A Bit Of A Nose Job

Last night (actually it was the early hours of this morning) I was unable to sleep so I was sitting at the computer drafting a post for this blog (I haven't finished it yet, but will probably do so tonight or tomorrow) when I remembered that I needed to make an appointment to see my GP because the results of my ambulatory blood pressure test were in. So I logged into the website to see if there were any appointments available and while I was there I happened to look at the 'Letters' section of my medical records and saw that a fax had been scanned in relating to my referral under the 'two week rule'. Opening this item I was horrified to see that the hospital appointment was this morning and had I not yet received a letter from the hospital informing me of this fact.

So, it was a change of plans for today and a trip to the hospital to see the consultant dermatologist for him to have a look at the area on my nose that has been causing me so much trouble over the last couple of months. I arrived early (I always do, I am a bit of an early freak) and as luck would have it I was taken into the consulting room at least 20 minutes before my appointment time. I sat there for a couple of minutes and then the consultant arrived with his SHO and he took the usual history; illnesses, medication that I am taking, how long had I been troubled by this strange area on my nose. Then it was onto the examination couch for him to have a look at it under magnification and to prod it and stretch it and generally have a good feel at it.

The diagnosis? Probably a basal cell carcinoma. Then he made a small mark on my nose and told the SHO that he wanted a biopsy taken and that I should go back to see him in three weeks. After that I was escorted to the operating theatre and the biopsy was done. There was the usual briefing about what exactly was going to happen, I was made comfortable on the operating couch, and asked to sign the consent form. This was the first problem. I had taken my glasses off and put them in my handbag before getting on to the couch and now I couldn't see where I needed to sign on the form. So the very nice SHO pointed me in the right direction on the form and I scribbled something that experience tells me was probably a pretty good attempt at my signature.

Then I was covered with some towels to ensure that my clothes would not be covered in blood and told that the local anaesthetic was to be administered. The area where the biopsy was to be taken was very near my left eye and it was suggested that because of the bright lights that would be shining on the area I might like to close my eyes. I was going to do exactly that anyway because there was no way that I was going to watch a needle approaching my eye; I'm afraid that I am not very good when it comes to injections of any sort and local anaesthetics in particular. There is no doubt that this injection was the most painful part of the whole procedure, for after a few minutes the area was completely numb and tests to see whether I could feel anything sharp touching the area showed that the anaesthetic had done its job. The biopsy was taken and then it was a case of trying to stop some of the bleeding sufficiently for a stitch to be inserted. I take aspirin every day because I have an unusual form of angina and this means that it can be quite difficult to stop bleeding sometimes, and today was one of those occasions.

Eventually the flow slowed enough for the stitch to be put in place, with some difficulty because of the strange location of the offending area, some antibiotic gel was placed on the wound and I was finished. There was the offer of a plaster to put on the wound but I declined until I tried to put my glasses on and found that even with the effects of the local anaesthetic still present I could feel that this was not going to be easy. So, the decision was made that a plaster would be necessary, but again because of the position of the wound and its proximity to my eye, some surgery would be necessary on the plaster to enable it to cover the wound but at the same time make sure that it did not affect my eye. Then it was off to the reception desk to hand in the paperwork about my follow-up appointment, the letter for which will be sent to me soon (I hope).

It is now some hours since the procedure was carried out and the effects of the anaesthetic have worn off and the wound is now giving me some pain. I've taken paracetamol for the pain, as instructed, I've made an appointment with the practice nurse to have the stitch removed next Thursday, and I am hoping that I can manage to get some sleep tonight to make up for all that I missed last night.

Because I had not received the letter from the hospital telling me about my appointment, in the normal course of events I would have missed it and been marked as a 'did not attend'. The fact that I have online access to my GP medical records meant that I found out about the appointment in time to be able to attend, so the hospital's time was not wasted in me not turning up and becoming an addition to the statistics of 'no shows'. This means that I will have another example of the benefits of online record access when I give my next presentation.

About an hour and a half after I got back home from the hospital the postman delivered a letter. Yes, you've guessed. It was the letter giving me details of my appointment.

Still In The Land Of The Living

Life has been a little difficult over the last few weeks and it has affected me so much that I haven't even had the enthusiasm to blog, but I have been thinking about it and today I have decided to do something about it. I was going to venture into the garden this morning to do battle with some of my overgrown shrubs, but rain has stopped play (actually it started before I even managed to get out of the back door) so I shall write something for the blog instead.

