Confessions of a GP (26 page)

I love the fact that my job allows me to meet all types of people of all ages and backgrounds. It is the best part about being a doctor and of the several thousand patients I see each year, I’m rather fond of most. There are, however, one or two patients like Mr Smythe who regularly irritate and infuriate me. All doctors dislike one or two of their patients but, with the exception of occasional confessional whispers between close colleagues, we rarely admit to it. I had already been a doctor for several years when a consultant psychiatrist took me aside and told me that it was okay to dislike some of my patients. Hearing those words was like a huge weight being lifted off my shoulders. I was able to release my guilt that had been bubbling beneath the surface and eating away at me from the inside. It felt immensely liberating to now admit these feelings and reassure myself that they were normal and, in some ways, healthy. The revelation for me as a doctor was that while I now felt able to admit to myself my personal dislike of a patient, it must not stop me from treating him or her as fairly and professionally as I would any other patient.

Boundaries

Mark is about my age and I can’t help but like the bloke. He is friendly, funny and interesting and if he wasn’t one of my patients, I imagine he could well be one of my friends. He has bipolar disorder, which means that he can get very depressed at times and at others can become as high as a kite and dangerously manic. It is a tough condition to live with and I like to see him every few weeks to make sure everything is stable.

After a few months I’ve got to know him quite well. I know about his job and his family and his relationships. He can see the funny side of his illness and he makes me laugh with some of the stories he tells. Each time he comes to see me he asks how I am. Lots of my patients ask me this but most don’t actually want me to answer. People visit the doctor to gratefully offload in one direction only. I don’t have a problem with that, but Mark is different. We get on well and I genuinely feel that he does care how I am. It feels odd him calling me Dr Daniels rather than using my first name and I think that he would like me to take down my professional barrier and have our consultations as more like chats between two friends.

It is very tempting to give in and do just that. My days at work can be long and lonely. I am constantly speaking and interacting with people, but at the same time I’m not really allowed to be my real self or relax. I would love to have a proper chat with Mark and tell him a funny story about my weekend or let him know what really pissed me off about something that happened that morning, but I don’t. I keep the barrier up for the protection of both of us. Mark is not my friend, he is my patient. If he viewed me as a friend, he might feel uneasy disclosing something to me. He might worry about what I thought or care about my opinion of him. At some time in the future he might become really unwell and need advice he doesn’t want to hear, or worse still one day he might need sectioning. How could I act objectively as his doctor if I regarded him as a friend? It might come across as a bit stuffy calling myself Dr Daniels and refusing to talk about myself to patients, but boundaries are important. Mark has other friends but I’m his only GP. The doctor–patient relationship is unique and worth maintaining.

Smoking

Regardless of why a patient comes to see me, I am required to ask them if they smoke and if they say yes to give them ‘smoking cessation advice’. I do this because it is probably a good idea that my smoking patients give up. I also do it because it earns the practice points and we all know what points mean.

Personally, I’ve never been that convinced about giving smoking cessation advice. I have tried various techniques and am not sure any of them really work. Here are a few of my best efforts:

‘Smoking is bad for you’ (patient probably knows this).

‘Smoking will kill you’ (patient probably knows this, too, and now I’ll have put their blood pressure up, which will mess up my hypertension targets).

‘Smoke if you want to, I really couldn’t give a monkey’s’ (reverse psychology – maybe they’ll give up to spite me).

‘Stop smoking right now!’ said in an authoritative paternal doctortype way (patient would probably laugh because I’m not very good at being authoritative – ask my cat).

As with all addictions, beating them is only possible when the addict is really ready to give up, hence I only give smoking cessation advice when it is the patient’s idea. Sometimes I’ll give my smokers a bit of unsubtle prompting: ‘Hmm, you’ve had a fair few chesty coughs this winter. Why do you think that is?’ If the 40 per day smoker insists that it is because of an allergy to the neighbour’s rabbit or the office’s air-conditioning system, I don’t bother with stop-smoking advice. If they recognise that smoking is harming them and genuinely want to give up, I am only too happy to give as much help, encouragement and nicotine patches as humanly possible.

