Benjamin Daniels - Further Confessions of a GP

‘Brian, some men find that beta-blocker medication like the one you’re taking for your blood pressure can affect their ability to have erections. Do you ever find this to be a problem?’

‘Well, funny you should say that, Doctor. Me and the wife here have been struggling to manage in the bedroom department for some time. When we’re alone together I just can’t seem to get the little fella to stand to attention these days.’

Wow, I think to myself. What a breakthrough. The nice sex therapist lady was right. We do need to talk more about sex with our patients. Perhaps I can make a real difference to Brian and Deidre’s relationship. Perhaps the sexual frustration is the reason why they’re always bickering.

‘Mind you, I do still get erections though, Doctor,’ Brian said, interrupting my thought process.

‘This young lass got on the bus last Tuesday. It was a right warm day if you remember and, cor blimey Dr Daniels, you should have seen her! Gorgeous she was. Legs this long and a little top that didn’t leave much to the imagination if you catch my drift…’

Brian went on to explain in some detail each item of his young passenger’s clothing, and the relative part of her anatomy that was exposed as a result. ‘Rock solid I was, Doctor. Could barely keep the bus on the road! I could see her in my rear-view mirror and I had wood from the stop outside Boots on the high road all the way to the leisure centre past South Street. That’s five stops, and I got caught at the lights just before the bridge. I really don’t think it’s the blood pressure tablets that are the problem, Doctor. I think it might be Deidre. She’s not the woman she was. Just doesn’t really do it for me any more.’

Deidre had been sitting quietly up until now, but I could sense her rising fury. ‘Don’t you worry, Dr Daniels, erection or no erection, Brian doesn’t do a great deal for me either these days. In fact, he never really did. Even when we were young I always had a lot more fun on my own, if you know what I mean.’

Brian and Deidre went on to describe each other’s inadequacies in the bedroom department in some detail. To make things even more awkward, they didn’t speak directly to each other but instead spoke to me as if the other wasn’t present. I sank as deeply as I possibly could into my chair and cursed myself for turning what could have been a nice simple consultation into something so toe-curlingly awkward that I wished the ground would swallow me up. I tried to think of some useful interjections, but I was well out of my depth with this one, so instead I sat excruciatingly silent until Brian and Deidre decided that I had heard enough and left.

My brief attempt at viewing my patients as ‘sexual beings’ was well and truly over.

Maggie had come back to see me after seeing the cancer specialist again.

‘He was very nice, but he soon discharged me when I decided that I wasn’t going to have any chemotherapy.’

‘How are you coping?’

‘Everyone keeps telling me how brave I am. They tell me I’m a fighter and that I’m strong. I’m fucking dying and they just talk to me about staying positive. The problem is, Dr Daniels, I’m not that brave or strong or positive. Right now I’m scared. In fact, I’m thoroughly terrified. It’s as if I’m not allowed to admit it to anyone because I have to be so godforsaking brave the whole bloody time.’

‘It’s okay. You’re allowed to be scared.’

‘How about fucking terrified?’

‘Yup, that too.’

‘I’m all right when people are around or when I’m busy, but when everyone else is out and I’m alone in the house, I can’t stop myself from wondering about the end. How will it be? Will I be in pain? Will it be next week or still months away? Will I stop breathing first or will it be my heart that stops? Will I already be in a coma or will I feel myself dying? I need to have some power over this. Sometimes I wish I could piss off to Switzerland and end it all now. I just want to wrestle back control over this whole sodding thing.’

Regardless of the person with the cancer, the same clichés seem to recur time and time again. One of which is sufferers of the disease being universally thought of as ‘brave’. The public image is of ‘brave’ cancer sufferers heroically running marathons while defiantly sporting their chemotherapy-induced baldness. It’s as if the brave label arrives the moment you are diagnosed with cancer and you’re not allowed to be anything else. Reality TV personality Jade Goody morphed from being a national hate figure to being some sort of serene martyr the moment she was given her cancer diagnosis. In fact, such was the furore when she died that some people were calling for cervical cancer to be renamed ‘Jade Goody disease’. I thought I was going to have to start telling people that their smear revealed some abnormal Jade Goody cells on their cervix or that the Goody had spread to their liver. Jesus, as if breaking bad news isn’t hard enough already!

It wasn’t that Maggie was any less brave than anyone else. She was having a thoroughly normal reaction to the knowledge that she was going to die. We hadn’t really known each other well before her diagnosis, but she seemed to have acquired an immense trust in me since I spotted that she had cancer. To be fair, it wasn’t some sort of clever diagnosis worthy of House , but she clearly appreciated me sending her straight into hospital that first afternoon. There was no cure, but we were going to do everything we could to ‘keep her comfortable’. There’s another classic cancer cliché that Maggie hates.

Once a year our surgery sends out hundreds of anonymous patient satisfaction questionnaires. It always makes me feel a little under scrutiny, but overall I can’t dismiss the potential value of finding out what my patients really think about me. Some of the questions are about general matters, such as telephone access and how long it takes to get an appointment. Others are more directly targeted towards the patient’s interactions with the doctor, and contributors are specifically invited to comment on the experience of their most recent consultation.

When the collated results are emailed to me, I eagerly read them through. Being a good doctor isn’t just about being popular, but I can’t pretend that I wouldn’t feel thoroughly demoralised if all my patients reported in their questionnaires that they hated me!

This year, the first question asked whether the doctor helped them feel at ease. Phew, 85 per cent of my patients felt I had done this. The second question was whether the patient felt that their concerns had been listened to: 83 per cent scored me highly on this one. A further 88 per cent of the respondents were impressed with my ability to communicate with them. It was a relief that I was scoring well, but I was only reaching the average scores that most GPs achieve on these standardised surveys. Despite the regular pounding we get in the media, overall satisfaction in GP services remains consistently high.

The final question asked if the patients felt that their last consultation had helped lead to an improvement in their physical or mental health. On this I scored 40 per cent. Ouch! That meant for the majority of my patients, although they were put at ease, had their concerns listened to and were well communicated with, their actual health was no better off after seeing me than it was before.

This might seem like an epic failure, but actually it is a very accurate description of what a doctor does. The famous French writer Voltaire said that ‘the art of medicine consists in amusing the patient while nature cures the disease’. I would add that nature sometimes makes them worse too, but ultimately our role is often to offer a distraction while time and the miraculous natural healing abilities of the human body work their magic. Some of my patients are very aware of the limits of my therapeutic abilities, but others seem to feel that I should be performing miracles. Regardless of their expectations of my curative powers, every patient expects me to be nice to them.