Read Confessions of a GP Online
Authors: Benjamin Daniels
Tags: #General, #Biography & Autobiography, #Humor, #Medical, #Topic, #Family & General Practice, #Business & Professional
That beach really was gorgeous and although in no hurry to die myself, I can’t think of a more perfect place to expire. To drop down dead on golden white sands after a swim in crystal clear waters seems a rather nice way to go. If it were me, I wouldn’t then want some sweaty pasty English bloke to spend an hour jumping up and down on my chest in front of a crowd of nosy onlookers.
One of my female patients has begun visiting me twice a week. During our consultations, she pulls in her chair very close to me and strokes my leg. She always kisses me when she leaves and has taken to buying me presents despite my objections. During our last consultation, she attempted (unsuccessfully) to slip me an envelope full of cash.
Ethel is 93 and her behaviour is generally thought to be a bit ‘batty’ and ‘comical’ rather than anything more concerning. Were I a young female GP receiving this sort of attention from a male patient, everyone would be a bit more concerned, but given that Ethel isn’t exactly threatening my personal safety or my marriage, her affections remain nothing more than a source of amusement to the receptionists and other doctors.
Generally speaking, receiving gifts from patients can be awkward. Sometimes patients simply want to say thank you for putting in that extra bit of effort, but I generally feel uncomfortable receiving gifts. I’m being paid very well to look after my patients and so shouldn’t really expect an extra incentive such as a nice bottle of wine at Christmas to do my job. I feel especially bad if a patient who I know doesn’t have much money buys me an expensive gift that they can’t afford. Declining the gift can cause offence but it is a difficult area.
Sometimes gifts put an odd slant on the consultation. I received a very expensive bottle of champagne from one of my patients one Christmas. The bottle was very happily received (and consumed), although I was slightly surprised as the patient wasn’t someone that I saw very regularly. Two weeks later I received a form to complete with regard to his entitlement to incapacity benefit payments. The patient had been on long-term sick benefits for a long time but I did question his genuine need to be signed off work. I filled in the form honestly but I wonder whether the bottle of bubbly was an attempt to be a bit of softener.
One of my colleagues once got left the entirety of the contents of a patient’s house in her will. He had a big dilemma as to whether he should accept this and, after much debate, eventually decided to sell her belongings and give the money to charity. After spending a long weekend trawling through her possessions, he ended up having to fork out £200 to have everything taken away by a house clearance company, as there was nothing of any value whatsoever. He wasn’t best pleased.
I can’t speak for other doctors, but personally if a patient ever wants to thank me, I would love a card or letter expressing this. As with us all, it is nice to be told that we are doing a good job sometimes, even if it is simply what we are being paid to do. I’m not that keen on wine and chocolates make me fat. Envelopes of cash are a bit dodgy and will get me struck off, so a card is just right.
I know very little about economics and, to be honest, I don’t really understand exactly why interest rates go up and down. My main concern is how much my mortgage payments are each month. Fortunately for us, we have the Bank of England to make decisions about interest rates. It is an independent organisation, unrelated to the ambitions of individual political parties and politicians, which works to maintain the stability of the economy. I have no idea who the individual members of the bank committee are. I imagine them to be wise old men with white beards who sit at a round table somewhere, possibly in a bank vault or a castle. Wherever they work from, the important thing is that as a nation, we generally seem to trust that the decisions that they make are the right ones and ultimately for the benefit of us all. I’m relieved that politicians who know little about economics aren’t allowed to make dangerous decisions such as slashing interest rates to win votes. Unfortunately, we are not so lucky with regard to decisions made about healthcare.
All the recent big policies with regard to the NHS appear to have been to win votes rather than actually improve the service that it provides. They have been made by politicians who have never worked in a medical setting and are fairly healthy so rarely use the NHS. They are policies targeted to impress the important voters. People who are genuinely vulnerable and unwell don’t tend to vote and certainly don’t swing elections. This means that the elderly and mentally ill are pretty much neglected. The worried well, however, are a much more important voting population. Young healthy commuters are the least wanting with regard to health requirements, but the politicians need their votes. Opening surgeries on Saturday mornings, four-hour A&E waiting times and having choice over which hospital a GP refers you to are all examples of this. They are not necessarily bad ideas, but they have all been poorly thought through and instigated. Most of us who actually work in the health service could think of many more deserving causes to throw millions of pounds at.
My solution would be to have an equivalent of the Bank of England for the NHS: a small expert organisation that could basically manage the NHS and help make the important decisions about how taxpayers’ money is best spent on our health. It would be independent and not be affiliated to a political party or be directly affected by general elections. It could be made up of experienced nurses, hospital doctors, GPs, managers and patients who all have very recent and direct experience of being at the coalface of the NHS.
It may seem slightly undemocratic to have our NHS not directly managed by the elected government, but the elected politicians are clueless morons and keep fucking things up! Would it work? I don’t know. Would it just add another tier of ineffectual managers? I hope not. Would it be worth a try? I think so.
I know I can appear judgemental in my description of some of my patients. I don’t mean to be. I try to treat all my patients equally and fairly. If I’m judgemental at times I think that it is not because I’m a doctor but simply because I’m human.
As a doctor, it can be difficult not to allow my own personal morals to reflect on how I view and treat a patient. For example, one morning I spent a long, tearful consultation with a lovely couple in their late thirties who had just failed in their fifth attempt at IVF. They had run out of money and hope and were emotionally distraught at the recognition that they would never conceive their own children. Later that morning, a woman came in requesting her fifth abortion. I don’t have any ethical problem with abortions, but I did find myself judging her. Did she realise how hard it was for some people to conceive? Did she consider how much it cost the NHS each year to perform so many abortions? Contraception is free and readily available in this country. How could she have been so careless so many times?