Angry man

Angry man is red in the face and if I didn’t know it was medically impossible, I wouldn’t be surprised to see steam billowing out of his ears in a cartoon-like fashion.

‘You need to give me some diazepam to calm me down, Doctor. I’m on edge. I feel like I’m going to hit someone!’

‘Why are you so upset at the moment? Would you like to talk about it?’

‘Look, Doctor, I’m not here to talk about my problems. I need you to give me something to calm me down.’

‘I’m sorry but I don’t prescribe diazepam for anger. We need to find a better way of dealing with the problem. I know of a very good anger-management course I could put you in touch with…’

I didn’t think angry man could get any angrier, but I am wrong. He starts beating the desk and he pushes his face next to mine.

‘Look, if you don’t give me something to calm me down, I don’t like to think what might happen. I could really fly off the handle and hurt someone. You could be responsible for someone really getting hurt.’

‘If you hurt someone, you need to take responsibility for that yourself.’

Angry man stands up menacingly and, for a moment, I think he is going to hit me. I cower inwardly and wish my nose wasn’t quite such a large target. Angry man calls me a fucking disgrace to the medical profession and then he leaves. I actually think that my complete lack of physical presence is a great advantage in these situations. I look about as menacing as an anorexic kitten playing with some cotton wool and this seems to deter even the most threatening of would-be nose breakers.

As the door slams, I give myself a few moments to compose myself and then carry on with the afternoon surgery. The rest of the day continues uneventfully and after Mrs Gibson’s exceptionally large haemorrhoids and yet another ‘funny turn’ from Mr Polucovski, angry man’s outburst is but a distant memory.

Two hours later I am standing at the checkout in Sainsburys, having stopped off on the way home from work. The boy on the checkout is particularly slow and I am regretting that I didn’t pick the next queue over which seems to be travelling at twice the speed. The man behind me is putting his shopping on the belt and as I glance up, my heart skips a beat. It is angry man. We are trapped in the slowest checkout queue in history and the antagonism of our last meeting has switched to an overwhelming awkwardness. It is too late to swap to another till so we both shuffle along uncomfortably in the quiet confinement of the queue.

Earlier this afternoon I had imagined angry man to be in a perpetual state of rage, but now as my eyes browse over his shopping, I begin to see another side of him. I am relieved to see that he isn’t buying a baseball bat and a book about serial killers. Instead, his basket holds a bunch of fair-trade bananas, some extra soft toilet paper and a Harry Potter book. Suddenly, angry man isn’t the big scary man that he was a couple of hours ago. This opportune insight into the man behind the fury warms me to him slightly. I consider trying to find a few words to break the ice, but our super-slow checkout boy has finally managed to scan all my items and it is time for me to pay. As I leave, not-so-angry man gives me an awkward nod and I wonder if our next encounter in the surgery might be a little less heated.

Maintaining interest

After practising medicine for some time, the average grumpy doctor will have seen many thousands of patients pass before him or her. In the early part of our careers we greet every medical condition with genuine intrigue and gusto, but as the years pass it can become harder and harder to muster up the enthusiasm to keep ourselves awake during slow afternoon surgeries.

Having said that, there are a few ways in which you, the patient, can grab the attention of even the most indifferent of doctors:

1. Have a rare condition
   . Your diagnosis should be common enough that we learnt about it at medical school but rare enough to be something that we have never actually seen before in the flesh. Be warned, however, that if it is so rare that we can’t recognise it or have never heard of it, our feelings of incompetence will lead to frustration and resentment, which will most likely be taken out on you.
   
2. Have a diagnosis with a good name
   . I love the way
   molluscum contagiosum
   rolls off the tongue. The delightful Latin words entertain me so much that I have forgiven the fact that the condition they describe is an extremely mundane skin lesion that I have seen many hundreds of times.
   
