said the tin. Dust chicken all over. Avoid inhalation. Piece of cake, thought I, who have taken appendices out after 72 hours without sleep; let the dusting and non inhalation begin. I seized a surprised chicken by the feet, and opened the tin.

The next 10 minutes were the stuff of farce. I attempted to dust the chicken. Unfortunately I had only two hands, and one was holding the chicken, now upside down and flapping frantically, while the other held the pot. The third hand which I required to dust the dust on to the flailing, furious bird was not available, it was on my children who were indoors playing on the Wii.

After a futile few minutes the chicken was undusted the others had gone berserk, and I had realised that the only way forward was to stand on the spot and rotate while flinging the mite dust in all directions like a manic fire hydrant. After a panicked orgy of squawking and manic laughter the chickens, the bedding, the hen hut and the doctor were white with dust. I expect we inhaled. But it worked.

It's an allegory of general practice. We have an all-encompassing curriculum. We plan and structure the consultation, check and recheck our knowledge base, read the evidence and measure the cost, tackle the nigh impossible, unpredictable and unlimited workload with method and calm.

But patients come in flocks, flapping, squawking and cross. Morning surgery starts at nine and finishes at one, and in between I rotate manically, flinging evidence-based medicine around like dust, making judgments, smelling cigarettes, alcohol and wee, drawing blood and conclusions, fitting coils, offering marriage guidance, dispensing old wives' wisdom, hurling instinct, reflex and my best effort into the once calm, clear air of the surgery until everyone has inhaled and the pot is empty. Yet, somehow, it works.

Dr Selby is a GP from Suffolk. Email her at GPcolumnists@ haymarket.com.

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