My young medical colleague in a city practice had just completed writing a pad prescription for an oral contraceptive for a woman who infrequently came to the practice. My colleague noted that she had not had a Pap smear for three years and she willingly agreed that in the presence of the practice nurse she would have one now. My young colleague went to fetch the nurse and noted that a man was having an unusual type of convulsion on the floor of the waiting room. He administered necessary first aid to the young man, who then stood up and seemed perfectly lucid and well. My colleague’s Pap smear patient suddenly rushed from the examination room where she had been left on the couch during this man’s alleged convulsion, grabbed him by the arm, dashed out of the door and was never to be seen again.
Two hours later, two separate pharmacists phoned my young colleague to enquire whether the amounts of opioids written on his prescriptions for this young woman and the alleged epileptic were indeed correct. My young colleague then noted that five pages had been removed from the back of his prescription pad. The oral contraceptive script of course already had his signature on it, and this had been forged onto the stolen prescription pages.
DISCUSSION AND LESSONS LEARNED
This situation would be unlikely to occur if prescriptions were generated electronically; indeed, the young colleague’s practice has used the electronic system ever since.
Prescription pads are frequently stolen in toto from clinics, and drug abusers have learnt every conceivable method of obtaining these, including my colleague’s non-epileptic young man.
Many practices including this one keep a list of drugs of habitation and addiction, which doctors in the practice refuse to supply to patients except those known to be genuine medical users rather than possible abusers.
Other items of medical equipment are frequently stolen (in addition to the clinic’s magazines!) and syringes and needles particularly should be kept securely.
TONSILLITIS: TRAPS FOR THE UNWARY
In country practice I had acquired the skills for tonsillectomy, a much over-performed operation in past years. A colleague from another country practice referred to me a 20-year-old woman for tonsillectomy. I thought that the tonsils were normal, but both he and the patient insisted they should be removed because of a recent shocking attack of tonsillitis. I obliged.
A few months later he rang saying he had a 23-year-old woman with another terrible bout of tonsillitis. This seemed most unusual and so I requested to see the patient the following day. Indeed she did have severe tonsillitis, but she also had petechiae on the soft palate, widespread lymphadenopathy, splenomegaly and a positive Paul–Bunnell test. (Refer to Figure 7.1)
View of throat showing ‘tonsillitis’ of Epstein—Barr mononucleosis. Photo courtesy of Hugh Newton-John.