DR COPPERFIELD INSIDE THE MIND OF A GP
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There’s a bunch of researchers in Ohio who specialise in wounding patients, making them angry and then sitting back to observe the effect of stress on the healing process. (Which reminds me, I must finish that My Dream Job article for the BMJ.) I first heard about them in 2005 when they inflicted injuries on married couples, sat them in a room for half an hour and asked them to talk about something that really annoyed them about their spouse. The ensuing atmosphere of mutual loathing slowed their recovery rates by about 20 per cent.
This week, the same team published the results of further studies. These involved blistering the forearms of masochistic volunteers, then getting them to complete questionnaires about how they dealt with stress and how they expressed anger.
You might argue that the population under scrutiny, comprising potential gimp-mask wearers living within an hour’s travelling time of Ohio State University, may not be representative of humanity as a whole, but the study’s findings ring true. Subjects who described themselves as unable to control their negative feelings took longer to heal, leaving them more time to lick their wounds.
Until recently, any patient who had suffered at the latex-gloved hands of the surgeons at their local centre of excellence was expected to show up in the outpatient clinic for a check-up a few days later. Not any longer. Postop patients are now directed to see their GP to have their wound assessed and get an idea of when they can return to work.
I advise patients with a nicely healing appendicectomy scar to buy some own-brand paracetamol and sticking plaster at the local supermarket, and to tell their boss to expect them back on the job in two or three weeks.
Nursey, fresh from her free lunch with a representative from Megadrug’s Unthinkably Expensive Dressings Division, will send them home with a hundred quids’ worth of impregnated gauze, sticky-backed clingfilm and enough hypoallergenic tape to last for several months.
I have noticed that patients whose wounds aren’t healing so well invariably have one thing in common: they’re angry. You’d suppose that this was a result of their complication. They complain that the surgeon they picked at random off the NHS Choose and Book website bought his qualifications over the internet and gets the ward sister to sew on his shirt buttons. They feel that they’ve been stitched up.
However true this might be – and it’s worth remembering that consultants usually leave the boring wound closures to their junior staff or a passing medical student so aren’t really to blame if bits of bowel start to poke through next day – I wonder whether these patients’ irate responses to their predicament could be sabotaging their healing.
Doctors have known for decades that stressed-out patients catch every virus that’s going. They suffer more severe symptoms as a result, which they unfailingly describe in Technicolor detail – red rashes, green snot, yellow stools, blue phlegm – and also take longer to recover.
We try to explain this by the high levels of stress hormones such as adrenalin and cortisol in the blood, and point accusingly at a snappily named molecule known as interluekin-6, which is a key player in the immune system.
If the Ohio State sadists are correct, it’s the patient’s preexisting ability to handle stress that determines how quickly they will recover. They’re not angry because things have gone wrong, things have gone wrong because they’re angry.
So there’s this chicken and this egg. The chicken could be the infected wound or the everlasting cold that laid the egg of the patient’s anger. Or it could be that the festering wound or the virus that won’t burn itself out are, in fact, the eggs, laid by a Really Angry Chicken, who needs to cross the road. Why? To go to its anger management class.
Dr Copperfield is a GP in Essex. He also writes for www.DoctorPortal.co.uk. Mark Henderson is away
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