And you thought you were healthy

The people of Framingham, Massachusetts enjoying their breakfast

Deciding when to begin treatment for heart disease prevention is a big part of the GP curriculum. Once you start a drug for blood pressure the chances are you'll be on it for the rest of your life. Until you either get sufficiently demented to stop taking them, or just too bored to keep popping pills when you'd rather be down the bowling club chatting up the other octogenerians.

Your GP will almost certainly use the "Framingham risk calculator" to see if you need to take a statin, a blood pressure tablet and an aspirin a day. It is a useful tool. If it came about that you had a heart attack and weren't on a buffet of medicines beforehand, many GPs are afraid they will be sued. So they will tap in your details. If Dr Genesis were 70, didn't smoke (although he's thinking of starting up cigars when he hits 75), wasn't diabetic, had a blood pressure of 140/90 and a cholesterol of 6 he would be a happy man. He would consider himself one of the healthiest 70 year old men in the world.

Think again my friend. For Dr Genesis would be classed as "high risk" by the Framingham calculator. He would have a 20% chance of having a heart attack/stroke/angina/sudden cardiac death in the next 10 years. He would instantly be advised to take an aspirin, a statin, at least one if not two antihypertensives and do more exercise. No cigars for Dr Genesis.

Dr Genesis would have the good sense to gently decline his GP's best efforts. He is a little prone to gastritis so would refuse the aspirin. He enjoys tennis and wouldn't want to risk muscle ache from a statin. He is rather fond of his electrolyte balance and so would eschew a diuretic or ACE inhibitor. He would take his chances and do his best to avoid doctors.

But many do not have Dr Genesis's wily and fox-like cunning brain. They will swallow the medicine because it what they have been told to do. They will think of themselves as ill. What a shame.

Roll of the die

Ou est le needle?

Christmas period in GP land, deep in the heart of Worryshire. Almost all of Dr Genesis' surgery is dealing with people with coughs and colds. Runny nose, achy, sore throat, a cough that's "gone to my chest" and, of course, there's no way they could go to work.

Dr Genesis was ill a few weeks ago. Achy all over, shivering uncontrollably, no appetite (not even for expensive chocolates). He lay in bed all evening, drank lots of sweet tea and took the morning off. But he went in for his afternoon clinic.

But then Dr Genesis has a strongly internal locus of control. He believes he is responsible for his health. So when he gets ill, he blames himself. He thinks of himself as weak. So he must regain his strength quickly.

The problem with all these patients is one of risk assessment. Fever, sweating, poor appetite, glands up in the neck. Hang on, this sounds familiar. It sounds like the patients Dr Genesis saw when he worked in a haematology clinic. They had lymphoma.

So which one of these people with a cough or cold has lymphoma or leukaemia? Hopefully none of them. If any of them do, let's hope it's Hodgkins.