Confessions of a GP (16 page)

John was present during my first consultation with Sung. I asked Sung a question and when she looked at me blankly, John offered to help translate. I was impressed that John had learnt Thai, only to find that instead of translating my question into Sung’s native language, he just repeated it in English but shouted in a slightly odd stereotype of a Chinese accent. It was like a Russ Abbot sketch from the 1980s.

After a few months, while her husband was at work, Sung started to learn English at a language school and took a part-time job in a burger bar with other students her age. It was not long after this that John came to see me with symptoms of painful discharge from his penis. I did a swab because I suspected chlamydia. Chlamydia can hang around undetected for a long time, but I didn’t think that John had been anywhere near a woman for years until Sung came along. John had also proudly told me that Sung was a virgin when they got married. It seemed fairly obvious to me that Sung was sleeping around, but what did I tell John? When the results came back from his swab, I explained that chlamydia was a sexually transmitted infection and advised that Sung came in to be tested and treated as well. Despite them both having a course of antibiotics, John came back with another sexually transmitted infection not long afterwards. I tried to hint gently that these infections were probably coming from outside of the marriage but John simply couldn’t accept that this could be possible. How much right did I have to interfere with this relationship? John was blinkered and in love. Sung was 19 and having fun with lads of her own age. I was watching this car crash unfold each week. If John were a friend, maybe I would have given him a shake and pointed out the obvious, but he wasn’t a friend, he was my patient.

A few months later, Sung left John for a 20-year-old boy who played bass in a band. John was devastated and ended up on antidepressants. ‘Why didn’t you tell me she was being unfaithful?’ he blubbed. What could I say? My job was to point out the facts and hope that John reached his own conclusions. Perhaps I should have made those facts a little clearer.

Dead people

I’ve seen loads of dead people but I’m still quite scared of corpses. As a hospital doctor, one of my jobs was to go and certify death. During a night on call, I would be covering ten or more wards and be up most of the night doing odd jobs and reviewing sick patients. I recall one night when, after having just got to bed at about 4 a.m., my pager went off. The nurse on one of the geriatric wards told me that one of the patients had died. It was an expected death so although there was no resuscitation and CPR necessary, a doctor needed to certify the death before the body could be taken to the morgue.

It was a cold dark night and I had to force myself out of my warm bed to make the long trudge from the on-call room to the hospital. ‘Room 12,’ the nurse said as I wandered on to the ward. Rubbing the sleep from my eyes, I stumbled into the darkened side room. To certify death, a doctor has to ensure the patient isn’t breathing, that his heart isn’t beating, that his pupils are fixed and dilated and that he doesn’t respond to pain. The pain response is usually elicited by rubbing your knuckles really hard onto the front of the person’s chest. It is call it a sternal rub. It hurts like hell and we also use it a lot on alive patients in A&E, as it wakes people from even the deepest drunken stupor. The room was dark and quiet and I was all alone with the body lying in the bed in front of me. Still half-asleep I decided to start with the pain response. As I pressed my knuckles hard onto the corpse’s chest, it jumped up, grabbed my hand and let out an ear-piercing scream. This was soon joined by an equally loud and terrified scream that was being emitted by me. The nurse then flew into the room and said, ‘Sorry, Doctor, did I say room 12? I meant room 10.’

Holistic earwax

Veronica Davis rarely came to see me as she favoured alternative medicine to the more conventional kind that I was attempting to practise. The very fact that she was in my consulting room that morning suggested that she must have been fairly desperate to have ventured in to see me.

‘Hello Ms Davis, how can I help you today?’

‘I don’t care what you say, I’m not seeing a surgeon. I won’t let those barbarians invade me with their implements of torture.’

‘I’m sorry, Ms Davis, but I’m not quite sure what the problem is.’

‘I’ve got a serious ear problem, but I swear to God I’ll die before you send me to one of those filthy disease-ridden hospitals. I know my rights. My body is my body and I’ll be the one who decides if it gets chopped open, thank you very much.’

‘First things first, let’s have a look in that ear, shall we? Hmmm. Seems it is a bit blocked up with some earwax.’

