‘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.
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
