Blog entry by Rcgp Learning
Dr. Sam T. Claus was in the middle of a pleasant dream involving a mug of hot chocolate, several mince pies and a re-run of “It’s a Wonderful Life”. Inexplicably, the film was interrupted by a beeping noise and he woke to realise that his pager had gone off. Cursing the day when he decided to work in a practice that still does its own on call, he dialled the messaging service.
An hour later he was trudging through the snow to see Rudolph, a regular patient with a distinctive rhinophyma. Rudolph claimed this was due to rosacea, but Sam had his suspicions. Rudolph had told the messaging service that he was light-headed and thought it was his heart. Sam had other suspicions.
Sam found Rudolph on the sofa worse for wear snuggling with the remnants of a bacon sandwich. Concerned that getting close to Rudolph’s breath might get him into trouble with the local constabulary, Sam made a brief assessment and told Rudolph the unsurprising news that he had a hangover.
“But that’s not possible Doc”, exclaimed an indignant Rudolph “I’ve done my research”.
He pulled out a bag full of packets including some long-acting propranolol, a sachet of dried yeast and some fructose tablets.
“I’ve been online doc, any one of these will sort out a hangover and I took all three. There must be something wrong with me”.
“Aha” said Sam “you’ve consulted Dr. Google? I’m afraid he has led you astray. A meta-analysis of online hangover cures1 has clearly shown that none of them are any use – the only prevention is to drink moderately, or not at all. Have some paracetamol and lots of water– you’ll feel better soon”.
Sam left Rudolph to sleep it off, heading for the local nursing home where he was due for a ward round. He paused to pick up his beagle, Comet, this being an enlightened home which felt that the residents would benefit from contact with animals. As he made his rounds, Sam couldn’t resist the chocolates on most of the nursing stations and he reflected on how likely it would be that the boxes would still be there that evening. Probably not, a study having shown that the mean survival time of a chocolate on a hospital ward is 51 minutes2, with half the box generally being eaten in under two hours.
Sam’s mood worsened when he was asked to see Mrs. Blitzen, an elderly woman with severe diarrhoea following a course of co-amoxiclav. Cursing the overuse of broad-spectrum antibiotics, Sam approached her room and was amazed to see Comet race ahead of him, bark and lay down against her door. A sudden flash of recognition hit Sam as he remembered that Comet had taken part in a study whereby beagles were trained to detect Clostridium difficile and could do so with over 90% sensitivity and specificity3. Pulling on his gloves he prepared to dazzle the nurses with his quick-fire diagnostic skills.
Later that evening, a colleague now on-call, Sam was delighted to find that “It’s a wonderful life” was actually on the TV. Settling down with a hot chocolate and a plate of mince pies he reflected on his day and the curiosities that he might come across the next time he had the joy of holding the on-call pager.
- Pittler Max H, Verster Joris C, Ernst Edzard. Interventions for preventing or treating alcohol hangover: systematic review of randomised controlled trials BMJ 2005; 331 :1515
- Gajendragadkar Parag R, Moualed Daniel J, Nicolson Phillip L R, Adjei Felicia D, Cakebread Holly E, Duehmke Rudolf M et al. The survival time of chocolates on hospital wards: covert observational study BMJ 2013; 347 :f7198
- Bomers Marije K, van Agtmael Michiel A, LuikHotsche, van Veen Merk C, Vandenbroucke-Grauls Christina M J E, Smulders Yvo M et al. Using a dog’s superior olfactory sensitivity to identify Clostridium difficile in stools and patients: proof of principle study BMJ 2012; 345 :e7396