Benjamin Daniels - Confessions of a GP

Some areas have wonderful emergency social services with a team of physios, carers and social workers on call to provide urgent assessments and vital care to people who desperately need it. They keep people out of hospital, saving money and preventing people from catching MRSA and other hospital bugs. Unfortunately, most emergency social services teams are terribly underfunded, understaffed and suffer from low morale. They might not have a flashing blue light on their cars but they are desperately needed and would pay for themselves many times over by preventing unnecessary hospital admissions, especially at Christmas.

This is an ethical dilemma that I faced and I have no idea if I did the right thing or not. I wonder what you will think. A mother came in to see me with her 12-year-old daughter and asked for her to be put on the pill. I said no and Mum was furious.

Basically, the daughter, whom I’ll call Amy, looked more like a 15-year-old than a 12-year-old. However, she wasn’t 15, she was 12! Her mother told me that she had ‘aggressive conduct disorder’. I had never heard of this but Mum explained to me that her condition resulted in her refusing to do anything that her mum told her to do, becoming very aggressive and basically doing anything that she wanted. She sounded like a stroppy 12-year-old with no boundaries to me. The difference between Amy and most moody 12-year-olds was that every evening Amy went to the local park with some older teenagers and drank alcohol, took drugs and had sex. She also refused to go to school. Mum told me that she physically couldn’t stop Amy from leaving the house. If she tried to do so, Amy would lash out at her and start hitting her mum and smashing up the house. Mum then showed me some of the bruises on her arms to prove it. Amy was bigger than her mum and there was no dad or partner around at home for support.

As far I was concerned, a 12-year-old having sex was child abuse and indicated a need to have social services and child protection services involved. I was amazed to hear that these services were already in place with social workers, the police and child psychiatrists all involved with her care and having regular child protection meetings. Despite this, there had been no change in Amy’s behaviour. Mum’s basic standpoint was that she couldn’t stop Amy from having sex but did at least want her to avoid the trauma of having an abortion or a baby. I just couldn’t believe that Mum appeared to be so accepting of her daughter’s behaviour.

Amy herself was in the room with us but sat silently in the chair staring at the floor. I tried to engage her and ask her a few questions. I even tried to speak to her without her mum present, but I got no response whatsoever. I am allowed to prescribe the pill to under-16s but I have to be convinced that they have the ability to understand all about the pill and make the decision as to whether they want to take it or not. As Amy refused to talk to me, I couldn’t be sure of this so I felt justified in not prescribing the pill for this reason.

Amy’s mum left, annoyed. ‘Don’t judge me,’ she said as she got up and left. ‘Do you not think I’ve tried everything I can to help and protect Amy? I love my daughter.’ It was too late. I had judged her. I feel that a parent must be able to physically prevent their 12-year-old daughter from having sex, getting drunk and taking drugs. Maybe my opinion will change if I ever have a teenage daughter. I’m not suggesting that Amy should have been taken into care and locked away, but shouldn’t there have been something more on offer from social services to give support for Mum and help her protect her vulnerable child? What was the future going to be for Amy? The advantage of being her GP was that I’d probably find out if I hung around for long enough. I just hoped she wouldn’t pitch up to see me next week pregnant.

Medics’ humour can be fairly brutal and one of our favourite games was stitching up our mates. Ed was a friend from medical school but when the rest of us qualified, he failed his exams and the poor bugger had to retake. Six months later, he did qualify and came and joined us as a hospital doctor. Ed was taking over my job on the ward and was extremely nervous about his first day. As I left on my last evening, I had the ward in fairly good shape ready for Ed to take over in the morning. However, we thought it might be entertaining to fish out a few embarrassing photos of Ed from medical school. Using the ward computer, we put a particularly unflattering photo of Ed on a notice. It stated: ‘THIS MAN CLAIMS TO BE A DOCTOR CALLED DR EDWARD BENNETT. HE IS A CONMAN. PLEASE REPORT HIM TO SECURITY IF SEEN ON THE PREMISES.’ We put the notices up on the ward that he was due to start on the next morning and then left for our new placements at different hospitals. Poor old Ed spent his entire first morning having to try to prove that he was really a doctor and eventually had to ask the dean of the medical school to confirm his identity.

Poor Ed was eventually allowed to start work and he survived his first year as a doctor. His next job was as a casualty doctor and, unfortunately, his first day was equally disastrous. We have a system where, at the beginning of August, we all swap jobs overnight. Often a doctor will be on call in one hospital one evening and then start work in a hospital in a different part of the country the next day. This is what happened to Ed. After finishing a shift at midnight, he woke up at 4 a.m. to drive 100 miles to a new hospital to start work in A&E. Ed didn’t know the area and was driving around town lost, trying to find the hospital. Unfortunately, the combination of being sleep-deprived and lost resulted in him crashing his car on a roundabout. He wasn’t badly hurt but the paramedics wanted to play things safe and he was wheeled into the A&E department where he had been due to start work, strapped to a spinal board and wearing a neck brace.

Being ill as a doctor is always a difficult experience, especially if you end up being admitted to the hospital in which you work. During my first year as a doctor, I was admitted for an operation on my ankle. It was very odd being on the other side and quite an eye-opener. My friends, of course, saw it as an excellent opportunity to stitch me up. They managed to find my drug card and thought that it would be hilarious to write me up for all sorts of unnecessary medications that would mostly have to be inserted up my backside. Still dopey from the anaesthetic, I had to fend off a particularly enthusiastic Filipino nurse who was determined to carry out all the doctors’ carefully written instructions.

Camouflage man is frightening when you first meet him. He has a big bushy beard and wears head-to-toe army camouflage gear, complete with balaclava and army cap. He is homeless and carries all his belongings in a large holdall on his back that he secures to his body with a long chain that is wrapped around him several times and locked with a big padlock. Camouflage man has paranoid delusions that he is being followed and people are trying to attack him and steal from him. These thoughts are partly because of his mental illness and partly because life on the street is tough and he regularly gets beaten up and robbed. You would probably cross the road if you saw camouflage man walking towards you, but now that I know him I realise that he is much more afraid of you than you are of him. His real name is Nigel.

Nigel is mentally ill but because he doesn’t fit nicely into one neat category of mental illness, no one has really taken responsibility for him. Nigel has had schizophrenia since he was a teenager but because he is also an alcoholic and homeless, no one is very sure which team should be looking after him. Nigel won’t take any medication and won’t attend any psychiatric appointments. He often disappears for a few months at a time, but he always resurfaces and as his GP, I am perhaps the only healthcare professional with whom he regularly has contact.