Today I had the pleasure/misfortune of meeting Mr R.......
Before he came in for his consultation I had browsed his file. He had been in 6 times in the last 7 months, always with the same complaint.
He was obsessed with herpes. Sounds strange enough for this clinic.
He was convinced that he had herpes anythime a random bump popped up anywhere.
TUTORIAL ON HERPES:
For those of you who don't know....and Mr R you should really pay attention here.
There are two types of the herpes virus. Herpes Simplex 1 and 2. 1 is mainly the oral type (cold sores) and 2 being mostly the genital type. It is spread by body fluids.
Now Mr R is convinced that he has caught herpes on the tube, after holding onto the rail, or after shaking someone's hand. This would only happen if someone had licked their fingers or shoved them you know where and then touched him AND he needs to have broken skin.
This paranoia has driven him to compulsively hand wash. He washes his hands over 20 times a day, convinced that there are germs on them. He now has extremely dry hands that have cracked. So the cycle continues.....he thinks he will definitely get herpes now with cracked skin....washes his hands more....etc etc.
He has come in today because he has a tiny red bump on his hand.
LMM: Hello. I am LMM, how can I help you?
Mr R: Hello. I am sure you have seen from my file that I have been here a lot before. I know I have a problem but I think I may REALLY have herpes this time.
LMM: And what makes you think you have herpes?
Mr R: I have this bump on my hand and my hand is red.
LMM: Let's have a look at your hands then.
At this point knowing his paranoia, I get the alcohol gel and larder a huge amount onto my hands.
Mr R: I don't mean to be rude, but do you mind wearing gloves?
LMM: No, not at all. I completely understand.
Slightly miffed, I put on gloves.
LMM: It looks like you have a mild contact eczema on your hands. It is probably due to excessive handwashing.
Mr R: But on the internet..........
Oh FUCK! I hate the fucking internet. If you think the internet is right, then pay the 12 year old who has written random facts online for the consultation.....ARGH!!!! If you googled anything it would come up as cancer, HIV, DEATH so don't do it.....or go to a proper website.
Mr R: .............they said that excema can lead to herpes and cause herpetic eczema.
LMM: That looks completely different to what you have Mr R. You have an area of dry skin and a small area of redness with one TINY papule. It is not herpes.
Mr R: I would still like to have the swab for herpes.
LMM: I can take the swab, although I don't advise it.
Mr R: I want the swab.
I begin to swab the small affected areas.
Mr R: Don't forget about this spot over here.
Mr R: And this one here.
Mr R: And what about this area?
LMM: I think we have all we need.
Mr R: Can you prick that bump with a needle to get a better swab?
LMM: No I don't think that is a good idea.
Mr R: Please do it. I won't be able to sleep otherwise.....PLEASE!
LMM: OK OK.
Mr R: Is that needle clean?
Oh for heaven's sake!
Eventually, swab taken, paperwork completed, Mr R leaves and I breathe a huge sigh of relief. My annoying patient for the day is done and usually there is only one, until.......................................
(Brrrrrring brrrring....phone ringing)
Receptionist: Hi, remember Mr R from this morning?
Receptionist: He's on the other line and wants to speak to you.
LMM: OK put him through.........(Mother of pearl what does he want now?)
LMM: Hello Mr R, how can I help you?
Mr R: I am sorry to bother you LMM, but since I left your office I have been very anxious about something. I cannot stop thinking about it.
LMM: Mr R I have explained to you alreay that the likelihood of you having herpes is extremely low and you need to be reassured that you don't have herpes......
Mr R: No it's not that.
LMM: Well what is it?
Mr R: Well....um....no I cannot say......
LMM: Tell me. Maybe I can help with your anxiety.
Mr R: I was just wondering....no it's too rude.
LMM: Mr R, if you don't tell me what is concerning you, then I can't help you.
Mr R: I just wanted to know, do you think there is a chance.....excuse my rudeness......that some of your saliva could have dropped on the glove and then you touched my hands?
Yes I am known to drool on patients!
LMM: No I don't think that could've happened.
Mr R: But if it did and you had herpes and my skin was broken.......
Now I have discuss my own sexual health with a patient.
LMM: That is extremely unlikey and Mr R, if you must know, I don't not have herpes.
Mr R: 1 or 2?
LMM: I don't have either. Now you will have to wait for the results to come back, but I don't want you to worry anymore.
Mr R: I am sorry for being so rude. I really shouldn't have said that.
LMM: No its alright. I do understand where you are coming from (and I really did mean that)
Mr R: It's extremely rude. this has driven me mad. I can't even play with my own son, even though I know he doesn't have herpes (at this point he starts to cry)
LMM: Mr R it is understandable that you feel this way. You need to continue with your counselling and if you have any other questions, feel free to call me.
Mr R had initially irritated me beyond belief, but then my heart melted when he spoke about his son and I couldn't imagine anything worse than having an irrational preoccupation with something.
Hopefully I won't see him again.....but I know that is unlikely.