3. Make me laugh
   . I will pardon a boring medical condition if it was obtained in a comical fashion. Sprained ankles are very dull but you will be entirely absolved if you managed to achieve your sprain by trying to do the moonwalk in a kebab shop while dressed as Scooby-Doo. If you actually just sprained your ankle by stepping awkwardly off the kerb, make up a more entertaining story and your doctor will view you in a better light.
   
4. Be attractive
   . When I was working in A&E, the orthopaedic surgeons were famous for avoiding seeing patients at any cost. The only time we ever saw them demonstrate any degree of enthusiasm about their chosen profession was when a particularly beautiful dance student injured her knee. I’m sure she didn’t really need admitting but they insisted that they kept a close eye on her on the ward for a few days.
   
5. Have a truly embarrassing problem
   . It must be awful to have to tell your doctor that you have an object stuck up your bottom, but if it is any consolation, it will absolutely make your doctor’s day. For me, the icing on the cake is always the ridiculous accompanying explanation: ‘So I was trying to save water by washing the vegetables while also taking a shower and then I slipped and what are the chances of landing on that courgette…’
   

I am proud to say that I do listen and show interest in my patients because I still maintain enthusiasm for my job. This is not because my day-to-day work in general practice is on the cutting edge of medical science, but because I have a genuine interest in the people and the stories behind the science of the illnesses. Of course, quite rightly when you are ill or injured, you have absolutely no reason to give two monkeys’ whether your condition holds any academic curiosity or entertainment value to the doctor you’re seeing – and why should you? Just one thing, though, if at the end of a long surgery you are 15 minutes through a monologue describing the detailed chronology of your athlete’s foot, don’t be overly offended if your doctor’s eyes glaze over somewhat.

The future?

If you get a bunch of GPs in a room together, it won’t be long before they start moaning about their jobs. This never ceases to amaze me, as I think we have it fairly good at the moment. We are paid well, work good hours and have an interesting and rewarding occupation. Despite this, GPs spend a great deal of time complaining about almost everything. I even heard a couple of GP partners complaining about how high their tax bill was going to be this year. I couldn’t help but point out that if they were going to earn 120K, then they couldn’t really expect any sympathy for paying a bit more to the treasury come April!

Some of my older patients reminisce fondly about the time when their own GP was on call 24 hours a day and was always on hand for an emergency visit. My uncle was one of those GPs. He would disappear from family dinners to deliver a baby, get home at 5 a.m. and then start morning surgery at 8 a.m. with a huge line of patients queuing out into the street. There is a wonderfully romantic, old-fashioned idea about that bygone time of the loyal and dedicated family GP. My auntie still has her late husband’s ex-patients stopping her in the street and telling her what a wonderful doctor he was. My uncle had no life outside of his work and rarely spent any time with his family. He missed his children growing up and dropped down dead shortly after retiring. I wouldn’t want to have had his life. My generation of young GPs is mostly much better at finding a balance between work and home life. I’m sorry that my patients have to see a GP they don’t know if they need a doctor on a Sunday night or while I’m on holiday, but I have a life too.

All in all, I’m quite positive about the future of general practice. There are always scaremongering stories about big supermarket chains setting up surgeries and shipping in lots of Eastern European doctors to take over our jobs. I think this is unlikely. Yes, patients grumble about struggling to get through on the phone or their doctor running late, but individually most GPs are quite well liked and valued by their patients. My experience of patients is that they are a fairly loyal bunch. I’m not sure that a huge number would be lured away to Tesco if they opened surgeries at the back of their stores. I can see that some would be attracted by the convenience of supermarket doctors, especially if they ran a 24-hour service, but ultimately most patients like the familiarity and friendliness of their local practices. Although there is a lot of potential profit to be made out of running GP surgeries, there is also a hell of a lot of red tape and hoops to jump through. I’m not sure whether Tesco would really want the bother. I may eat my words someday but I think that our jobs and future are fairly secure.