Benjamin Daniels - Confessions of a GP

Until this day, that is. Here it was in front of me, the widespread rash all over the body and the classic lesions in the mouth. I ‘Googled’ measles and, sure enough, Sebastian’s rash looked the same as the one on my computer screen. My final test was to grab Sue, our oldest receptionist, and bring her into the room. ‘Is this measles?’ I asked her. Taken aback but flattered to be asked her medical opinion, Sue took a quick glance and said, ‘That’s it. All four of my kids have had it.’ There it was: measles, a disease that killed millions of children before widespread vaccinations almost eradicated it completely. As a doctor who had only practised medicine in the twenty-first century, I should never have seen this disease. Measles was back and had become a disease of the middle classes. A disease of Hampstead, Wimbledon and Harrogate – so frustratingly unnecessary.

I was actually quite angry. Sebastian’s mum was unrepentant. ‘I think it is important for my child to build up his own natural immune system. He is on a special whole-food diet that boosts it naturally.’ I was fuming now. ‘The immune system is very specific,’ I tried to explain calmly. ‘The only way that Sebastian can become immune to measles is to either have the vaccine or to have the disease itself, assuming he survives it. He can eat all the organic dates and wholemeal rice in the world, it won’t give him immunity to measles, mumps, rubella, diphtheria, tetanus, meningitis C, whooping cough, haemophilus influenza and tuberculosis. These really aren’t nice illnesses, you know!’ It was not the time to be angry as Sebastian was quite unwell. There is no cure for measles but having no experience of the disease, I wanted the paediatricians to check him over. I sent them up to the hospital with strict instructions for Mum to keep Sebastian isolated from the other children in the waiting room.

Not all children can have vaccines. They can be harmful to children who have diseases of their immune system such as HIV or those having chemotherapy for cancer. Previously, these children were protected because healthy children were all vaccinated and so a disease outbreak was prevented. Now that healthy children such as Sebastian are no longer being vaccinated, these vulnerable children are at risk. The last thing a child on chemotherapy needs is a bout of measles. Vaccinating isn’t just about protecting your own child.

‘What can I do for you today, Darryl?’

‘’Allo Dr Daniels. How are you?’

‘Fine, thank you, Darryl.’

‘I ’ope you’re ’aving a good day and that.’

Darryl was a local thug who had somehow avoided ever having been locked up despite years of fights, assaults and petty crime. He tended to be rude and demanding so his less than impressive attempt at being charming meant that he must have wanted something.

‘I need a letter to say I couldn’t go to my community service last Thursday.’

‘Why was that?’

‘I had bad flu.’

It annoys me when people say they have flu when actually they have a bit of a cold. However, it wasn’t the time to correct Darryl. He was significantly bigger than me and I have naturally cowardly tendencies.

‘Are you still unwell?’

‘No, I’m better now.’

‘Well, why didn’t you come in at the time you were unwell?’

‘I phoned up the receptionist and she told me that there were no appointments available except for emergencies. She also told me that my symptoms were probably viral and I should take some paracetamol and go to bed.’

We had clearly trained our receptionists too well and now Darryl had worked out how to get out of his community service without getting in the shit.

‘I didn’t want to waste an emergency appointment and that.’

How noble of you, Darryl. Such a shame that your high sense of altruistic morals couldn’t have been better demonstrated when you were kicking the shit out of some poor lad who’d accidentally spilt your pint. (I thought this rather than said it, for obvious reasons.)

I really didn’t want to write a letter for Darryl. I also had had a bit of man flu that Thursday. I had ventured in and spent the day feeling miserable. I didn’t see why Darryl couldn’t have done the same. I imagine he had a few beers the night before and decided to give the leaf sweeping a miss for the day, knowing he could hoodwink some foolish GP into writing a letter to get him off the hook.

‘My probation officer says I need a letter and that. I’m on my last warning for missing community service days. They’re threatening to take me back to court and put me away.’

So there I was, writing a letter as if to excuse my child from doing PE at school:

Dear Probation Officer,

We both know Darryl is an unpleasant little scrot who will do anything to slime his way out of trouble and get out of doing any work. He tells me he had a bit of a snuffly nose last week (boo hoo) and now wants me to write a letter so he doesn’t have to go back to court to face a breach of his community service order.

Please send him straight to jail and lock him up for ever as I am in a particularly unsympathetic mood due to the fact that I’m running late because of time-wasting twats like Darryl.

This was the letter I would love to have written. One day I will write it and bask in momentary satisfaction before they suspend me for unprofessional conduct and Darryl comes to my house and beats seven lumps of shit out of me. I hoped the probation officer would read between the lines of the more mundane letter that I actually wrote:

Dear Probation Officer,

Darryl tells me that he couldn’t go to his community service last Thursday as he had symptoms of a viral infection. He was not examined at the time and his symptoms have since resolved.

Nothing in this letter required any small degree of medical knowledge or skill, but the very fact that it was written by a doctor rather than his aunt Doris meant that Darryl would probably get off the hook with the court and avoid going to jail.

My last hospital job before I became a GP was in psychiatry. I already knew that I wanted to be a GP by this stage and, given the large amount of psychiatry in general practice, I thought that it wouldn’t be a bad idea to spend six months learning a bit more about mental health. The job I had was actually in forensic psychiatry. I was on a locked ward with patients who were supposedly ‘criminally insane’. I loved going to parties and telling people I was a forensic psychiatrist. It sounds good, doesn’t it? It gave people the impression that I was akin to the Robbie Coltrane figure in Cracker , solving crimes and bringing insane criminals to their knees with my brilliant questioning and diagnoses. The reality, of course, was very different. I wasn’t really a forensic psychiatrist, I was the junior doctor attached to the forensic psychiatry team. I wandered around the ward doing the odd blood test and checking blood pressures. Occasionally, I would write a letter to the Home Office asking whether a patient would be allowed to go to his sister’s wedding as long as he promised not to drink too much or murder anyone.

The patients themselves were a mixed bunch. They had all committed crimes of some sort while mentally unwell, but many of them didn’t really need to be locked away. One of the lads had set fire to a homeless hostel when he was having scary delusions and hallucinations because of schizophrenia. There was no malice involved in his crime. In his psychotic state he had simply been trying to save the other residents by smoking out the evil spirits. His symptoms were well controlled now by medication and he wouldn’t have hurt a fly; however, arson is taken seriously so he was locked up on our ward. Another patient became quite paranoid when smoking weed. He got into an argument at a party and stabbed someone. I’m not sure if it was the paranoia to blame or simply the stupidity that lots of young blokes have when a bit drunk and stoned. That was ten years earlier, but he remained on our ward because he was still apparently a danger to society.