Pre-Scool

The other day, while we were at the jetty attempting to catch another fish, we saw a group of lots of little tiny silver fish swimming around under us. "Look," says Imogen, "it's a pre-school of fish!" They were small.

We caught a tiny little rock cod, while Imogen, Emily and Charlotte danced in the outgoing tide on the bottom platform of the jetty. The fish, like us, went back to its home.

Regular readers will know that yesterday was Monday, and that this means comments about the pre-school bus and the box of vegetables. The bus has been very reliable recently. (So have the vegetables, actually!) After Imi got on the bus, I ran (well, walked very quickly) to preschool myself (with the buggy) to chat to the teacher about Imi's progress. We're very proud about how well she's done settling in there in such a short space of time. She has made a particular effort to try to get to know different children in the class, choosing someone different each time they are asked to "choose a friend to go to the bathroom with." (Insert your own joke here.)

Today Imogen came home from pre-school with a home-made robot (though I'm not sure it can do the washing up or put Emily and Charlotte in the bath, as the cardboard boxes would go all soggy) and the biggest piece of artwork I've ever seen outside a major art gallery.

If I seem distracted while writing this, it's because I'm trying to prepare a teaching session on otitis media, tonsillitis, sinusitis and other respiratory tract kind of illnesses. In my mind I'm trying to sift the evidence around diagnosis (which symptoms and signs are most significant) and which treatments are most effective, and does it matter whether your patient is indigenous or not? You might find all this quite boring. Strangely enough I don't (that's why I'm a GP!) For something that we blithely call "minor illness" it's not minor for the patient, because it makes you feel like you're about to die and, as it turns out, it's not minor for the doctor trying to navigate your way through a maze of evidence and uncertainty about the best thing to do.

What? You'd rather hear about those small fish again? Well, because they were very small, Imogen said it was a pre-school of fish. I wonder where she gets her sense of humour from?

Dingbats

Last night I was on call for Jo again, and it's really making me relearn my Emergency, acute general practice and ward stuff - very good for me. We've realised how much Jo's skills and my skills complement each other - Jo is very good on procedural, anaesthetic type things, where as I'm much more comfortable with the broad general practice stuff. It means that we both think we look like complete dingbats on the ward for different reasons!

I've found it interesting being in a hospital environment again. I don't feel at home there, and I've realised how the context changes your consultation skills - it's very easy to be much more doctor centred interviewing someone on a bed. I've taken to using one particular room in the Emergency ward as it looks more like a GP room, and I know how to use that environment effectively.

(This may sound weird, but there's a whole literature on consulting skills which we teach doctors training to be GPs which definitely makes them more effective (as well as popular with patients). And consulting skills overlap with, but are separate to, communication skills. Consulting skills are about managing what we grandly term "The Consultation" which encompasses using the room, the roles of the people involved, using the computer, using the time....etc.....etc. Communication skills is the part which involves talking with, and much more importantly listening to, the other person. I'm glad that's cleared up, then.)

It was a busy weekend on call. There was a big football tournament (football=rugby league here) this weekend, so we saw all sorts of twisted knees and injured shoulders. Apparently the winning team get $10,000 each! That's more than Jo gets paid for me being on call.