Fat lazy male nurse

There is a relatively new blog on the block, which is well worth a visit for the best picture of Hillary Clinton I have seen this year. But apart from that...oh dear.

The blog is written by the self-deprecatingly named “fat lazy male nurse”, so he obviously has a sense of humour, which always helps. In more detail, he describes himself in the following way:

12 years nursing in A&E, being forced to be polite to the kind of people I wouldn't share a life raft with if I was on the Titanic. Now working in Unscheduled Care and realising that the grass really isn't any greener!

Obviously a sympathetic sort of chap. And in the profile, he styles himself as an Advanced Nurse Practitioner. Advanced, eh? That sounds good. I wonder what it means? What ever it means, fatman has not taken his medication recently because he is getting in a tizzy about the case currently up in front of the GMC of a doctor who delegated his job to his practice nurses. The GMC is not criticising the nurses. Indeed, for all we know, the nurses may have reported the doctor for inappropriate delegation. But fatman is off on a rant:

The usual nurse bashers have had a dig, Dr Crippen, Ferret Fancier, and the usual bollocks is spouted about quacktitioners. It amazes me that both of them seem to think that this a good excuse to have a pop at nurses again. So let me see if I get this straight. A doctor fucks up, behaves outrageously, and according to his medical brethren it's all the nurses' fault.

And then we move on to his little article entitled “Unrealistic expectations” which is worth printing in full.

Unrealistic expectations

I saw a lady recently with a painful foot - it was painful when she woke up. Doesn't remember injuring it, but; 'would like an Xray please in case I broke it rolling over in my sleep'! Now I don't know about you, but since I had my kids I've been a fairly light sleeper and tend to wake at the slightest sound. Before the advent of nippers I would sleep like a log and be virtually unwakeable. However, if I injured myself during the night, I'm sure I would wake up - probably screaming in pain!

In order to break a bone in one's foot, it is acknowledged that significant force must be applied to the foot. It doesn't just happen when you roll over in the night.

So unless someone drove a car over your foot whilst you were sleeping, a maniac came into your room and twatted your foot with a sledge hammer, or you indulge in skydiving whilst asleep. It is highly unlikely that you have a broken bone in your foot. So an Xray is not indicated, is it?

 Oh, and some bastard painkillers might help as well! (Unrealistic expectations)

I would not want this man seeing a member of my family. This case demonstrates so eloquently why it is not safe to let people like this loose on the front end of the NHS.

Let us call the "painful foot lady" Alice. Of course, Alice may be someone who rolls up at casualty a dozen times a week with a load of trivial nonsense. But fatman does not say that. To a doctor, this is an interesting case. But doctors like medical puzzles. Solving medical puzzles is what they are trained to do.

Let us think a little more about Alice. As fatman says, it is unlikely she has broken a bone in her foot during the night. So why is her foot suddenly so painful that she takes herself to a hospital. Perhaps she has a pathological fracture. You do not need much trauma for those. You get pathological fractures with cancer. With breast cancer, for example. It would be a bit odd to find a pathological fracture in a foot, but it can happen. I wonder if fatman checked Alice’s breasts? Probably not. What else may be going on? Well, gout is a classic for a painful foot, though you would expect the foot to be red and swollen. I wonder if fatman bothered to have a look? He doesn’t say. Then there is multiple myeloma. Always difficult to diagnose and protean in its presentation. Myeloma causes unexpected bone pain. Or Paget’s disease, that’s a thought. Notoriously painful. And then osteoporotic collapse of an arch in the foot. Fatman does not say how old Alice is. I wonder if he has heard of osteoporosis? Or Paget’s? Or multiple myeloma? And then there is calcium metabolism, and disseminated thyroid malignancies and I have not even moved on to the exotica yet. I will find a medical student and ask for another twenty causes of foot pain that have slipped my brain.

Is it likely that Alice has anything serious? I do not honestly know. Probably not. But it is odd for a person to present with severe sudden onset foot pain in the absence of trauma. Probably nothing too serious but, in my judgement, worth an X-Ray (for reasons that fatman and Alice would not understand) and a physical examination of the rest of her body, and an Hb, and an ESR, and maybe a urate, and maybe even a protein electrophoresis. This is the sort clinical problem I would put to a medical student. It is the sort of clinical problem I would discuss with a fellow doctor whilst fatman is in the sluice washing a bedpan, which is what he is trained to do. Sadly, fatman was not in the sluice.

Fatman was in charge.