Confessions of a GP (3 page)

I picked up my pager at five that evening and sat there looking at it timidly. This small black box would come to be hated by me during my future years as a hospital doctor. This box would wake me from sleep and interrupt my meals. When completely overloaded with work and feeling like I couldn’t cope, this small inconspicuous little box would bleep and tell me that I had another five urgent things to deal with. Of course I was unaware of all of this on that first innocent evening. Instead, I had a naïve excitement that I was finally considered important enough to have my own pager and that it might actually go off. I had been practising how I should best answer it:

‘Hello, it’s Dr Daniels, vascular surgical house officer.’

That’s right, my first job was as the junior in the vascular surgery team. I didn’t really know what vascular surgery was, but I liked the sound of it. Perhaps I could drop the house officer bit and just answer by saying: ‘Hi. Dr Daniels, vascular surgeon.’ Hmm that would sound much more impressive. I could just picture the attractive nurse swooning on the other end of the line.

To my surprise, at about ten minutes past five my pager did go off. I took a deep breath and answered the call: ‘Hi. Dr Daniels, vascular surgeon.’ There was a sigh from the other end of the telephone. It was my consultant and new boss. ‘You are not a vascular surgeon, you are my most junior and least useful helper monkey. Some poor bastard has popped his aorta and I’m going to be in theatre with the registrar all evening trying to fix him. I need you to order us a chicken chow mein, a sweet and sour pork and two egg fried rice. Have them delivered to theatre reception.’ The phone went dead. That was it. All those years of study and my first job as a doctor was to order a Chinese takeaway. Consultant surgeons have a wonderful way of ensuring that their junior doctors don’t get above themselves.

Over the next hour my pager started going off increasingly frequently until it built up to what felt like a constant chorus of bleeps. Jobs that would take a few minutes for me to do now, took an hour back then because I was so new and inexperienced. I decided that the cocky doctor role didn’t suit me so I went for the pathetic vulnerable new doctor approach. It worked and the nurses soon began to feel sorry for me. They offered to make me tea, showed me the secret biscuit cupboard and helped me find my feet. Just as I was beginning to gain a little confidence, my pager made a frightening sound. Instead of the normal slow, steady bleep there was a stream of quick staccato bleeps followed by the words ‘Cardiac arrest Willow ward…Cardiac arrest Willow ward.’ To my horror, that was the ward that my consultant covered. That meant that I should really be there. I started running. The adrenaline was pumping, my white coat was sailing behind me as I zipped passed people in the corridor. I was important. It felt great! Suddenly, as I got closer to Willow ward, a terrifying thought dawned on me, ‘Oh my God. What if I’m the first doctor there!!!! I’ve only ever resuscitated a rubber dummy in training exercises. I’ve never had to do the real thing.’ To my left was the gents’ toilet. Doubts began to race through my head. ‘Perhaps I could just nip in there and hide for a bit. I can reappear in a few minutes once the cavalry has arrived.’ It was tempting, but I bravely decided to keep on running and meet my fate.

Lying in a bed was a frail old lady with her pyjamas ripped open and her torso exposed. She was grey and lifeless and I can remember her ribs protruding out of her chest wall. A couple of nurses were frantically running around looking for oxygen and the patient’s notes, while another nurse was doing chest compressions. To my relief, a remarkably relaxed-looking medical registrar was standing at the head of the bed and calmly taking charge. A monitor was set up and it was clear even to me that the wiggly lines on the screen meant that the patient needed to be shocked. A few other doctors soon turned up and I was pretty much a spectator as they expertly performed a few rounds of CPR (cardiopulmonary resuscitation) followed by a set of shocks. It was all very dramatic but the woman didn’t seem to be making any signs of a revival. Thinking that I had managed to escape my first cardiac arrest as an onlooker only, I began to consider sneaking away, aware of how many mundane jobs were waiting for me to be done on other wards. Unfortunately, the relaxed-looking registrar spotted me and called me forward. ‘This one’s not coming back; shall we let the house officer have a go with the defibrillator?’ I had just done my CPR training and it was all still clear in my mind. This was my big moment. For some reason, I had it in my head that if it was me who shocked her, she would suddenly come round. What a great story that would be, I thought as I stepped up to the bed. The one thing that the instructors had really emphasised in the resuscitation training was the importance of safety. I had to make sure that all the doctors, nurses and oxygen masks were clear of the bed before shocking the patient. I stepped up and took the paddles. Lifting them out of the machine I carefully placed them on the woman’s chest. Looking all around me, I started the drill: ‘Oxygen away, head clear, feet clear, charging to 360, shocking at 360.’

