Winter; discontent; you know the drill.

Contemplating a day full of flu patients

Contemplating a day full of flu patients

Winter is coming

As any Game of Thrones character will tell you – and most eventually do – winter is coming.

In the land of general practice, a long way from the nearest fur-coated dwarf or icicled king, we instead rely on six signs to detect winter’s approach.

1 The first sign is the season’s first use of the word ‘lurgy’. A word unspoken for nine months of the year, lurgy comes out of hibernation just as everything else enters it. No one knows the word origin: my guess is a bastardisation of URTI; or a contraction of metallurgy, the ancient term for metalworker’s lung (I haven’t looked it up).

2 The second sign that winter is coming depends on where you practice. In my Victorian days (the location, not the era), patients would start wearing duffel coats and scarves. Now in Queensland, I know it’s cold outside when the blokes wear long socks under their sandals.

3 The third sign is the three-child, bulk diagnosis. During spring, when three young children enter the room, variously carried and prodded by their sleep-deprived mother, you can pretty much type ‘gastro’ straight away. But a cluster of children in winter always indicates three URTIs. Unless it’s three lurgies. As soon as they shuffle in, prepare your spiel on viral illnesses or, if you’re my after-hours locum service, three antibiotic scripts.

4 Fourth, each winter is heralded by a rise in billings. Frequent, short consultations for self-limiting illnesses. GPs who practice in alpine areas experience a winter billing slope steeper than a ski jump, although the long hours take a toll and they usually crash on landing during spring.

winter icicle 5 Fifth, many of those short consultations involve patients who are well aware that you can’t cure them, but their employer suffers from GANFYD syndrome: Get A Note From Your Doctor. So your winter of discontent is spent filling in paperwork. Often you’re the only doctor doing it, because your colleague is at home with a lurgy, wondering if they need to attend the same surgery they are absent from, for a GANFYD.

6 Finally, certain medical diagnoses make winter inevitable: shins get ‘erythema ab igne’ from exposure in front of the open fire – a very British complaint – and then there’s Seasonal Affective Disorder, with its entirely appropriate acronym. Albert Camus would have been medicated for it, if only DSM IV had been invented. Instead, he wrote timeless prose:

“In the depth of winter, I finally learned that within me there lay an invincible summer.”

Invincible summers are a long way off. Meanwhile the lurgies, URTIs, GANFYDs and duffel coats whisper to us like a seasonally disordered soothsayer: winter is coming.

This article was first published in Medical Observer, May 2015

About Dr Justin Coleman

Justin is a GP working in Aboriginal health in Brisbane, Australia. He is also a medical writer, editor and blogger. Further details at https://drjustincoleman.com/
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4 Responses to Winter; discontent; you know the drill.

  1. fnmyalgia says:

    You have no idea how debilitated the SADs can be. Flat-bottomed troop transports carrying a Ships Army Detachment (who signed up because of their love of open spaces), rolling around on ocean swells. Your SADs don’t carry their emesis bag 7/24

  2. anneharrison says:

    Ah, winter. All those lurgies which end up from GP land through A&E to the wards whilst my arm remains sore from the dreaded flu vax, so nobly suffered so I don’t spread the disease around the hospital. By the way, the term lurgy originates, most appropriately, with the Goons, who wrote an episode around this fictitious disease about to sweep over Europe and into Britain. Sound familiar?

    • Wow, I had no idea about the Goons connection, Anne, and I am a big fan, so that is a simply delightful word origin! It also explains its usual accompanying adjective: the ‘dreaded’ lurgy, which was a repeated phrase in that one 1954 radio episode.
      I just read an explanation at http://www.worldwidewords.org/qa/qa-dre1.htm which spells it lurgi – I guess you’d have to go back to the original radio script to confirm the correct spelling.
      Being both a word geek, and someone whose teenage comedy writing was heavily influenced by Spike Milligan (including my Yr 11 final English exam piece – my worst essay mark ever), this connection has made my day.

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