‘Does it need an operation?’

‘No, I think some olive oil drops should do the trick.’

Ms Davis had clearly been expecting to have to fight me and 20 others off her as we forced her into a waiting operating theatre to be sliced open by some bloodthirsty surgeons. I don’t have many friends who are surgeons and you won’t often find me first in the queue to defend them, but I do think they are perhaps misrepresented sometimes. The alternative medicine brigade needs to realise that surgeons don’t cut you open for fun. They would probably rather be playing rugby or getting very drunk and accusing each other of being gay. That is what they like doing best. They will only cut you open if they really have to. If you decide you don’t want to be operated on, they will be only too happy to have one less patient on their ever-growing waiting lists. Very few surgeons are good at the touchy-feely sensitive stuff, but then us touchy-feely GPs would be rubbish at fixing a broken pelvis or repairing a burst aorta. You should see the mess I make trying to carve a roast chicken! We each have our skills and if it were me that was in need of an operation, I would happily put up with a slightly insensitive posh rugby boy if I knew that he was a good surgeon and could put me back together again.

Veronica had spent hundreds of pounds on alternative treatments for her ear problem before she came to see me. Neither the homoeopath, cranial osteopath, herbalist, nor Reiki practitioner had actually looked in her ear. If they had, they would have seen a whole lot of hard brown wax that looked pretty painful. It annoys me that alternative practitioners call themselves holistic without actually knowing how the body works. Surely that basic knowledge is as important a part of treating someone holistically as looking after their emotional and spiritual needs. I decided not to give in to the overwhelming desire to be smug with Veronica but instead just felt relieved that the consultation was drawing to a close with a simple diagnosis and simple treatment.

‘But why has it happened?’

‘Excuse me?’

‘Why has the earwax formed? There must be a reason. Do you think it is because there has been an imbalance in my energies?’

‘Erm, no. It just happens sometimes. I get too much earwax sometimes, too. Bloody annoying.’

‘Well, perhaps, Dr Daniels you’re not facing up to some deep emotional issues that are being suppressed. Everything happens for a reason. You should look at your health more holistically.’

I’m all for trying to balance and integrate the physical, mental, emotional and spiritual aspects of disease, but this was earwax.
Bloody earwax!

Obesity register

Jemma is 28 and has come to see me about an infected insect bite on her ankle. She is nice enough but not very confident and admits to feeling a bit nervous around doctors. We have a bit of a chat and I like to think that I put her at ease. Her bite needs some antibiotics and all is straightforward until my computer butts in. Flashing up on my screen is ‘WEIGH PATIENT AND CONSIDER INCLUSION ON OBESITY REGISTER.’ Yet another target in our target-based world. The computer wants me to weigh Jemma and if she is above a certain weight, I would be obliged to put her on a special register along with our other overweight patients. Hmm, how can I put this tactfully to Jemma?

‘Oh Jemma, before you go, I’ve noticed you’re a bit of a porker. Jump on the scales; mind not to break them now, cupcake. That’s it…16 stone. Bloody hell, you are a big girl! We’re going to have to put you on our special fatties list. That’s it, have a good cry. Maybe it will burn off a few calories. See you again soon for another weigh-in. Won’t that be fun?’

Okay, so I am a little more subtle than that, but I do object to having to put my overweight patients on an obesity register. Perhaps I’m wrong here, but I imagine that a young woman would not want a young slim male doctor, whom she doesn’t know, pointing out that she is overweight (something she is probably already aware of). Especially when she has come to see him about something completely unrelated.

Of course I recognise that obesity is a large problem with social and medical consequences. I sometimes have patients who come in to ask me specifically about their size and to seek advice and support about losing weight. When this happens, I’m happy to listen and try to offer some encouragement. I explain about eating less and exercising more, but generally the world is already oversaturated with information about losing weight. I don’t really have that much more to add other than a sympathetic ear and a few supportive words.

