This has been designed to show how the different components of the immune system develop individually and work together. I realised that a flowchart would be an excellent way to demonstrate this and was surprised to find that there wasn’t anything suitable on the internet that linked both the innate and adaptive systems. I know the diagram looks a bit dry but if you spend 5 minutes reading through it, I hope you'll find it useful. I'll hopefully add some images to make it more appealing at a later date.
The flowchart is based on information from lectures and several textbooks and has proven to be an excellent tool for revision and in developing a foundational understanding of the immune system for many students.
This video - produced by students at Oxford University Medical School in conjunction with the ENT faculty - demonstrates how to perform an examination of the ear using an otoscope. It also demonstrates the anatomy of the tympanic membrane.
A 68 year old woman presented to the ear, nose, and throat (ENT) clinic with gradually worsening bilateral hearing loss over at least the past five years. This was associated with some non-intrusive tinnitus but no other otological symptoms, history of vertigo, or associated systemic problems. She found that she was increasing the TV volume to a level that her family found uncomfortable, and she had started to avoid social situations because she struggled to hear conversation among the background noise. Her medical history was unremarkable except for well controlled hypertension, for which she was taking amlodipine. She also had no history of excessive noise exposure, no previous otological problems, and no family history of note.
I’m sure there are times when all us GPs feel under-appreciated — by our patients, staff, specialist colleagues or society in general. You can’t blame them for sometimes taking us for granted — it’s part of the human condition. People don’t value what they have until they lose it, whether “it” is the ability to walk or a domestic fairy who makes sure there’s always spare toilet paper.
It’s a common lament that we can’t be at our own funerals to hear how much we’re loved. Mind you, eulogies are rarely objective and balanced. Nonetheless, it’s a pity we’re not around to hear the praise — deserved or otherwise — that is expressed once we’re gone.
The long-serving, somewhat-taken-for-granted GP has a non-fatal way of bringing out the appreciation in his or her patients and staff: moving on.
After 10 years of GP-ing in the Noosa hinterland and a lifetime of living in south-east Queensland, I headed south of the border: to northern NSW. The hardest part of the move for me — harder than selling my house in a depressed market, harder than dealing with banks, builders, real estate agents, solicitors and Australia Post, harder even than trying to get rational answers out of my telecommunications company after they cut off my internet and phone prematurely — was telling my patients that I was leaving.
I knew many of my patients were very attached. I knew they’d come to me expecting to receive a loyal, life-long partner kind of doctoring, rather than the one-night-stand variety. But I had no idea how difficult it would be to break the “I’m leaving you” news again and again and again.
Hard as breaking up a relationship may be, at least you only have to do it once when you leave a romantic partnership. For me, telling patients I was leaving felt a bit like breaking up with hundreds of boyfriends, one after the other after the other.
You may interpret this as my being too close to my patients or not close enough to my boyfriends, but the fact is I found the protracted process exhausting, emotionally draining and just plain horrible. The “it’s not you, it’s me” part goes without saying and
I know I am far from irreplaceable, but seeing the tears well up in countless eyes because of the words I’ve uttered was enough to break my tender heart.
Looking on the bright side, as I am wont to do, if I’d ever felt under-appreciated, I sure don’t now. I received more expressions of gratitude in those last three months than I did in the previous decade. To hear how influential I was in some of my patients’ lives put a warm glow in my battered heart. And as much as it hurt me to see my patients upset, it probably would’ve hurt me more if they’d been completely indifferent to my leaving.
However, I did please someone. Mrs L had been trying for years to get her husband to agree to move interstate to be near family. His last remaining excuse was that his multiple complex medical problems meant that he couldn’t possibly leave me, his long-term GP. A grateful Mrs L rang me within hours of my informing them of my impending departure to say:
“He’s finally come around. Thank you so much for deciding to leave us.”
It’s nice to be appreciated!
(This blog post has been adapted from a column first published in Australian Doctor www.australiandoctor.com.au/opinions/the-last-word/the-last-word-on-moving-on- )
Dr Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/