Confessions of a GP (17 page)

Other body fluids that have been brought to my surgery include:

1. A condom full of semen – the patient was worried that it was a funny colour.
   
2. Various samples of vaginal discharge on tampons and one miscarriage wrapped up in a tissue.
   
3. Lots of poo. One woman brought in a week’s worth of her baby’s soiled nappies. Each was neatly labelled with a time and date and she lay them out on my surgery floor in chronological order. ‘As you can see, Dr Daniels, last Thursday morning is considerably more yellow and viscous in consistency than Saturday afternoon’s.’ I spend a lot of time convincing first-time mums it is normal for baby poo to be a bright mustard-yellow colour.
   

My only true body fluid aversion is sputum. I just can’t bear the stuff. Every time I view sputum, I get a flashback to a particularly long ward round in which I was involved as a medical student. I was extremely hung over and after several hours of traipsing around hot and smelly wards, we finally got to our last patient, who I will call Mr Phlegming. He was an old guy with emphysema (knackered lungs from smoking) and spent his days coughing up gallons of sputum and collecting it to show us on the ward round. As we arrived, Mr Phlegming enthusiastically held out a plastic cup full to the brim with sputum. It had a plastic lid on it and clearly none of us including the consultant was particularly keen to examine its contents. Medics are a hierarchical lot and the pot got handed down from consultant to registrar, to senior house officer to house officer and then finally to me. As the medical student, I was clearly at the bottom of the food chain and as I held the cup in my hand it felt unfeasibly heavy. ‘Come along, take a look,’ my consultant barked impatiently. Opening the lid, I was greeted with a swirling mass of muck. Not quite green and not quite brown. Not quite liquid and not quite solid. It had a colour and physical state all of its own. I began to feel my stomach gurgle and then made my excuses, just reaching the toilet before spewing. Give me shit, piss, blood and vomit any day.

Racism

I’m meeting George for the first time. Everyone tells me how great he is. ‘Good old George. He really is the salt of the earth. A retired docker. Always has a smile on his face. Brings us a tin of chocolates every Christmas. Everyone loves George.’ After ten minutes with George I can’t help but agree that he’s a nice old boy. He’s in his late seventies and, apart from a bad hip, he is basically fit and well. Cheery and friendly, we have a bit of a chat about the misfortunes of the local football team and he reminisces briefly about the good old days. After a bit of a look at his hip, I suggest that he might want to consider seeing the orthopaedic doctor as he could benefit from a hip replacement. ‘Well, if you think it might help, Doc…One thing, though, I won’t see no Paki doctor, will I?’

I hate it when this happens. You meet someone you think is nice enough and they turn out to be a raging bigot. It’s so much easier to hate racists when they fulfil my expectation of being all-round arseholes. What do I do now? Do I confront a man in his late seventies about his life-long racist beliefs and try to re-educate him? Perhaps I could accidentally forget to make the referral? Some might argue that as patients are now encouraged to have ‘choice’ over which consultant they see, I should follow his request and find him the white British surgeon he wants. Remember it’s not my job to judge, simply to treat and serve my patients to the best of my abilities.

‘Some of my best friends are Asian doctors and they are also very good at their jobs,’ I say firmly. ‘If you want the referral to be made, then you’ll get which ever doctor is allocated to you. We don’t make allowances for racism.’ George looks a bit taken aback.

‘I’m not a racist or nothing. It’s just I saw that Dr Singh bloke with my bad knee and I didn’t understand a word he was saying.’

My friend Chirag is a GP and was born in Wembley to Indian parents. He has a London accent, is good-looking, dresses slickly and is a bit of a charmer. He is well liked by even some of his most hardened racist patients. My friend Anil, however, was born and brought up in India. He moved to the UK seven years ago after qualifying from medical school back home in Bangalore. Anil has a moustache, a side parting, unfashionable clothes and a thick Indian accent. He struggles to understand anyone with a strong regional accent and couldn’t give a monkey’s about beer, football or regional rivalry. He is a very good and dedicated doctor but the patients tend not to warm to him and he has suffered from quite a lot of active discrimination from both patients and staff.