Currently, we reach our target and get our points (and money, of course) by simply having patients on the register. We don’t do anything with the register. There aren’t teams of dieticians waiting to give advice and support to our overweight patients. There are no good slimming medicines that have been shown to significantly reduce weight in the long term. All in all, the list is currently fairly devoid of function other than successfully alienating a significant percentage of our patients. Perhaps we should make our obese patients wear a little yellow cake logo on their clothes so we can differentiate them from our ‘normal’ patients? Of course, I’m overemphasising the point here, but I just feel that weight is a very sensitive subject and although encouraging healthy lifestyles is vital, are an enforced obesity register and regular weigh-ins the answer?

Dr Arbury

Dr Margaret Arbury is a GP and a formidable character. In my mind she is a cross between Mary Poppins and Margaret Thatcher. She is in her forties but has the air and dress sense of someone much older and from a different time altogether. Ultimately, she is very unlike the normal slightly fluffy, friendly female GP. As she opens her door to call in her patients, she ushers them in like an impatient schoolteacher. ‘Come along, come along, Mrs Foster, one has other patients to see.’ The patients are absolutely terrified of her and, as she puts it herself, she simply will not tolerate nonsense. Dr Arbury has never married and her real passion in life is horses. General practice seems an unlikely career choice for her and by her own admission she doesn’t enjoy it, but it does enable her to spend a couple of days a week at work and the rest of the time at the stables.

There is a part of me that admires Dr Arbury’s no-nonsense approach. She is a very good doctor clinically and is excellent at diagnosing and treating disease. She is not so good at doing the touchy-feely, sensitive stuff. Any sort of mental health issue tends to be treated with a ‘pull yourself together’-type response and she prides herself at never giving out sick notes to the ‘whining bone idle’.

There are some who respond well to her brutal but often reassuring honesty. ‘Mr Evans, you are not dying of pneumonia, you have a cold, now stop making such a fuss and go home.’ ‘Thank you, Doctor. I was hoping you would say it was nothing serious.’ If she decides that her patient is unwell, however, she will fight hand and tooth to get her/him the best treatment possible. I once heard some poor secretary trying to convince Dr Arbury that there would be a six-week wait until her patient could be seen by the hospital specialist. It didn’t take long before Dr Arbury had the consultant on the phone and was instructing him on exactly when and where the appointment would take place. Getting to the point quickly means that she always runs to time, which is also popular.

The interesting thing for me is how many of the more difficult, needy patients respond well to her. One of my patients is an addict whose alcohol and Valium use I had been trying desperately to reduce for some time. To my amazement, she responded much better to being given a good telling off by Dr Arbury than by my softly-softly sensitive encouragement. The advantage of being a patient in a big practice is that you can choose the GP who suits you. As new GPs, we are often warned not to be too nice and fluffy or we’ll get all the clingy needy patients latching on to us. Some difficult, needy patients often avoid seeing tough doctors like Dr Arbury because they don’t get the sympathy and attention they crave. It sounds a bit patronising but sometimes I think that a firm word and some home truths can do us all a lot of good. Sometimes, my patients need a sympathetic ear and a bit of genuine empathy. At other times, like all of us, they need a good kick up the backside. The difficult part is getting the right balance.

Body fluids

Patients often take it upon themselves to bring in various samples of their body fluids for my perusal. I would like to emphasise that this is normally not appreciated. A pot of urine is generally not too bothersome. Often in a jam jar, I hold it to the light, stroke my chin and let out a ‘hmmm’. I like doing this as it makes me feel like an old-fashioned doctor from the nineteenth century. Apparently, they were keen on diagnosing all sorts of illnesses by looking at the urine and then tasting it! Unlike a nineteenth-century doctor, I look but don’t drink. I also hold back from prescribing leaches or a tonic of mercury, but instead dipstick the urine and usually offer some antibiotics for a urine infection. If you are going to use a jam jar to hold your urine sample, please wash it out first. I once tested a urine sample and broke the news to the patient that it was full of sugar and therefore a diagnosis of diabetes was possible. Fortunately for the patient, it turned out that the urine was full of sugar because the jar still had a bit of strawberry jam swimming around in it.