PERIPHERALIA

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I find that in my consulting rooms I am on home territory 
and that there is some reasonable control over the events 
that occur with my patients. In the rooms there is all the 
equipment, files and backup that I need. This all changes 
once I step outside the door into the street outside. When I 
am out-and-about in the community, either socially or on a 
shopping trip or to play sport, I leave a lot of the control and 
firewalls behind.

It is in these situations that we are vulnerable to the Car-
Park consultation or the “I’m-so-glad-I’ve-caught-you” 
consultation as well as “Corridor Consultations” by the staff or 
patients when I am visiting the hospital.  

One of my out-and-about trips occurred when my son was 
home from university and we went shopping together in 
our local Pick ’n Pay. At the end of our shopping he recorded 
that I had done three consultations by the time we left the 
shopping centre. One was in the vegetable department 
(a rash on a leg in the section where the broccoli was on 
special), another in the aisle that contained the tea, coffee 
and sugar and a final one in the queue while waiting for the 
cashier.

One of the other great dangers of being out-and-about are 
dinner parties or similar social occasions: “Doctor, could I ask 
your opinion about my niece, father, friend…,” always gets 
the red lights flashing. It may be seeking confirmation of a 
diagnosis that has been made or a criticism of treatment that 
has been given. At this point I have usually had a couple of 
glasses of Pinotage Special Edition neuronal release therapy. 
I am then in an expansive mood as a world authority on all 
illnesses known to man.  

The golden rule here is to try to fermez la bouche (close 
the mouth). “Never believe what a patient tells you to the 
detriment of a brother physician” said Sir William Osler “even 
though you may think it to be true”. The right answer here is 
to comment carefully that it is very difficult to give an opinion 
without knowing the full case history. Apparently up to fifty 
percent of legal cases against doctors are initiated due to 
comments by other doctors, nurses or medical personnel.

The other alarm bells should start ringing when the statement 
is “Dr Smith said….,” or “the specialist said….,”. What is about 

to follow is often the second-hand interpretation of what 
they thought the doctor said. So rule number two is a similar 
caution to Sir William Osler’s advice but is subtly different. We 
should not always believe what a patient says a doctor told 
them whether it sounds right or wrong. You then apply rule 
three.  

Rule three is “I think that is my phone ringing, will you kindly 
excuse me”.

There are other types of out-and-about consultations apart 
from dinner table conversations.

Many moons ago I was once doing a rural clinic in the Injasuti 
Valley in the Drakensberg mountains when someone came 
running to the clinic to say that a patient was giving birth 
in the field on the other side of the fence by the Injasuti 
river. She had been in labour since the early morning and 
had walked down from the top of the valley to the clinic but 
did not quite get to us. I went out and climbed through the 
fence and found her lying in the dry grass by the river. To my 
dismay there were two little feet already presenting. It was 
going to be a breech delivery. 

 It is in moments like these that I have wondered if the practice 
of medicine was a wise choice and that perhaps I would have 
had a more peaceful life as a bank clerk or an accountant. 
I asked the nurse who had come with me to go back and 
bring some artery forceps and ties for the cord but I would 
not be able to suction the baby or do much resuscitation if it 
was compromised. I calmed down to a panic and the mother 
then gave a couple of pushes and I managed to deliver the 
arms. Then with my left hand around the neck and my right 
index finger in the baby’s mouth the mother pushed the 
baby slowly out. The baby cried heartily. The mother smiled. 
I looked up. The midday sun was dancing in flashes of light 
on the surface of the Injasuti river as it flowed slowly by. A 
fine pale blue sky stretched for miles into the far horizons of 
the mountains. Life was beginning again in an African world.

Chris Ellis is a family physician in Pietermaritzburg, 
KwaZulu-Natal

E mail: cristobalellis@gmail.com

The out-and-about consultation