The Georges of this world appear to have made some changes with regard to their racism. In my experience they are now more tolerant of the colour of someone’s skin as long as the person speaks with a good British accent and can join in with a joke about Geordies or Scousers or the England football team. The other development is that patients tend to recognise that it is no longer acceptable to publicly verbalise their bigoted ideas, although they will still make a few sly racist comments if they think they can get away with them. I’ll leave it to you to decide if these changes are any form of improvement or not.

It seems such a shame that racism has remained a deeply ingrained tradition of white working-class culture in certain parts of this country. Over the last 50 years or so overall prejudice has reduced and I think that the NHS has done more than any other institution to help transform racist ideas. There are a great number of different nationalities working within the NHS and has been for so many years that lots of people have had their only exposure to non-white people while going to hospital or seeing their GP. There is a story about an Indian GP who moved to a small Scottish Highlands town back in the 1960s. Initially, he and his family were met with some suspicion, but after a short period he became a much-loved member of the community and the attitudes of the local people were changed for ever.

Some people, unfortunately, are beyond help. I saw a fat middle-aged white man from the local estate who was requesting a prescription for some Viagra. He hadn’t worked for years, citing his bad back, but his real disability was his enormous gut and the deep resistance he had to getting up off his sofa. I was happy to prescribe him some Viagra but explained that it wasn’t available for free on the NHS and that he would be charged for his prescription. ‘I bet the Pakis and immigrants don’t have to pay, Doctor? You’d give me the pills for free if I was one of those asylum-seeking suicide bombers,’ he retorted. I desperately wanted to point out that, first, it was unlikely that al-Qaeda make explosive suicide belts that would fit his enormous 64-inch waist and, second, that were anyone to demand a prescription while strapped with many kilograms of high explosives then, yes, I would undoubtedly write them the prescription of their choice completely free of charge. My reasoning for this would be my natural instinct to avoid getting myself blown up rather than because of a government policy that favoured non-whites as he appeared to be suggesting. I kept my mouth shut but did take great pleasure in writing out the private prescription, knowing that this racist heap of lard would have to pay for his erections while mine still came completely free of charge.

Sleep

Is not being able to sleep a medical problem? I’m not sure it is. I see lots of people telling me that they can’t sleep and they want me to give them a cure. Usually, they ask for a sleeping pill and are then surprised by my reluctance to prescribe them one. We all have nights lying awake and watching the clock slowly tick by. It’s not much fun but it strikes me as part of being human. Some people struggle more than others but usually we can find a reason for not sleeping. Causes can be divided into extrinsic and intrinsic. Extrinsic factors include having a crying baby or noisy neighbours keeping you awake. I can’t do much about those, but intrinsic factors such as stress, anxiety, excitement and pain are probably more common causes of insomnia. There is usually something keeping us awake and I always feel that there are plenty of routes to explore before we make the knee-jerk reaction of reaching for the sleeping pills.

The problem with sleeping pills is that they are addictive and stop working after a short period. The manufacturers advise that they should not be taken for more than a month, but despite this I have literally hundreds of patients who have been taking sleeping pills for up to 40 years! Benzodiazepines (benzos) are still the most commonly prescribed sleeping tablet (aka Valium, diazepam, temazepam, etc.). For those patients on these medications, stopping them is extremely difficult. My patients on Valium are like any addicts. They crave their drug and will often lie, cheat and steal to make sure they don’t miss their next dose. In the rougher parts of this country, Valium has a street value and is sold by drug-pushers along with heroin and crack cocaine. If it is viewed by dealers and junkies as an illicit drug, maybe it is time that doctors saw it in the same way.

