Confessions of a GP. Benjamin Daniels

broken dreams, or assume that I have lost my empathy and respect for the people who expectantly seek my help or advice. I guess it’s just that the often grim reality of practising inner city medicine is not quite what I had expected it to be. I no longer dream of miracle cures and magic bullets and I have definitely given up waiting to dramatically re-inflate that collapsed lung. Instead, I acknowledge that my role is to listen and share the pains, concerns and sufferings of the people who sit before me. I offer the odd nugget of good advice and provide some support at times of need. Perhaps just occasionally I even make a small difference in someone’s life. The intention of this book is simply to give an honest but light-hearted insight into some of the joys, frustrations and absurdities of being an inner city NHS GP today. I hope you enjoy it.

      I have only been a GP for three years but I do genuinely love the job. I like the variety and getting to know my patients. I find it challenging and rewarding. Sometimes I even make a diagnosis and cure someone! I’m currently working as a locum which means that I work in different GP surgeries in different parts of the country, covering other GPs when they are away. I also still do some shifts as an A&E doctor from time to time. Some of my posts have just been for one day, others have been for over a year and I get to see the good, bad and ugly side of general practice, patients and the NHS. I love my job and think that it is one of the most interesting out there. I hope that after reading this book you might agree with me, or if not at least realise that it isn’t just about seeing coughs and colds.

       Mrs Peacock

      Like parents, doctors are not supposed to have favourites but I have to admit to being rather fond of Mrs Peacock. She is well into her eighties and her memory has been deteriorating over the last few years. Most weeks she develops a medical problem and calls up the surgery requesting me to visit. When I arrive, the medical problem has been resolved or at least forgotten and I end up changing the fuse on the washing machine or helping her to find her address book, which we eventually locate in the fridge. As I tuck into a milky cup of tea and a stale coconut macaroon, I reflect that my medical skills probably aren’t being put to best use. I imagine the grumbling taxpayer wouldn’t be too pleased to know that having forked out over £250,000 to put me through my medical school training, they are now paying my high GP wages in order for me to ineptly try to recall which coloured wire is earth in Mrs Peacock’s ageing plug.

      Mrs Peacock needs a bit of social support much more than she needs a doctor so when I return to the surgery I spend 30 minutes trying to get through to social services on the phone. When I finally get through, I am told that because of her dementia, Mrs Peacock needs a psychiatric assessment before they can offer any social assistance. The psychiatrist is off sick with depression and the waiting list to see the stand-in psychiatrist is three months. I’m also reminded that Mrs Peacock will need to have had a long list of expensive tests to exclude a medical cause for her memory loss. Three months and many normal test results later, Mrs Peacock forgot to go to her appointment and had to return to the back of the queue.

      Through no fault of her own, Mrs Peacock has cost the NHS a small fortune. Her heart scan, blood tests and hospital appointments all cost money and we GPs don’t come cheap, either. Mrs Peacock does have mild dementia but more importantly she is lonely. She needs someone to pop in for a cup of tea from time to time and remind her to feed her long-suffering cat. It would appear that this service is not on offer, so, in the meantime, I’ll continue to visit from time to time. When the coconut macaroons become so inedible that even the hungry cat won’t eat them, I’ll think again about trying to get Mrs Peacock some more help.

       Tom Jones

      The term ‘presenting complaint’ is what we use when we describe what the patient comes in complaining about – i.e. the patient’s words rather than our diagnosis. Normally as a GP the presenting complaint will be ‘back pain’ or ‘earache’ or ‘not sleeping’. Elaine Tibb’s presenting complaint was different. When I said, ‘Hello Miss Tibbs. What can I help you with today?’ she said, ‘I’m having pornographic dreams about Tom Jones.’ Her words, not mine.

      For the more common presenting complaints, most doctors will already have a check list of questions in their heads. For example, a female patient says, ‘I’ve got tummy pain’ and I say, ‘Where, and for how long?’ and ‘Have you got any vaginal discharge?’ When faced with the presenting complaint of pornographic dreams about a celebrity, I was left hopelessly speechless. When discussing Elaine’s sexual fantasies, I was very keen not to know where, for how long and if there had been any vaginal discharge. Unfortunately, I didn’t get a chance to point this out to Elaine before every minuscule aspect of the dreams was described in surprisingly graphic detail.

      I am rarely left speechless by a patient’s opening gambit, but as with Elaine, there are always a few that do leave me at a complete loss. My personal favourites are:

      When I eat a lot of rice cakes, it makes my wee smell of rice cakes;

      I masturbate 10 to 15 times per day – what should I do?

      I ate four Easter eggs this morning and now I feel sick;

      My husband can’t satisfy me sexually;

      When I was in church this morning, I was overcome by the power of the Lord;

      I think my vagina is haunted.

      Elaine is a classic example of someone that we GPs see fairly regularly. She was odd and eccentric, but not quite mentally ill. She was slightly obsessive and delusional but not really harming herself or anyone else. Admittedly she didn’t work, but she functioned reasonably well from day to day and didn’t really have any insight into the fact that other people found her to be a tad unusual. Instead, Elaine generally saw most of the rest of the world as slightly peculiar and felt it was just her and, of course, her darling Tom Jones who were the only normal ones. Looking through her patient records, I noted that she did once see a psychiatrist a few years back. He diagnosed her as having ‘some abnormal and obsessive personality traits but no active psychosis’. This is psychiatry speak for ‘slightly odd but basically harmless’

      ‘He does love me, you know, Doctor. If he met me, he would know it straight away. We’re made for each other.’

      ‘Isn’t Tom Jones happily married and living in America?’

      ‘No no no! He loves me, doctor.’ Elaine would have happily spent all afternoon telling me about her Tom Jones fantasies, but I felt that we needed to move things on. I used the classic GP phrase that we pull out of the bag when we feel that we’re not getting very far. ‘So Elaine, what are you hoping that I’m going to do for you today?’

      ‘Well, doctor, I need you to write Tom a letter. It would sound better coming from you. He’s a doctor as well. Well, not a real doctor, but I’m sure he’d be a wonderful doctor if he wanted to be. He’s very kind you know and oooh so gorgeous and anyway, I’m sure if you just explained everything he would see sense, I know he would.’

      Basically, I was being asked to stalk Tom Jones on Elaine’s behalf. I could imagine the letter.

      Dear Tom,

      Please will you leave your wife, family and LA mansion and move into a council bedsit with a slightly odd woman with straggly hair and a duffel coat that she has been wearing since 1983. It will make my life slightly easier as she won’t keep coming to the surgery and annoying me with her graphic descriptions of your imaginary sex life.

      Best wishes,

      Dr Daniels

      Stalking is defined as a ‘constellation of behaviours in which an individual inflicts upon another repeated unwanted intrusions and communications’. Elaine probably would have quite liked to have stalked Tom Jones, but I don’t think she really had it in her. For Elaine, her problems with relating to everyday folk had resulted in her focusing all her energy on an imaginary relationship with a person whom she would never meet. I guess this was a good way to protect herself from the struggles and potential rejections of real-life