Opinion  

I use the holistic approach of removing his trousers, enabling me to discover that he has both legs down the same hole in his pants and is in need of a memory assessment.

It reminds me that, aside from being probably the only woman in the world willing to access Mr Bilious' groin (trust me, it was only the pleasure of a job well done) I am at my best when focused on people, not symptoms. Yet there's the quality framework.

Friday night found me driving round and round the Coventry ring road whilst the sat nav issued instructions like 'take the fourth exit' in an increasingly smug voice. The problem is, when you approach a roundabout the size of Basildon singing, with a piano in the back that falls over whenever you turn the steering wheel, you have a lot to concentrate on, and if the machine doesn't say, 'third lane in, and stop that hideous racket' then you go wrong.

Three times round the same roundabout I went, trying to count to four whilst murdering extracts from Moulin Rouge. When the road system finally spat me out I joined the M1 by accident and ended up halfway to London. Without relying on the short term objectives of the sat nav I might have had a broader view of where I was coming from and where I was going to - which brings me back to the quality framework.

I wonder if it is GPs' sat nav. It's immediate gains are obvious - we're turning the right way, doing the right things, patients may even be living longer as a result. But are they enjoying it? Does it matter?

What's it actually like to be 90 and multimedicated when for 89 years you ate nothing for breakfast but a pickled onion and a bottle of stout and felt perfectly well on it without ever knowing your systolic BP was 106?

We may be taking the right turns, but are we always going the right way? I resolve to think of Mr Bilious' underpants every day from now on. And they say we GPs have it easy.

Dr Selby is a GP from Suffolk. Email her at GPcolumnists@haymarket.com