Diazepam is a type of tranquilliser and works on specific receptors in the brain to relax muscles, relieve anxiety and cause sedation. In the short term it can seem like a wonder drug for all those angst-ridden insomniacs. The problem is the side effects. The body gradually gets accustomed to the sedative effect of the medicine and after a short period of time the drugs are no longer effective. Users start needing higher doses to have the same effect. They find that without the drug they feel increasingly anxious and unwell and can have quite severe physical side effects such as abdominal cramps, vomiting and even seizures. Taking sleeping pills at night often makes them feel slow and sluggish during the following day. I’ve had to sign people off work who were addicted to sleeping pills when they were too tired to work safely as a truck driver or machine operator during the day.

I’m not suggesting that we stop prescribing these medications altogether, as benzos do have their uses. They are valuable in calming and relaxing people prior to operations and if it wasn’t for benzos, B. A. Baracas would never have got on a plane! They can also be used to bring epileptics out of a fit and I often prescribe them when someone is under acute stress. For example, in the immediate period after a bereavement or a when a relationship has ended, a short course of diazepam can help someone to get through the first few terrible days. They are also good for patients with severe muscle spasm such as a slipped disc in the back.

I fully accept that there are drug and alcohol addicts out there. To add to those numbers many more addicts created by doctors and, principally GPs, seems such a shame. There is still a strong culture of prescribing sleeping tablets among some GPs. It is the quick fix for both patient and doctor. The patient gets a pill that makes them feel relaxed and able to sleep and the doctor gets the patient out of the room quickly. It is much tougher for both patient and doctor to try to identify the underlying cause of the sleeping problem. Depression, pain and anxiety are all difficult issues and ten minutes isn’t nearly enough time to handle them. For my patients who can’t sleep, I usually ask why they think they can’t sleep. I then move on to something called ‘sleep hygiene’ and offer advice about exercise during the day and having a hot bath and cocoa just before bedtime. I even add in a bit of feng shui and advise never to use the bedroom for anything other than as a place to sleep so that the bedroom tunes the brain into sleeping rather than thinking. Some patients like all this holistic stuff, others just want a magic pill and are disappointed when I say no.

Magic wand

My niece was five and for her birthday she got a pink fairy outfit that she insisted on wearing every day. The outfit came complete with a pink glittery magic wand, which, upon waving, lit up and made a ‘
didledidledidledidledeeee
’ magic wand-type sound. I would love to borrow the fairy outfit and magic wand for some of my more difficult patients…

So, Kelly. Let me summarise, you’re a 25-year-old single mum with three screaming children. You live in a cold, damp two-bedroom council flat and you’ve just had a big row with your mum and sister. It is a miserable wet day in late November and you’ve got no money for Christmas. You’ve been depressed for years and have already tried several different types of antidepressants but nothing has helped and today you’ve come to see me so that I can give you a pill to make you happy. Hold on, I’ll just get my magic wand…
Didledidledidledidledeeee
.

So, Mr Jackson, you’ve been having headaches everyday for 30 years. You’ve had multiple brain scans and blood tests and have been seen by three very good neurologists. A cause for your headaches has never been found and no medication has ever helped resolve them. You’ve come to see me today because you have a headache and want me to cure it…
Didledidledidledidledeeee
.

You have a cold and feel like shit…
Didledidledidledidledeeee
.

Of course, if I really had a magic wand, I wouldn’t waste it on my heart-sink patients. There are much more important problems in the world to resolve:

Didledidledidledidledeeee…
West Ham win the Premiership.

Didledidledidledidledeeee…
Man United get relegated and Alex Ferguson cries on
Match of the Day
.

Didledidledidledidledeeee…
Kylie lives next door to me but is otherwise unchanged.

Didledidledidledidledeeee…
Kylie finally realises that she has always found slightly geeky, big-nosed doctors really quite attractive.

Didledidledidledidledeeee…
Various other stuff involving myself and Kylie that I couldn’t possible put into print because my wife would kill me.

Okay…
Didledidledidledidledeeee…
World peace, end to poverty, reversal of climate change, etc. Yawn. Yawn.

Finally then I might find the energy to use my magic wand for the benefit of my heart-sink patients or I might just magic them off to another doctor.