BANG. My adrenaline had been pumping but I hadn’t expected that. I had stayed on my feet but had been thrown backwards with a jolt. That never happened with the dummies. I must have been looking slightly dazed and the registrar glanced over at me with faint amusement. ‘You’ve electrocuted yourself, you prat.’ Unfortunately, he was right. I had checked closely to make sure that the bed was clear of bystanders before I gave the electric shock, but I hadn’t realised that on running to the ward, I had shoved my stethoscope into the pocket of my white coat and as I was leaning over the patient, the nicely conductive metal tubes had been lying on the patient’s left hand.

As if to rub salt in the wound, my first pathetic effort at resuscitation led the woman to go straight into asystole (flatlining) and the registrar called it a day. The correct thing to have done would have been to report my electrocution as a critical incident and give me a bit of a check-over, but instead the registrar just disappeared off the ward chuckling to himself. I had made his night and he called me ‘Sparky’ for the rest of my six-month spell at the hospital. I was left to carry on with the boring jobs on the ward and by the following morning everyone had heard of my disastrous first night. Perhaps it was an early indicator that I was better suited to the slightly less dramatic world of general practice.

Jargon

At my secondary school I was known as Benny Big Nose. Not the most charming of nicknames, but nevertheless a beautifully simple and succinct summary of my name and most prominent facial feature. I sometimes wish medicine could be as straightforward. Why do we use long-winded medical jargon to describe something rather simple?

Purulent nasal discharge – snot; viral upper respiratory tract infection – a cold; infective gastroenteritis – the shits; strong urinary odour – stinks of piss.

One reason for medical jargon is so that we doctors can write something in the notes that if the patient were to read, they wouldn’t take offence and complain. There was a time a few years back when patients had no right at all to see their own medical notes. I was recently looking through the old paper notes of one retired farmer and the sole entry for 1973 was ‘Patient smells of pig shit.’ How beautifully jargon free.

When I first qualified, I loved all the medical jargon. I felt that it made us sound clever and elite and I got off on the fact that I could have a chat with a fellow medic on the train. However, it only takes an interaction with someone who uses jargon that you don’t understand to realise how annoying it can be. Current letters from our managers at the PCT (Primary Care Trust) have just this effect on me. What do phrases like ‘performance-based target strategies’ and ‘competence managed commissioning’ mean. They certainly don’t seem to bear any relevance to my daily routine of listening to people’s health grumbles and trying to make them feel a bit better.

Patients are always happiest if you skip the jargon and say it how it is. I find that replacing the phrase ‘stage-four renal impairment’ with ‘knackered kidneys’ or ‘mitotic growth’ with ‘cancer’ is generally appreciated. We all like to have things explained in terms we can understand and I just wish that NHS managers would write me letters in a language that I could comprehend.

It was Darren Mills who first named me Benny Big Nose. The last I heard, he was spending some well-deserved time at Her Majesty’s pleasure. His straightforward and direct manner seemed to get him in trouble from the teachers and later the police. However, Darren, if you’re out there, I’d like to say thank you for teaching me the valuable lesson of saying it how it is. You usually don’t cause as much offence as you think you might and most people will appreciate your honesty.

Proud to work for the NHS

One weekend I was doing a locum shift in A&E and saw a middle-aged German couple who had been involved in a car accident. They had been on a driving holiday around the UK and had crashed their car into a ditch. Fortunately, they weren’t severely hurt but an ambulance was with them within ten minutes and the paramedics gave some basic first aid before ferrying them to hospital. They were then seen by me and I organised some X-rays to make sure that the man didn’t have any neck injuries and to confirm a suspected dislocation of one of the woman’s fingers. The man’s neck X-ray was fine and I injected some local anaesthetic into the woman’s finger and popped the dislocated joint back into place. The healthcare assistant got them a cup of tea and a sandwich each and one of the nurses then cleaned and dressed a few of their cuts and scratches. Finally, the receptionist let them use her phone to call their car hire firm and organise a taxi back to their hotel.

