Confessions of a GP

‘Well, it’s not ideal. Really, it would be better to test you. Have you had any symptoms? Burning when you pee? Milky discharge from your penis?’

‘I’ve had nothing like that but I’m not taking any chances and I’m not having you stick a swab down my little guy. I just need a prescription for the one-off antibiotic…and one for my wife.’

‘Have you told her?’

‘God, no! She’d leave me. Now this azithromycin stuff, would it dissolve in her tea? I was thinking about crumbling the tablet into a pasta sauce but was worried that the cooking process might damage it.’

‘Look, I can’t encourage you to be secretly drugging your wife with antibiotics. What if she has an allergic reaction? It’s my name on the prescription. I would have to take responsibility.’

‘Doctor, please work with me here. Man to man. My marriage is on the line. Why don’t you prescribe me a double dose and what I do with the pills is my responsibility. I don’t mind paying for them.’

‘Look, I feel really uncomfortable about this. I appreciate your predicament but I’m not prepared to prescribe you this medication knowing that you’re going to give some secretly to your wife.’

‘Do you really want to be responsible for the break-up of a family, Dr Daniels?’

‘To be fair, it wasn’t me who cheated on my wife.’

‘You’re not paid to judge me, Doctor. Look, I’ve an idea. Why don’t you call my wife in for a smear and while your down there, you can do a quick swab for chlamydia.’

‘Look, we can’t just test people and give them medicines without them knowing. We need to have consent.’

‘There must be something you can do. If you don’t prescribe me these antibiotics, I’ll get them off the internet and that’s even more dodgy. God knows what I could be poisoning her with.’

‘I’ve got an idea. Why don’t you get yourself tested? It’s only a urine test and then if you’re negative, you don’t have to worry.’

‘And if I’m positive?’

‘We’ll cross that bridge when we get to it.’

Thankfully, Gary tested negative and I never had to worry about a second attempt by him trying to talk me into secretly drugging his wife.

Beach medicine

Last year I was lucky enough to have been lying on a white sandy beach with calm, crystal clear, blue waters lapping on the shore. It was a picture of idyllic tranquillity until a woman dropped down dead a few yards away. Had it been an episode of Baywatch, I would have run over heroically and, with sweat glistening on my tanned bulging biceps, I would have brought her back to life with a few seconds of mouth to mouth. The rescued lady would have been 22 years old with large false breasts and gleaming white teeth. After spitting out a couple of gulps of sea water, she would have gazed into my eyes with her make-up still perfect and declared her undying love for me.

Unfortunately, this wasn’t an episode of Baywatch. The woman was a German tourist in her late seventies and was dead as dead could be. I did run over and try resuscitation and my wife bravely started mouth to mouth, which was impressive given that the German woman had vomited before collapsing. A crowd of onlookers developed and an ambulance was apparently on its way, but after 15 minutes of CPR, it became clear that this lady wasn’t coming back. The problem we had now was what to do? The ambulance was coming from the other side of the island and could be another hour. The sun wasn’t reflecting off my tanned rippling biceps because I don’t actually have any. Instead, it was beating down on my pasty white back and I could feel that I was beginning to burn.

I really wanted to call it a day. Not just because I was getting sunburnt but because this woman was dead. In a hospital I would have ‘called it’. This is where the team running the resuscitation makes a decision to stop. I am quite happy to make this decision in a hospital because I am surrounded by lots of other doctors and nurses and a hospital full of equipment. On this beach I had none of that. I didn’t have a heart monitor to tell me if there was any electrical activity coming from the heart. I didn’t have a blood glucose machine to tell me that she wasn’t a diabetic with a very low blood sugar and I didn’t have a team of other doctors to agree that it was the right decision. I did, however, have my common sense. It would take at least another 45 minutes for the ambulance to reach us and then another hour on bumpy roads to get her to a small, poorly equipped hospital with no intensive care department. The husband had told me that she had survived a heart attack earlier in the year and so it didn’t take a diagnostic genius to work out that she had probably just had a second one after returning from an overenergetic swim.

I decided not to go with my common sense and instead we carried on with the chest compressions and mouth to mouth. This was not because I thought that there was any chance of this woman surviving, but because her distraught-looking husband needed to feel that absolutely everything that could be done was being done. The other concern was a legal one. Once you start a treatment, it can be a thorny matter about deciding to stop. I wasn’t in the UK and from a litigious viewpoint, it was a much safer decision to carry on with the pointless CPR. I had a big crowd of onlookers now and they were every bit an audience as our performance was purely for show. The ambulancemen did eventually arrive but, to be honest, they were fairly useless. They didn’t have much equipment and they couldn’t intubate (put a tube into the lungs to help breathing). They didn’t even have a defibrillator (machine to give the heart an electric shock). Instead, they scooped her up on a stretcher, plodded along the beach to the ambulance and drove her to the hospital, continuing to resuscitate in much the same ineffectual way as me.

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.

Gifts

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