A Family Doctor’s Casebook (part 1)

General practice partnerships are like marriage without the sex, muses Geoff as he installs himself at his consulting room desk.  He knows that kind of marriage. Shoving aside the piles of letters that need answering, he begins tending to the sick of North London.

Geoff is a GP from my novels One Night at the Jacaranda and Hampstead Fever.  Despite his problems and hang-ups, he’s everyone’s favourite. Geoff is a firm believer in the NHS, but the changes he’s seen in the 15 years since he qualified frustrate him immensely.

1 The first patient is a three-month old baby with the Lexus of pushchairs and a Yummy Mummy who reminds Geoff of his ex-wife.  She begins by complaining about the 20-minute wait, and the perennial parking problems within a mile of the health centre. All this is extremely inconvenient as she’ll now be late for her Pilates.

Geoff asks what he can do for her.

“It’s Alistair’s head,” she throws down like a gauntlet.

She’s right in thinking her baby’s skull is a tad asymmetrical. Plagiocephaly is common now that babies all sleep on their backs.  Geoff reassures her that it’ll right itself in time, once Alistair lifts his head and becomes more mobile.

FreeImages.com/Johan Graterol POSED BY MODEL

Yummy Mummy is sceptical. “Doesn’t he need one of those special helmets?”

Geoff explains that there’s no evidence they help.

The mother seems unconvinced. She’ll probably go and splash out thousands of pounds on a contraption that will only cause discomfort and inconvenient. Still, she’s now ready to move on to the next symptom. The practice has a new policy of one symptom per consultation, which Geoff routinely ignores. It’s demeaning to patients and wastes everyone’s time in the end.

The rash on Alistair’s buttocks looks like a common yeast infection which should soon respond to the cream Geoff recommends. This pleases the mother, until Geoff asks her not to leave Alistair’s dirty nappy in his consulting room bin.

“I don’t want to stink out the car,” says Yummy Mummy.

Geoff eventually persuades her to take the offending object away, even though he thinks she’s likely to dump it in the waiting room on her way out.

2 Next it’s Mr Legg in his nineties, with an aching left knee. Sometimes it’s his right knee, and sometimes it’s both, which is no wonder since both legs are badly deformed by arthritis. He attends the health centre every couple of weeks, yet refuses hospital treatment. As he puts it, “I don’t want to be a bother. There’s plenty of younger folks who need it more.” Mr Legg adds that he doubts it’s arthritis anyway.  “It’s probably just down to the shrapnel what got me during the war.”

Geoff asks where the shrapnel got him.

“In a little village near Germany, Doctor.”

doctor's bag

3 It’s a relief to see that young Mohammed’s eczema is improving. For a long while, his mother believed that a mild steroid was totally unsuitable for a three-year old, but the cream, along with emollients, has made a huge difference. Mohammed sleeps well now that he doesn’t scratch himself to ribbons. All in all, he’s a happy chappy, apart from a streaming cold that’s not a problem until he flings himself at Geoff and plonks a kiss on his cheek.

Geoff usually washes his hands between consultations. Today he washes his face as well.

FreeImages.com/Toni Mihailov

 

4 Now a young man sits before him. Unemployed, with a squat nose and tats up one arm. “Pain in me bollocks,” he says.

Might be a torsion. Uncommon in adults, Geoff knows, but, unless treated promptly, it can lead to gangrene of the testicle.

“Right. I need to take a look,” Geoff says, pulling the paper curtains across.

As he waits for the fellow to undress, he wipes the photo on his desk with a tissue. It’s Davey, aged four, at the beach in Norfolk. Happy days before the divorce.

“Ready yet?” Geoff calls out, increasingly aware of how late his clinic is running.

“Yeah. Course.”

Turns out the man is sitting fully clothed the other side of the drapes.

Patiently, Geoff explains what he needs to examine. Another three minutes pass while the man undresses.

On examination there’s nothing abnormal about the patient’s tackle, apart from the stink. Geoff peels off his gloves and flings them in the bin. “Hmm. All’s well there. When did you first get the pain?”

The man shrugs. “Maybe a week ago. But I ain’t got it no more, like. Not since I pulled that bird the other day.”

“Fair enough,” says Geoff, even though there’s nothing fair about it. The ugly, unemployed fucker gets laid just like that, while he, Geoff, has been celibate for ten months and counting.

***

Coming up soon, Geoff deals with a very personal problem. Meanwhile you may enjoy one of these posts:

How to Alienate Your Doctor in Ten Easy Steps

What Your Doctor is Really Saying

or, on a more serious note, an overview of sepsis in The Disease Nobody Knows About Until It’s Too Late.

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How to Alienate Your Doctor in 10 Easy Steps

Articles in newspapers and magazines often give advice on how to get the best out of your doctor. The idea is to maximize the benefits of a consultation and to relieve pressure on the NHS at the same time.

National Health Service logo

But where’s the fun in that?

With a little planning, you could properly annoy your doctor instead. Here’s my advice based on decades working in the NHS, together with one or two favourite tips from my fictional GP colleague Geoff, the doctor in Hampstead Fever.

Hewlett Packard Rapaport Sprague stethoscope

I like to think these are steps almost anyone can take.

1 Prepare for your appointment by not showering or washing for two weeks. Don’t wash your clothes or change your underwear either. With clean clothes, you’re just not playing the game.

2 Bring a list. It should include all the symptoms you’ve had in the last five years. Aim for about 20 or so different complaints.

3 if you don’t have enough symptoms of your own, bring the family. A babe in arms, a couple of hyperactive toddlers, and a deaf granny should do the trick.

4 Kick off the consultation with, “This won’t take a minute, doc.” Which is true. It will take an hour.

kitchen-clock

5 To help your doctor’s diagnostic skills, offer a couple of well-chosen newspaper cuttings or internet printouts. You know the kind of story: Vaccines Kill Millions, or New Miracle Cancer Drug. On no account must you allow your GP to dissuade you. After all, Dr Google is so much better than a living breathing doctor with actual qualifications.

6 When the baby’s nappy needs changing, leave the soiled one behind in the doctor’s bin. This ploy is a good one for the summer months.

7 It’s only polite to take your chewing gum out before saying, “Aah.” Leave it in a tidy blob on the GP’s desk.

8 Exhibit your verrucas, ingrown toenails, chilblains, or bunions at every consultation (what do you mean, you don’t have any?). Before you put your sock back on, it’s de rigueur to get it the right way round by shaking it vigorously at your GP.

sock

9 Don’t ask for an antibiotic for your cold. Demand one. You know your rights. If necessary, remind your doctor that you pay his or her wages.

10 Save your best symptom till last, and mention it only when you’re about to leave. Thus, hand on the doorknob, you can say, “While I’m here, doc…”

FreeImages.com/Robert Eiserloh

With a bit of practice, you should be able to piss your doctor off without even trying.

***

For the really perverse who actually want to get the best from their doctor, here’s my advice, along with some wisdom from fellow GP Mark Porter in The Times.