Posted by: Witch Doctor | August 20, 2009

The Telephone Consultation


Once upon a time, when The Witch Doctor was a medical student, she was taught many things.

The most important of these by far were:

1. How to take a thorough case history.

2. How to examine a patient.

She was taught that, if done properly, in most patients a sensible differential diagnosis would be reached and in many, an accurate final diagnosis. Thereafter some targeted investigations, along with a few routine ones that might uncover unexpected asymptomatic conditions would confirm the diagnosis. Then the patient was treated accordingly.

On entering the room before the formal consultation starts, assessments are being made. How a patient walks, talks, smiles and dresses, as well as the appearance of the skin, eyes, hands, fingernails, hair and even eyebrows and a host other little signs are all quickly observed and subliminally taken into account by the well trained medical brain. It is not protocol driven. It is a fast system of integration as a result of years of training and calling upon accumulated experience. Doctors can’t help but do this. It is ingrained. Doctors find themselves doing this in the tube, at petrol stations and on the golf course. Then they have to pinch themselves as a reminder that they are not at work.

Incidentally, this initial assimilation might be why a few doctors seem preoccupied when you first meet them and consequently fail “The Smiley Metric” test.

These teachings have served The Witch Doctor well over the years and she, like all her colleagues, has diagnosed most common, many less common, and indeed some very rare conditions accurately, using history and examination alone.


Sadly, The Witch Doctor was taught wrongly.

It is no longer necessary to take a thorough case history and examine a patient.

It is no longer necessary to have years of training.

Indeed, it is no longer necessary to have any training at all. Well, that’s an exaggeration, I suppose. Six hours training is deemed to be necessary. Six hours training, a protocol, a telephone or internet connection will do.

That is how swine flu is diagnosed.

That is how the decision to treat with Tamiflu is made.

No differential diagnosis is necessary.

No exclusion of any other possible life threatening medical condition is considered important.
With fingers and toes crossed we’ll get away with it.

Won’t we Gov?

If we lose a few patients here and there with meningitis or septicaemia or an underlying condition making infection more likely, so what?

That’s life.

And death.

Sacrificing the few for the “good” of the many.

All of this is so easy, perhaps we could have volunteers diagnosing over the phone.

Perhaps the Third Sector could take over.

What a wonderful, imaginative, money-saving change The Witch Doctor has seen in her lifetime.

And what a waste of time, her life seems to have been!


Mark you, I suppose the 6 hour training for Swine Flu diagnosis and treatment was an exception. It is the kind of emergency procedure a third world country might follow in the case of a national calamity where resources are absent and circumstances dire with massive numbers of people dying all around – just like flies.

Were you aware of a national emergency in the UK during the summer, My Black Cat?

I didn’t pick up on it somehow.

It seems to have passed me by.

In the meantime GP Informed seems to have made an intriguing but rather quaint observation:


Whatever next?

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  1. From my experience of call centres I won’t even trust them for computer advice, never mind my health!

    Yesterday at lunchtime I got handed a leaflet about something called ‘The Great Care Debate’. Looked less like a debate to me and more like a set of patronisingly simplistic questions, to which I’m presumably expected to say “oh yes, that all sounds wonderful.” Questions seem to be connected to both health and social care services.

    Here’s the link if you feel like checking it out:

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