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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A Week to Remember in the Surgery

“An alcoholic is someone who drinks more than his doctor” thinks Geoff as he attacks the second bottle of red.  This isn’t going to help, but it’s Friday and, let’s face it, it’s been a bit of a week.  He waits for the microwave to do its thing with dinner.

Geoff is a family doctor in suburban London, or he would be if he were real.  As it is, he’s just a figment of my imagination.  At 38, he’s divorced and already worn out.

On Monday, Geoff had. expected a two-minute silence but nobody had read the memo.  “Was there a memo?” says the practice manager.  It was a mystery how the staff always take note of the senior partner’s memos though.

His colleagues in the practice think losing two minutes at 11am would be completely out of order.  Especially when Remembrance Day falls on a Monday.  Especially when there are targets to meet, hoops to jump through.

crumpled poppyThe practice nurse is wearing a poppy, now crumpled out of shape and dangling precariously from its pin.  One of the receptionists has one too. The rest don’t bother.

So at the precise moment when Geoff thought he might be standing shoulder to shoulder, if not with all those who serve, then at least with all those who work in the health centre, he’s peering at a patient with spots.

“What can I do for you today?” asks Geoff.  Every doctor knows you never ask what’s wrong today, because patients reply that’s what they came to find out. You don’t ask them what brought them, either. Not unless you want to hear about the 168 bus.

By way of reply, he unzips his flies and whips it out.  That’s where the spots are.  The patient wants antibiotics.  Geoff wants him to get checked out properly.  So he sends him to the Pox Palace, but he uses the correct name instead: sexual health clinic.

On Wednesday the computer database is down.  Turns out it’s a national outage.  “National outrage, more like” fumes Geoff.  Still, he likes idea of free-range consulting.  He can look people in the eye and do proper medicine instead of being fixated on the computer screen.  Funny how much easier it is to listen when you’re not at the mercy of stupid pop-up menus ordering you to ask if they’re depressed, check their medications, and offer a change of contraception.

But by the time the computer’s back on at 11.30am, he’s accumulated pages of illegible patient notes and 20 patients who really need to be seen again.

It’s late on Friday when Geoff finally leaves. He sees that the wall by the No Smoking sign outside the health centre has been used to stub out cigarettes. And he can guess which patients did it.  He goes and scrubs it, because nobody else will.

Now it looks like this.small dirty wall

Surely that entitles him to a bonus glass of wine or two.

 

Alcohol abuse is common in doctors but the expression ‘drunken sailor’ has a lot of truth in it.