As I let them know that they were free to go, the German man got his wallet out and tried to give me his Visa card. I explained that he didn’t have to pay me so he then started giving me his address so that he could be billed at home. I literally had to spend ten minutes convincing him that the treatment he had received was free of charge. ‘But everyone has been so good to us,’ he protested. ‘I wouldn’t have got any better treatment back home. Why do you British spend so much time complaining about your health service?’ It was one of those moments where I simply felt an overwhelming pride to be a part of the NHS. Of course, there are days when I spend a lot of time apologising for the inadequacies of the NHS, but overall I still believe that if you are genuinely unwell or have an accident, there aren’t many places on the planet where you would get a better service.

Sitting around with a bunch of GPs recently, I was surprised by how many thought that there should be a charge to be seen in A&E or by a GP. The general consensus was that £5 would be just enough to keep out some of the time-wasters and make people think twice before pitching up to see us. I have to say I couldn’t disagree more. I appreciate that the NHS isn’t free because we pay for it with our taxes, but it is free at the point of delivery and I feel that is something fundamentally vital in maintaining some of the original ideals of Nye Bevan and the other founders of the NHS. A charge would keep away some of the more vulnerable people who needed our help most and suddenly change the dynamic and mindset of the patients who would now be paying directly for our services.

Drug reps

Sixteen tablets of a supermarket’s own brand ibuprofen cost just 35p, while 16 tablets of Neurofen cost £1.99. This is strange to believe considering they really are exactly the same medicine. The drug company that makes Neurofen uses clever advertising and packaging to convince us to pay over five times more money than we need to.

Drug companies are very good at overcharging us for medicine. In the world of prescription drugs, millions of pounds are wasted by the NHS because doctors prescribe expensive ones when they could be prescribing much cheaper versions of exactly the same medicines. How do the pharmaceutical companies hoodwink us into doing that? Again, it is all about marketing. Young and attractive drug reps come and promote their drugs, while buying us lunch or even taking us out for dinner at posh restaurants. They feed us biased information on why we should use their more expensive medicine and give us free pens and mugs sporting their brand. (There are now much stricter rules than there used to be about how much drug reps can spend on us doctors. For example, the free gifts that they give us now have to be under the value of £5 and when drug reps take us all out for a slap-up meal, there has to be an ‘educational’ component to the evening rather than a completely uninterrupted session of good food and expensive wine. The drug companies’ all-expenses-paid trips to ‘conferences’ in the Caribbean have stopped, too.)

I used to attend the lunches and dinners. As I pocketed the free gifts and scoffed down the expensive nosh, I convinced myself that we doctors were too ‘savvy’ to be influenced by colourful flip charts and pretty smiles. The pharmaceutical industry, of course, knows that this isn’t the case. A few hundred quid taking some GPs out for dinner is peanuts compared to the money they can make if one or two of us start prescribing their drug.

In the USA, pharmaceutical companies employ ex-American football players and cheerleaders to sell their products. Doctors are suckers for a pretty face like everyone else. The attractive female reps are sent to sell their products to the predominantly male surgical consultants, while the pretty-boy male reps sell to the more female-dominated obstetric and paediatric departments. Fortunately in this country, our retired sports stars tend to fall ungracefully into alcoholism and gambling addiction rather than trying to sell us overpriced medicines. I can’t imagine even the most star-struck doctor being convinced to prescribe an antidepressant promoted by Gazza or a painkiller endorsed by Vinnie Jones.

As well as constant pressure from drug reps, GPs also face resistance from patients when trying to change medication. Whenever I can, I try to switch my patients from the more expensive medicines to the cheaper ones that do the same thing. Unfortunately, this can be very unpopular with patients. Often they get used to a certain packet and tablet colour and no amount of persuasion will convince them to switch. One elderly lady once stormed into my surgery furious that I had changed her medicine: