Margaret McCartney: Doctor's notes

· I have no idea why I haven't spotted it before. At the bottom of the new, computerised forms we are now using to refer people to hospital, there is a little box. It asks if the patient has a preference as to the gender of his or her consultant. Maybe some men would prefer to see a male doctor about certain things. But how much preference is acceptable? If a male patient didn't want to see a woman consultant about, say, his dodgy gall bladder, should I think that's OK and tick the box for a male consultant? And what about obstetrics? Well, what mattered to me most when I gave birth was that the hospital was decent (it was, and there was no choice of which hospital that was) and that my obstetrician was experienced, kind and sensible (they were - all three, and all male). This kind of "choice" seems like it holds fairly ghastly possibilities that won't stop with sexism. Should patients be allowed to choose which religion or race their consultant is? The box should go.

· On the subject of same-sex care, that used to be thought protection enough, so that if you were a woman doctor examining a woman, there was no need for a chaperone. Not so, says the General Medical Council. A chaperone should be offered whenever the doctor does an intimate - breast, genital or rectal - examination, guidance says. But aren't other examinations "intimate"? What about, for example, ophthalmoscopy, when, with the lights switched off, a light is shone into the eye from a distance of only centimetres? Or an examination, say, of the neck - is that intimate? Possibly.

As borne out by the correspondence pages of the medical press, doctors are increasingly afraid of doing such examinations without a chaperone. And where do chaperones come from? The GMC and the legal defence bodies are clear that a patient's friend or a family member isn't good enough: they are not independent, and you may not wish them to be privy to information shared in the appointment. As for nurses, they aren't always available to come and act as a chaperone, and they have their own work to do. The Ayling inquiry, which reported last year after Dr Clifford Ayling was jailed after inappropriately examining women, made it clear that it would not be acceptable to use untrained staff - such as practice receptionists - for the role of chaperoning either. It seems people will have to be specifically trained for the job instead.

In the meantime, patients are being told to return when a chaperone is available - or the doctor avoids doing the examination altogether. Given the (necessary) hassle involved, it is ironic that in the majority of cases the chaperone is not there for the patient's protection, but the doctor's.

· There's too much fuss about testing for HIV, says a recent editorial in the British Medical Journal. We should be offering and doing tests for it in the same way as we test for other serious chronic illnesses, it says. And it's a good point. The idea of seeing a counsellor in a specialist setting for prolonged pre-test discussions is very 1980s. HIV still isn't curable - like most chronic illnesses - but it's certainly very treatable, and the earlier the better. There are an estimated 50,000 people in the UK with HIV, a third of whom haven't yet been diagnosed as having it. So, the authors say, we should be running tests more often. Of course, people should still be informed when they're being tested - but does testing for HIV really have implications beyond that of any serious illness such as hepatitis, leukaemia or TB? If we think it does, we may be unwittingly perpetuating the stigma of it by still treating it as a dreaded "special case", which isn't going to help anyone.

· Thank goodness it's been discovered! "Hurried woman syndrome", says the Daily Mail, is caused by chronic stress resulting from the demands of "juggling work with a hectic family life, such as bringing up children and caring for elderly relatives". The symptoms of tiredness, weight gain and trouble sleeping can be relieved by - I'm so glad they told us this - "reducing your pace of life and organising things better". There's a book and a website, where Dr Brent Bost wants to heal the suffering of an estimated 30 million women with his seven-step programme. Like text-messaging addiction and compulsive shopping before it, hurried woman syndrome is all about creating a modern pathology. But we don't need our normal lives medicalised, thanks anyway. In any case, drinking a glass of wine while ignoring the ironing is cure enough for this one.

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