In my early years as a consultant outpatient clinics were large and difficult to manage. Several junior doctors would join you in seeing in excess of 50 patients in one session. (writes Kirkintilloch Herald columnist Dr Frank Dunn)
The sense of achievement was not so much that you had provided good medical care, but more that you had got through the clinic.
The training component for your juniors was dubious at best, because of the time constraints.
The clinics could not be described as enjoyable (apart from the mandatory coffee break), because we were rushed off our feet.
When the number of junior doctors was reduced at clinics things had to change.
Now most clinics are not only consultant-led, but consultant delivered.
I see the majority of patients myself and now have the time to more effectively provide training for the juniors.
We seem to be able to manage the work load and in this we receive much needed help from skilled nurse practitioners.
Time is such an important commodity to give to our patients.
They know when you are rushed, and this can compromise communication regarding all aspects of care.
You learn so much from patients when you give them time to chat.
I saw an 87-year-old patient recently with breathlessness who was as sharp as someone in their 20s.
She mentioned that her mother had lived to 95 and attributed this to a glass of hot water last thing at night.
My grandmother lived till 98, and we attributed her longevity to a nightcap of hot milk, with a liberal dollop of whisky.
She took half of this on retiring, and the remainder if she woke up in the wee small hours.
Which of these remedies was more influential could only be determined by a clinical trial, and I am sure volunteers would not be a problem.
The elderly patient at the clinic attended with her daughter, and I have always maintained that the secret of long life is having daughters. They are that bit more attentive than sons. On this criteria I am vulnerable.
The daughter was extremely supportive, although I was impressed by the clear independence of her mother.
We spoke of the different treatment options, and the patient had a view about her likely preference.
This all helped in my decision making.
A satisfactory consultation was concluded, at least in part, because there was no sense of having to rush.
I recently saw another elderly patient who had a valve operation over 50 years ago for rheumatic heart disease.
This involved stretching open the narrowed valve with two fingers. No further operations have been required.
Despite the developments in heart surgery that operation stood the test of time more than any other.
She told me she still said a daily prayer for the surgeon. His name was Professor WH Bain, whom I knew well and greatly admired.
He was a pioneer of valve surgery in Glasgow and died a few weeks ago. I was able to let his family know of how appreciative the patient was.
We are now half way through alcohol free January. Those who felt this meant that there was no charge for alcohol, will be disappointed.
All in all it is a sound idea and has the advantage of making it easier to stick to the recommended amount for the rest of the year.
I am pursuing a modification of the alcohol free January which bans alcohol from Monday to Thursday.
This plan has worked well thus far with only one minor glitch.