Last Wednesday I gave a presentation about patients having access to their GP medical records online to some of the members of the local PCT. The seminar was arranged by 'B' who used to be my GP until his retirement from full-time practice last year. We are doing an increasing number of these presentations and as he is on the local PCT it was only a matter of time before I was asked to make a presentation to them. I was to be the 'star turn' at the seminar which was held at the local Town Hall and, more interestingly, in the actual Council Chamber.

The presentation went well and there were lots of questions afterwards; the rest of the seminar proved to be very interesting too. One of the outcomes of the seminar is that the PCT is to try to ensure that all GP practices within the PCT provide any patient that requires it with online access to their records. My practice was the first in the country to do this, and any practice in the country which uses a particular application for the management of patient records (this is about 60% of them, and all but one practice in the local PCT) can provide this access today at no cost to either the practice or the patient. As a result of discussions after the seminar it is possible that I may be involved in visiting all the practices in the PCT to talk to them about using this facility and encouraging them in giving their patients the same access that I enjoy.

There are a number of benefits in having access to my medical records, as well as the ability to book appointments online and to order repeat prescriptions by this method too. Visits to outpatient clinics always require you to give details of current medication and of previous illnesses, operations, and dates when symptoms occurred. In the past this has tended to be guess work for some of these things, but this is no longer the case for me as I can make a list of all the information that I am likely to be asked for, and should I be asked for some information that I do not have to hand I can access it easily while at the outpatient clinic if there is a computer to hand.

This government has wasted billions of pounds trying to develop 'Connecting for Health' which is intended to serve a similar purpose for the whole of the NHS. It is a shame that they didn't look at what was already being achieved in one part of the NHS and build on that instead of starting from scratch on a system that has cost so much money and which is felt by many to be insecure.

Another Presentation

I have to give another presentation about patients having access to their medical records this week. This time it is to some of the members of the local PCT including local council members and possibly local MPs.

The GP surgery at which I am registered has allowed its patients to have full access to their medical records for about 30 years and was the first in the country to allow patients access to their records online. While there are now 50 or more practices that allow this, it is something that is possible in at least 60% of the GP practices in the country and yet it is not yet available to patients even though it is available at no cost.

This week's presentation will be made using my PowerPoint slides because I have only a limited time in which to make my presentation, but I am sure that there will be lots of questions after the presentation; there always is.

Frustration

My mood, while not exactly brilliant, has been reasonably stable over the last few days, but sleep has been something else. I sleep well when I use medication to help, probably too well, but sleep badly when I don't.

I had a very successful day giving a presentation to GPs and Practice Managers for one of our Strategic Health Authorities last Wednesday, and then got roped in to talk to some high ranking people from most of the Strategic Health Authorities in England that evening. It made for a very long day, having left home at about 5.50am and not arriving back home again until 10.20pm, but I think it was worth it because they were all very interested in what I had to say about patients having access to their GP medical records online. I am due to give another presentation in a couple of weeks, this time to my local Primary Care Trust, and in September I will be making a presentation and taking part in a discussion at the Department of Health.

I am always very nervous and anxious for a couple of days before each of these events, but a bit like an old trouper on the stage, once the spotlight is on me I seem to be able to hold my own in front of the audience and I always get super feedback from those who attend the presentations. It seems that hearing things from a patient makes a big difference to their appreciation of the subject. After these events I then suffer a real adrenalin high that lasts for 24-48 hours, almost like a manic period, before crashing back down into depression. Fortunately, the collapse into depression has not been so severe this time, but neither has it been a bed of roses.

My knitting has been causing me some problems over the last week or so. After having had some problems that resulted in me having to unpick a few rows, I managed to get back on track and was progressing well. Then, on Sunday, I discovered an error which required me to have to unpick some rows again. Only one and a half rows this time but it was annoying all the same. I had only six more rows to knit until I got to the end of the main part of the shawl and could start on the edging (the pattern for which I still have to create). I decided to take a break from the knitting yesterday, but started work on the unpicking today, corrected the mistake and then was progressing well until I found that I had one stitch too many in a particular part of the pattern which was obvious and would require me to start unpicking again. This time it needs about five rows to be unpicked so this is going to be a long job.

Hence the frustration. It seems that this shawl is determined to cause me as many problems as it possibly can before I finish it. I'll see how I am feeling tomorrow before deciding to do any work on it. At times I feel like pulling the needle out and unravelling the lot but I know that this is silly and I would regret it the moment that I started doing it.

I may be feeling frustrated by it, even despairing a little, but I am not that desperate yet.