I also found myself feeling very judgemental during a child protection case conference. I was in a meeting with social workers, health visitors and other professionals discussing what should be done with an unborn baby belonging to one of my patients. I knew the mum-to-be well and, quite frankly, I thought she would make an absolutely terrible mother. She was rude, aggressive and always in trouble with the police. The dad wasn’t on the scene and her own family had disowned her. I just didn’t believe that she was the right person to give that baby the best start in life. Everyone in the meeting was very professional and positive. They were looking to implement extra support for the mum to help her with her new baby. I tried to be positive, too, and I do think kids are best off with their real parents, but a big part of me wanted to take that baby away at birth. I wanted to give him to the nice couple who kept failing with the IVF. I just felt that the child would have a better future with them than with its real mother.
Deep down I knew that I had no right to pass judgement on who would make better parents. I see my patients for ten minutes at a time and don’t have the right to decide if someone should have their child taken away. What do I really know about parenting anyway? Would I like someone passing judgement on what sort of dad I am? Back at the case conference we all agreed that once born, the baby would be put on to the child protection register but stay with the mum and be closely monitored. I hoped I’d be proved wrong and that the new mum would do a great job. I know it is not my place to judge my patients but it can be very difficult sometimes.
There is a lot of drama in medicine. As a doctor much of what I do is a performance rather than an attempt to actually gain important medical information. The examination is perhaps the most evident example of this. Examining patients is obviously important and sometimes I even find something abnormal…But a lot of the time the examination is a bit of a fraud. It is all part of my attempt to add mystique and importance to my job.
An example of this is when I visit one of my patients called Mr Briggs. Mr Briggs is well into his nineties and very frail. He has lots of things wrong with him, but unfortunately, they are mostly because of his excessive years and there isn’t a great deal I can do about them. I’m fairly certain that Mr Briggs is going to die within the next year and my main objective is to make sure he remains as comfortable as possible and that I provide reassurance and support for him and his wife. Whenever I visit Mr Briggs, I check his blood pressure. I check it every visit and it doesn’t change much. Even if it was raised, Mr Briggs has already said he doesn’t want to start any new medication and certainly doesn’t want to have any tests or investigations if he becomes more unwell.
Ultimately, I am not examining Mr Briggs for his physical health but for his emotional health. He is expecting me to examine him and by going through the motions, I am offering reassurance. Human-to-human contact is comforting. I am English so I don’t give Mr Briggs a hug. Instead, I use a blood pressure cuff and a stethoscope to reach out and make some soothing physical contact with this dying man. ‘Strong as an ox,’ I often say after listening to his heart. It sounds patronising written here but I know that Mr and Mrs Briggs are reassured by my words. ‘I wish the rest of my body was as strong as an ox,’ Mr Briggs will reply as I shake his hand on leaving. Sometimes I wonder whether my examinations of Mr Briggs are actually as much for my benefit as for his. If I didn’t have the extra gimmick of my stethoscope and blood pressure machine, how could I justify my visits? They are the instruments that define me as a doctor and without them I could simply be a visiting neighbour or the local vicar.
I am clearly not the only doctor who sometimes uses the examination as a bit of a show. One of my colleagues was visiting an elderly patient to give him a check-over and to reassure his wife. He had already mentioned that he would have a listen to his chest but then found that he had left his stethoscope at the surgery. Not wanting to admit this, he instead took out a 2p coin from his pocket and carefully placed it at various points on the patient’s back. He was using the coin to mimic the bell of his stethoscope and as the patient was facing the other way, he imagined he would be none the wiser. Apparently, the patient seemed happy enough but just as my colleague was on his way out he stopped him: ‘Just one thing, Doctor. I’ve seen some things in my time but I’ve never seen a doctor listen to my chest with a 2p coin.’ The doctor hadn’t noticed the mirror on the dresser that enabled the patient to watch him examining him. My colleague came clean and apparently they had a bit of a laugh about it. Just a lesson for us all not to ever try to pull the wool over our patients’ eyes!
An astounding part of being a doctor is that a complete stranger can walk into my consulting room and within two minutes I can be asking them about their deepest, darkest sexual habits. A full sexual history is vital for accurately diagnosing and treating many illnesses. It is also a great way to find out exactly what people get up to behind closed doors! I am still amazed by my patients’ sexual escapades and also about how honest, open and unembarrassed they are when telling me all about them. My patients make me feel very boring as they recall tales of dogging, rimming, fisting and various other sexual behaviours that I have to Google in order to know what they are talking about.
The youth in my area seem to be amazingly promiscuous and I was astonished when I met a patient who had kept her virginity until she got married at 23 years old. Her husband had apparently done the same and they had been using condoms for a couple of years until the previous month when they had decided to start trying for a baby. Jane, the woman in question, came to see me complaining of a creamy white vaginal discharge that she was now getting after sex. I feared the worst. I was sure her husband must have been having an affair and that she had caught some kind of sexually transmitted infection. I ordered a full set of vaginal swabs but everything came back as normal. It was only when she returned to see me and I asked her to explain her discharge symptoms in a little more detail that I realised that the post-coital discharge she was describing was actually just her husband’s semen.
Do GPs earn too much? That has certainly been the general consensus of the media over the last few years. I personally don’t know any GPs who earn £250K as reported by the press; however, most GP partners who work full time earn over £100K, which seems a lot of money to me. I am not a partner myself but do fairly well out of being a locum GP and just a few years ago I was working considerably more hours as a hospital doctor for less than half the money.