Benjamin Daniels - Confessions of a GP

Don’t ever ever ever say, ‘What’s up, Doc?’ It might seem momentarily amusing but it really isn’t. It is the equivalent of shouting, ‘I don’t belieeeve it’ to the actor from One Foot in the Grave , or shrieking, ‘Riiicky!’ to the corresponding EastEnders actor. We’ve heard it before and it just gets less and less funny. Some doctors hate being called ‘Doc’. I don’t really mind. In my football team there are three Bens but I’m the only doctor so I am affectionately called ‘Doc’. ‘On the ’ead, Doc’ has a certain ring to it. At school I was distinguished from the other Bens by being called ‘Big Nose’, so ‘Doc’ is a significant improvement.

Please don’t ask us medical questions when we’re not at work. I was at the barber’s and he asked me what I did for a living. I foolishly admitted that I was a doctor and he then proceeded to unbutton his shirt and ask me my opinion about a rash on his chest. We don’t want to answer medical questions on our day off and we certainly don’t want to examine you unless you are extremely attractive. I can promise you that this barber wasn’t! The awkward part of being asked medical questions outside of work is that I might need to ask embarrassing questions. For example, one of my wife’s friends asked me why she kept getting urine infections. When I started talking about the possible pH of her vagina and explaining how different sexual positions facilitate the passage of bacteria up the urethra, she looked rather disturbed. She blushed, made her excuses and has barely spoken to me since. My wife accused me of being inappropriate but at least her friend won’t ask me medical questions in the pub again. Some things are just best left for the consulting room.

If you’re a smoker, just be honest about it. So many smokers come in with awful chest infections and, when I ask them if they smoke, they proudly state, ‘No, Doctor.’ When I then ask, ‘Did you used to smoke?’ They say, ‘I haven’t had a cigarette for two days.’ This doesn’t make you a non-smoker and certainly doesn’t merit any congratulations from me. The fact that you have felt so breathless and unwell that you haven’t managed the ten-minute walk to the corner shop to buy your cigs makes you disabled, not an ex-smoker.

It is actually really refreshing when a smoker walks in and says, ‘Yes, Doctor, I smoke. I know that it’s bad for me but I like smoking and I don’t really want to stop.’ So many patients make up a lame excuse that they then recite to me: ‘I stopped for a few days and that, but then my sister Amy, she was really upset ’cause Kevin, her bloke, done the dirty on her again and I ’ad to comfort her and it was dead stressful and I ’ad to have a couple of cigs to calm me down…’

Sophie is 32 and about to have her first baby. She is not a patient but a friend. Typically of my generation of middle-class women, she focused on her herself and her career before considering starting a family. Up until now every aspect of her life has been very effectively managed. She is used to having complete control and we had joked that her wedding last year was run with ruthless efficiency like a military procedure. Sophie is delighted to be pregnant and, like every big event in her life, she has carefully researched everything there is to know about pregnancy and birth. The single most important conclusion she has made is that she doesn’t want her birth to have anything to do with the medical profession.

‘I’m not ill, you know. I’m having a baby. It is the most natural thing in the world. Why should I go to a bloody hospital?’

Sophie had long since rejected Western medicine in favour of homoeopathy, acupuncture and herbal treatments. She only eats organic food and her near-daily yoga classes keep her fit. She had never really had to consider conventional medical treatments because she had always kept herself so sickeningly healthy. Sophie felt very strongly about having her baby at home with no medical intervention and she was ready to battle for her cause at any opportunity. We met up for a coffee and she was spoiling for a fight. Much to her disappointment, I am not particularly adverse to home births. Evidence suggests that if the pregnancy is uncomplicated, a birth at home is just as safe as a birth in hospital and it is certainly a much nicer environment. My personal reservation about births at home is the possibility of me as a GP having anything to do with them. Gone are the days when a GP would happily get out of bed at 3 a.m. to assist with a difficult home delivery. I have only ever delivered a couple of babies. That was some years ago and I had a very experienced midwife watching my every clumsy move. You really wouldn’t want me anywhere near the delivery of your child.

Doctors see the births that go wrong. They are clearly the minority but even in this day and age, babies and – even very occasionally mothers – do still die during childbirth. When you see a problematic birth, it tends to stay with you. Given the choice personally, I would probably put up with unfriendly midwives and bad décor and have my baby in hospital. I would want the reassurance that a team of specialists was on hand should things go tits up. Of course, as a bloke I will never have to make the decision so my opinion is fairly irrelevant.

Home birth advocates would say that delivering your baby at home leads to fewer complications as the mother is more relaxed and this reduces the rate of births that go to Caesarean section. Both of my friends who had opted for home births ended up going on to have a Caesarean after being transferred to hospital by ambulance. Rather than pushing towards home births, shouldn’t we try to put more effort into building birthing centres or making hospital a nicer environment to give birth in?

My only other comment on home births is that they are something that I remain immensely dispassionate about. The birthing experience is clearly very important for the parents, but middle-class women complaining that hospitals are a bit sterile and unfriendly is not my biggest concern as a GP. Home births are almost solely a concern for the middle classes. As with homoeopathy, organic food and rejecting the MMR jab, they tend to be the choice of healthy, educated and well-adjusted parents. Whether their child is born at home or in hospital, the child will probably be welcomed into a warm, loving, supportive family.

The births that I am concerned about are those from the young, isolated, council-estate mums who are often bringing their children into less savoury environments. I spend a lot of time trying to make sure that these mothers have the support they need and, with the help of social workers, midwives and health visitors, that the child will be safe from potential neglect and abuse. Sophie feels that a bad birth experience, and particularly a Caesarean, can affect the future development and personality of the child. I personally doubt that is true. I feel that far more important is the mother’s ability to make an early bond with the child and give that child a stable, nurtured and safe start in life. Postnatal depression is perhaps the biggest contributor to mothers struggling to bond with their children. This can affect women of all classes and ages, but poverty, isolation and being a teenage mum are, in my experience, the biggest risk factors. I personally would rather money was spent providing for these vulnerable mothers than on funding home births.

It was a drizzly Tuesday morning in November and Michael was my fourth patient complaining of a cough and sore throat. My initial reaction was that I was seeing yet another case of man flu. Young men make such a fuss when they have a bit of a cold. They demand mountains of sympathy and expect you to discuss with them for hours the merits of Lemsip vs Beechams.