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.
Politics
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.
Passing judgement
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.
The examination game
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
