This morning's surgery.

2 patients stand out this morning.

Mary is 77. I see her regularly to check her blood pressure. It is always raised, and despite numerous alterations to her medication ranging from wholesale changes to subtle tweaks, I have had little success. 2 weeks ago I started her on a medication called diltiazem. I had been resisting this as she also takes a beta blocker. Both drugs can slow the heart, so this can be dangerous.

Today her blood pressure was excellent, the best I've ever seen it. I hope it's not a one-off!

Emma is a young Type 1 Diabetic. I was routinely reviewing her diabetes, which is generally excellently controlled with insulin injections. Emma has mastered managing her own diabetes. She adjusts the amount of insulin she takes depending on what she is doing day to day. There seemed very little I needed to do. Then I asked Emma whether her diabetes ever got her down. She became very tearful, and confessed that she often wondered if she was depressed, but had never felt brave enough to initiate this topic with a doctor, as they might think she was being silly.

We had a long chat, during which time I'm confident I was able to convince Emma that she could discuss depression with me on any occasion without fear of ridicule. This is one of the more satisfying aspects of being a GP, when you can draw out a patient's real worries which they otherwise would not have mentioned.