Mr Bundle
Mr Bundle, a 78-year-old gentleman — another casualty of a system designed to reduce the need for doctors. A local service has been developed where pharmacists are trained to manage simple conditions like coughs and colds. One of those conditions is shingles.
Unfortunately, without strict criteria or GP-led oversight, these services can often fall short of acceptable standards. In response to unprecedented demand — much of it arguably unnecessary and fear-driven — there’s been a shift to offload doctors’ workloads onto non-doctor professionals. These include physiotherapists, nurses, physician associates, and pharmacists. In theory, a good idea. In practice, not infrequently a big problem.
Mr Bundle is a victim of this. He’s had shingles for five weeks. He was correctly given Aciclovir — but his shingles was around his eye: ophthalmic shingles. Not to be neglected. Especially when the rash extends down the nose, as it does in his case. That’s a red flag. You don’t mess about.
This form of shingles can inflame the eye, affect vision, and even cause blindness. His vision has already deteriorated. I urgently refer him to the eye hospital.
Today he calls me. They didn’t give him any pain relief, though they’ve started treating the eye. There’s confirmed damage — whether temporary or permanent is unclear. I prescribe pregabalin for nerve pain. It works for shingles. Codeine and paracetamol don’t.
Poor Processes
A receptionist thinks it’s acceptable to book a patient into an appointment slot that expired 20 minutes ago — meaning I’m now 30 minutes behind. I send her a curt message: these decisions require my consent.
I desperately need protected management time to deal with these issues. Despite being Clinical Lead, I’ve been asking for this for five months with no progress. There’s simply no time during the clinical day — and still, no sign-off from the people who own the practice.
I gave up trying four months ago. It was making me stressed.
Meanwhile, the so-called leadership session remains with Helen — our Advanced Nurse Practitioner from before I arrived. She’s been doing fathomless work beyond all measurable metrics. As in, no one actually knows what she does. But she’s not held accountable.
We, the doctors, on the other hand, are micro-managed — perhaps because we’re paid more.
Stop Complaining.
On the topic of complaints: Helen’s bullish approach has now landed us a serious patient complaint. It’s escalating. The plot is treacle. Get your popcorn out.
Lunchtime Lockdown
Just as I finish morning clinic and am heading for lunch, a message from the Reception Manager:
“Lock your doors. On the phone to the police.”
A patient who previously threatened staff — and was de-registered — has come back. He’s high, drunk, and refusing to leave. We’ve been asked to stay indoors. There’s a hoo-ha outside with the police. Eventually, they escort him off the premises and warn him not to return. If he does, he’ll be arrested.
Afternoon Horror Show
My most noteworthy patient of the afternoon is Errol, a 93-year-old with a fistula — a hole connecting her colon to her skin, caused by a previous abscess. She was discharged by the surgeons, but the fistula has worsened. The dressing no longer contains the faeces. She walks in and my nostrils recoil and my eyes flicker.
MUST. KEEP. POKER. FACE.
It’s not pretty. The skin around the wound is inflamed. I urgently re-refer her to the consultant who discharged her two weeks ago — without checking the wound.
Redressing it takes forever. Her daughter has a lot of questions. I’ve never been good with bad smells, no matter how many I’ve faced. I answer patiently, but with each new question, I feel more and more infused with this dense faecal aroma and contemplate the long-term effects of this trauma.
She eventually leaves. I throw open the windows and drench myself in Californian white sage smudge spray. It burns my eyes. Worth it.
The next patient walks in, pauses, and looks at me judgementally.
“It wasn’t me, it was the dog.”
And tomorrow, we do it all again — dog or no dog.
Mindful Medic 
What a job my god! Patience of a saint you have.
LikeLike