lot more like Harry Potter than Pete Doherty. He did look pale and sickly but I was not sure whether that was the look he was trying to convey or whether he was actually unwell.
‘He’s taken an overdose, Doctor. Drugs! It’s drugs!’ Adrian’s mum wailed with her head in her hands.
Mum was completely frantic and shouting and crying. Adrian was sitting awkwardly in the chair visibly squirming while staring at the floor. After a couple of minutes, I was getting nowhere as Mum was hysterical and Adrian was monosyllabic so I politely asked Mum to wait outside. Once his mum had left the room, Adrian relaxed a bit and told me what had happened. He and his mates from his chemistry A level class had finished a mock exam and had gone to sit in the park to drink some cider. One of his mates had some cannabis and Adrian had tried some. Cider and cannabis don’t mix very well so after three puffs, Adrian had started feeling a little pale and unwell, known in my day as ‘pulling a whitey’. He had staggered home but, unfortunately, while on his way to his bedroom he had been intercepted by his mother. After a fierce interrogation, she had managed to force out of him that he had smoked some weed and then frantically dragged him straight to the surgery.
I brought Adrian’s mum back in and tried to calm her down.
‘Adrian’s going to be fine,’ I said.
‘Well, doesn’t he need some tests doing and his stomach pumped?’
‘I promise that won’t be necessary. He just needs to go home and get some sleep.’
‘Well, what will happen now? Doesn’t he need to go in for rehab? Won’t there be some aftereffects?’
‘Hmm, he might go and raid your fridge in about three hours but not much else.’
‘Please tell him never to take drugs again, Doctor. He’ll listen to you.’
Parents are very naive if they think that their teenagers will listen to me. I am not one of those cool 30-year- olds who DJ at the weekend and wear product in their hair. I listen to Radio 4, grow tomatoes and lately have found myself remarking on how comfortable and practical a combination of socks and sandals is. Until recently, I thought the Arctic Monkeys were a result of climate change. Your children will quite rightly view me as a geek and will under no circumstances take any lifestyle advice from me. On numerous occasions I have been instructed by parents to lecture their teenage offspring on subjects varying from sitting up straight to eating more vegetables. It is embarrassing and pointless.
Adrian and his mum left and I felt embarrassed on his behalf. I’m not advocating drugs. They are bad and certainly cannabis is now known to be considerably more harmful than previously thought. Having said all that, teenage boys with long straggly hair will sit in the park and smoke weed. It has been going on since the 1960s and so long as there are parks and spotty teenagers, it will continue into the future. The vast majority of these boys will eventually realise that there are more interesting things to do in the world and wake up to the fact that long greasy hair and heavy metal T-shirts are a bad look. Their mates will then betray them in years to come by putting embarrassing photos of them looking stoned and dishevelled on Facebook.
Sick notes
These are some people who have asked me to sign them off work. What do you think? Would you sign them off?
• A bloke in his late twenties works in some sort of IT firm. He has had a big row with his boss and has resigned, but doesn’t want to work out his notice because the atmosphere is horrible in the office. He’s a bit stressed about it all but isn’t depressed or unwell and is out looking for new jobs and going to interviews. He wants a sick note to say he doesn’t have to go to work for the next three weeks until his notice runs out. He won’t get paid unless he gets one.
• A woman has been on annual leave this week but has been in bed with a bad cold. She would like a sick note to say that she was unwell during her holiday so that she can take an extra week of annual leave at another time.
• A 25-year-old bloke has been on jobseeker’s allowance (the dole) for one year. Three months ago, he got really pissed, climbed a tree and then fell and fractured his leg, arm and pelvis. He is recovering quite well and is out of hospital but on crutches. If I give him a backdated sick note from when he had his accident, he can claim incapacity benefit for the time since his fall, which is more than jobseeker’s allowance. Of note: he has spent most of the last three months being looked after in an NHS hospital and so has not really needed much money.
• It is early November and a woman wants to be signed off on sick leave because Christmas is coming and her mother died at this time several years ago. Her cat has cancer and she thinks that she won’t be able to cope at work until January. She doesn’t have any symptoms of clinical depression.
• A man was sacked from his job because of heavy daytime drinking and being drunk at work. He feels that he is unable to work now because of his alcohol dependence. He is not willing to be referred to an alcohol counsellor or a rehab programme.
• A 25-year-old man was born with severely deformed arms and, at the age of 18, was signed off as disabled. A year ago he got a job at a supermarket but was sacked after being caught giving his friends unauthorised discounts. Now he wants to go back on to disability living allowance. He doesn’t have any new illnesses or disabilities.
• A 45-year-old woman who is extremely overweight and gets very short of breath because of her heavy smoking and large size. She did have a job in a supermarket but because it is on top of a hill she can’t get there. She is making no effort to stop smoking or to lose weight.
What do you think of this lot? Would you sign them off? As you can see, the decisions I make on sick notes are often less related to my medical knowledge and more to do with my general sympathies towards a particular person on that particular day. When I hand out a sick note, I am basically signing that person a cheque made up of taxpayers’ money.
Am I any more qualified to make these decisions than someone with no medical training? These patients are people doctors potentially know quite well and sometimes it can be hard to say no to them. It is also very difficult to prove or disprove what they are telling us. For example, I have a patient who tells me that she can’t work because she has a panic attack every time she leaves her house. Perhaps she does. Perhaps she doesn’t. I am not going to sit outside her house and follow her into town taking photos of her having a great time in a crowded shopping centre. Physical symptoms are equally difficult to disprove. If a patient tells me that he has back pain, who am I to disbelieve him. He may have multiple normal scans, X-rays and examinations, but if he tells me that his back hurts and he can’t work, do I have the right to call him a liar? We are taught to listen to our patients and try to do our best for them. It is very difficult all of a sudden to start distrusting them and try to catch them out.
Although I do have patients trying to pull the wool over my eyes, most of my patients who are requesting a sick note or claiming disability payments are doing so genuinely. They have an illness or disability and need some medical documentation to verify this so that they can get some money to live on. Most people do actually want to return to work as soon as possible. Whatever our job, we generally moan about it and look forward to having some time off for a few weeks a year, but ultimately most of us want to be employed. It is partly how we define ourselves and there is a social stigma attached to not working. From a personal perspective, my job is rewarding and I feel valued. If I take time off, then I feel I am letting down my colleagues and patients. I do sometimes wonder whether my work ethic would be so strong if I had a less appealing job. If I toiled stacking shelves overnight in a supermarket for the minimum wage, I can imagine that the temptation for ‘pulling a sickie’ would be pretty strong. Perhaps I could even hoodwink my GP into writing me off work completely. I could then get close to the same pittance sitting at home on disability payments.
Most GPs hate giving out sick notes and filling in disability claim forms. They take up time and valuable appointment slots. I heard of one GP in a particularly deprived part of Wales who completely gave up trying to assess his patients’ ability to work. He used to go into his crowded waiting room each morning and ask everyone who was in for a sick note to put up their hand. Without asking any of them a single question, he would then go round and dish out a sick note to each one of them and therefore clear half of his waiting room. This allowed him to spend his morning as a doctor rather than as a clerk for the Benefits Agency.
There are many millions of people on benefits and they are costing the country billions of pounds. As a GP, I have a social responsibility to try to encourage people to work. This is partly for the good of the national economy and also because working is good for you. Evidence shows that working is beneficial to our physical health and
