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.
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.