each minute passes in his presence, my empathy, patience and tolerance rapidly dwindle away. During my medical school training, I learnt all about many rare diseases that I am unlikely to ever encounter, but I was never really given any preparation for how to deal with the Marcus Smythes of this world.
I love the fact that my job allows me to meet all types of people of all ages and backgrounds. It is the best part about being a doctor and of the several thousand patients I see each year, I’m rather fond of most. There are, however, one or two patients like Mr Smythe who regularly irritate and infuriate me. All doctors dislike one or two of their patients but, with the exception of occasional confessional whispers between close colleagues, we rarely admit to it. I had already been a doctor for several years when a consultant psychiatrist took me aside and told me that it was okay to dislike some of my patients. Hearing those words was like a huge weight being lifted off my shoulders. I was able to release my guilt that had been bubbling beneath the surface and eating away at me from the inside. It felt immensely liberating to now admit these feelings and reassure myself that they were normal and, in some ways, healthy. The revelation for me as a doctor was that while I now felt able to admit to myself my personal dislike of a patient, it must not stop me from treating him or her as fairly and professionally as I would any other patient.
Boundaries
Mark is about my age and I can’t help but like the bloke. He is friendly, funny and interesting and if he wasn’t one of my patients, I imagine he could well be one of my friends. He has bipolar disorder, which means that he can get very depressed at times and at others can become as high as a kite and dangerously manic. It is a tough condition to live with and I like to see him every few weeks to make sure everything is stable.
After a few months I’ve got to know him quite well. I know about his job and his family and his relationships. He can see the funny side of his illness and he makes me laugh with some of the stories he tells. Each time he comes to see me he asks how I am. Lots of my patients ask me this but most don’t actually want me to answer. People visit the doctor to gratefully offload in one direction only. I don’t have a problem with that, but Mark is different. We get on well and I genuinely feel that he does care how I am. It feels odd him calling me Dr Daniels rather than using my first name and I think that he would like me to take down my professional barrier and have our consultations as more like chats between two friends.
It is very tempting to give in and do just that. My days at work can be long and lonely. I am constantly speaking and interacting with people, but at the same time I’m not really allowed to be my real self or relax. I would love to have a proper chat with Mark and tell him a funny story about my weekend or let him know what really pissed me off about something that happened that morning, but I don’t. I keep the barrier up for the protection of both of us. Mark is not my friend, he is my patient. If he viewed me as a friend, he might feel uneasy disclosing something to me. He might worry about what I thought or care about my opinion of him. At some time in the future he might become really unwell and need advice he doesn’t want to hear, or worse still one day he might need sectioning. How could I act objectively as his doctor if I regarded him as a friend? It might come across as a bit stuffy calling myself Dr Daniels and refusing to talk about myself to patients, but boundaries are important. Mark has other friends but I’m his only GP. The doctor–patient relationship is unique and worth maintaining.
Smoking
Regardless of why a patient comes to see me, I am required to ask them if they smoke and if they say yes to give them ‘smoking cessation advice’. I do this because it is probably a good idea that my smoking patients give up. I also do it because it earns the practice points and we all know what points mean.
Personally, I’ve never been that convinced about giving smoking cessation advice. I have tried various techniques and am not sure any of them really work. Here are a few of my best efforts:
• ‘Smoking is bad for you’ (patient probably knows this).
• ‘Smoking will kill you’ (patient probably knows this, too, and now I’ll have put their blood pressure up, which will mess up my hypertension targets).
• ‘Smoke if you want to, I really couldn’t give a monkey’s’ (reverse psychology — maybe they’ll give up to spite me).
• ‘Stop smoking right now!’ said in an authoritative paternal doctortype way (patient would probably laugh because I’m not very good at being authoritative — ask my cat).
As with all addictions, beating them is only possible when the addict is really ready to give up, hence I only give smoking cessation advice when it is the patient’s idea. Sometimes I’ll give my smokers a bit of unsubtle prompting: ‘Hmm, you’ve had a fair few chesty coughs this winter. Why do you think that is?’ If the 40 per day smoker insists that it is because of an allergy to the neighbour’s rabbit or the office’s air-conditioning system, I don’t bother with stop-smoking advice. If they recognise that smoking is harming them and genuinely want to give up, I am only too happy to give as much help, encouragement and nicotine patches as humanly possible.
Angry man
Angry man is red in the face and if I didn’t know it was medically impossible, I wouldn’t be surprised to see steam billowing out of his ears in a cartoon-like fashion.
‘You need to give me some diazepam to calm me down, Doctor. I’m on edge. I feel like I’m going to hit someone!’
‘Why are you so upset at the moment? Would you like to talk about it?’
‘Look, Doctor, I’m not here to talk about my problems. I need you to give me something to calm me down.’
‘I’m sorry but I don’t prescribe diazepam for anger. We need to find a better way of dealing with the problem. I know of a very good anger-management course I could put you in touch with…’
I didn’t think angry man could get any angrier, but I am wrong. He starts beating the desk and he pushes his face next to mine.
‘Look, if you don’t give me something to calm me down, I don’t like to think what might happen. I could really fly off the handle and hurt someone. You could be responsible for someone really getting hurt.’
‘If you hurt someone, you need to take responsibility for that yourself.’
Angry man stands up menacingly and, for a moment, I think he is going to hit me. I cower inwardly and wish my nose wasn’t quite such a large target. Angry man calls me a fucking disgrace to the medical profession and then he leaves. I actually think that my complete lack of physical presence is a great advantage in these situations. I look about as menacing as an anorexic kitten playing with some cotton wool and this seems to deter even the most threatening of would-be nose breakers.
As the door slams, I give myself a few moments to compose myself and then carry on with the afternoon surgery. The rest of the day continues uneventfully and after Mrs Gibson’s exceptionally large haemorrhoids and yet another ‘funny turn’ from Mr Polucovski, angry man’s outburst is but a distant memory.
Two hours later I am standing at the checkout in Sainsburys, having stopped off on the way home from work. The boy on the checkout is particularly slow and I am regretting that I didn’t pick the next queue over which seems to be travelling at twice the speed. The man behind me is putting his shopping on the belt and as I glance up, my heart skips a beat. It is angry man. We are trapped in the slowest checkout queue in history and the antagonism of our last meeting has switched to an overwhelming awkwardness. It is too late to swap to another till so we both shuffle along uncomfortably in the quiet confinement of the queue.
Earlier this afternoon I had imagined angry man to be in a perpetual state of rage, but now as my eyes browse over his shopping, I begin to see another side of him. I am relieved to see that he isn’t buying a baseball bat and a book about serial killers. Instead, his basket holds a bunch of fair-trade bananas, some extra soft toilet paper
