'The patient is a 37 year old male, he initially had groin pain for the last five weeks which he thought was muscle strain. However two days ago in the process of self examining his testicles he discovered acute tenderness and swelling in the area of the head of the epididymis. He is normally fit and healthy, although he is a shift worker. He takes no medicine and is not allergic to anything. He has not been sexually active for the last two years and has no urinary symptoms or symptoms of any sexually transmitted disease.'
I'm sitting in my GP office, the GP himself looking rather bored. The patient is myself and I'm a little concerned. I discovered the tenderness last night and while I treat myself for most injuries and illnesses, this is a bit outside of my sphere of knowledge. The GP surgery sees me ten minutes after I phone for an appointment – so full marks there.
The GP examines me, and hands me a prescription for Flucloxicillin, an antibiotic that on getting home and doing some research seems to be not ideally suited for my problem. Still, what the Hell, it's a week course and if it hasn't resolved I'll see him again.
A week later I'm back sitting before the same GP, the pain has got worse and spread into the other side of my groin. I'm a little more forceful.
He examines me. Well, he examines my healthy testicle and completely ignores my left one, the one that is paining me.
“Are you going to refer me to a urologist?”, I ask, “maybe under the two week rule?”
He smirks. 'That's not very helpful' I think.
“Go to Queen's A&E”, he tells me quite sharply, “Maybe they will scan you, if not phone me and let me know”.
It's not really an A&E job, but he can refer me through A&E – I just need a referral letter.
“Are you going to write me a referral letter?”
“No, just turn up”, he tells me.
This is naughty, the GP should write the letter and talk to the speciality – I try telling him this but he isn't listening.
“Just go to A&E”, he says, “Let me know if you are lucky”, and he motions me towards the door.
I leave thinking that I need a new GP. However I consider myself honoured, I've never heard him say more than four sentences during a consultation.
I hop on the bus to Queen's hospital already rehearsing the apologies that I'm going to make. I'm taking the bus because I suspect that the cost to park will be greater than the cost to getting two buses.
I reach Queen's, grab something to eat from the canteen and head to the A&E. I chat to the greeting nurse, starting with an apology, but he apologises to me.
“We don't have urology specialists at this hospital”.
I grit my teeth and think about strangling my GP.
“Your best bet is to go to King George's hospital, they have urologists there – sorry”.
I let him know that it's not his fault that my GP is an idiot and hop back on a bus to get home.
The bus breaks down and I walk the rest of the way. It's not been a fun day so far.
I decide to drive to King George's hospital and damn the cost – in reality driving and parking saves me £2.40. I head into the A&E to book in, the first thing I do is chat to a doctor at the reception. He listens to me and asks for the GP referral letter – I tell him that the GP told me that I didn't need one and that I apologise for the (lack of) actions of my GP.
The doctor calls over someone who I assume is one of the admin managers and asks her to ring the surgery.
With professionalism and grace she phones the surgery, explains to the GP that he's done the wrong thing and asks him to fax over a referral letter, the GP agrees to do this.
During the rest of my stay at the hospital no such fax appears. Sadly I'm not surprised.
I wait ten minutes before I'm seen by the triage nurse, considering I feeling rather relaxed my observations are a bit worrying (SpO2 of 95%, BP of 141/92 Pulse of 99), I think I need to take up some sort of exercise once this is over.
Once more I apologise to the triage nurse, she's very nice and tells me that she'll have a chat with the urologist as she is in the department at the moment.
I wait for about an hour, I'm not too sure how long exactly because I've got my nose buried in a Rick Dakan e-book. A young lady doctor appears and calls my name. We find a consultation room and she examines me and takes my history. She's got a very pleasant manner to her even if she does tell me that these things take longer to get better in the 'older man'. I splutter somewhat until she looks at my notes and, somewhat confused, notices that I'm only 37.
I think it's time to lose my grey beard.
She gives me two different courses of antibiotics better suited to fight any infection of the epididymus and books me in for a scan next week. I'm impressed with the speed of the scan and with the bedside manner of this doctor, the antibiotics will fight any infection (which is what I think I have) while the scan will rule out anything more malign like cancer or testicular torsion.
I head home happy that I'm being well looked after.
In one day I saw both the best, and the worst, of the NHS – I'm so unimpressed with my GP (I dread to think what my GP would have suggested if I hadn't pushed for being referred – would he have referred me or tried a different, equally ineffective, antibiotic), and yet I'm incredibly impressed with King George's hospital and the urologist and nursing staff there.
I have my scan on Monday – hopefully it'll show everything normal. Fingers crossed.