Benjamin Daniels - Confessions of a GP

It is very tempting to give in and do just that. My days at work can be long and lonely. I am constantly speaking and interacting with people, but at the same time I’m not really allowed to be my real self or relax. I would love to have a proper chat with Mark and tell him a funny story about my weekend or let him know what really pissed me off about something that happened that morning, but I don’t. I keep the barrier up for the protection of both of us. Mark is not my friend, he is my patient. If he viewed me as a friend, he might feel uneasy disclosing something to me. He might worry about what I thought or care about my opinion of him. At some time in the future he might become really unwell and need advice he doesn’t want to hear, or worse still one day he might need sectioning. How could I act objectively as his doctor if I regarded him as a friend? It might come across as a bit stuffy calling myself Dr Daniels and refusing to talk about myself to patients, but boundaries are important. Mark has other friends but I’m his only GP. The doctor–patient relationship is unique and worth maintaining.

Regardless of why a patient comes to see me, I am required to ask them if they smoke and if they say yes to give them ‘smoking cessation advice’. I do this because it is probably a good idea that my smoking patients give up. I also do it because it earns the practice points and we all know what points mean.

Personally, I’ve never been that convinced about giving smoking cessation advice. I have tried various techniques and am not sure any of them really work. Here are a few of my best efforts:

• ‘Smoking is bad for you’ (patient probably knows this).

• ‘Smoking will kill you’ (patient probably knows this, too, and now I’ll have put their blood pressure up, which will mess up my hypertension targets).

• ‘Smoke if you want to, I really couldn’t give a monkey’s’ (reverse psychology – maybe they’ll give up to spite me).

• ‘Stop smoking right now!’ said in an authoritative paternal doctortype way (patient would probably laugh because I’m not very good at being authoritative – ask my cat).

As with all addictions, beating them is only possible when the addict is really ready to give up, hence I only give smoking cessation advice when it is the patient’s idea. Sometimes I’ll give my smokers a bit of unsubtle prompting: ‘Hmm, you’ve had a fair few chesty coughs this winter. Why do you think that is?’ If the 40 per day smoker insists that it is because of an allergy to the neighbour’s rabbit or the office’s air-conditioning system, I don’t bother with stop-smoking advice. If they recognise that smoking is harming them and genuinely want to give up, I am only too happy to give as much help, encouragement and nicotine patches as humanly possible.

Angry man is red in the face and if I didn’t know it was medically impossible, I wouldn’t be surprised to see steam billowing out of his ears in a cartoon-like fashion.

‘You need to give me some diazepam to calm me down, Doctor. I’m on edge. I feel like I’m going to hit someone!’

‘Why are you so upset at the moment? Would you like to talk about it?’

‘Look, Doctor, I’m not here to talk about my problems. I need you to give me something to calm me down.’

‘I’m sorry but I don’t prescribe diazepam for anger. We need to find a better way of dealing with the problem. I know of a very good anger-management course I could put you in touch with…’

I didn’t think angry man could get any angrier, but I am wrong. He starts beating the desk and he pushes his face next to mine.

‘Look, if you don’t give me something to calm me down, I don’t like to think what might happen. I could really fly off the handle and hurt someone. You could be responsible for someone really getting hurt.’

‘If you hurt someone, you need to take responsibility for that yourself.’

Angry man stands up menacingly and, for a moment, I think he is going to hit me. I cower inwardly and wish my nose wasn’t quite such a large target. Angry man calls me a fucking disgrace to the medical profession and then he leaves. I actually think that my complete lack of physical presence is a great advantage in these situations. I look about as menacing as an anorexic kitten playing with some cotton wool and this seems to deter even the most threatening of would-be nose breakers.

As the door slams, I give myself a few moments to compose myself and then carry on with the afternoon surgery. The rest of the day continues uneventfully and after Mrs Gibson’s exceptionally large haemorrhoids and yet another ‘funny turn’ from Mr Polucovski, angry man’s outburst is but a distant memory.

Two hours later I am standing at the checkout in Sainsburys, having stopped off on the way home from work. The boy on the checkout is particularly slow and I am regretting that I didn’t pick the next queue over which seems to be travelling at twice the speed. The man behind me is putting his shopping on the belt and as I glance up, my heart skips a beat. It is angry man. We are trapped in the slowest checkout queue in history and the antagonism of our last meeting has switched to an overwhelming awkwardness. It is too late to swap to another till so we both shuffle along uncomfortably in the quiet confinement of the queue.

Earlier this afternoon I had imagined angry man to be in a perpetual state of rage, but now as my eyes browse over his shopping, I begin to see another side of him. I am relieved to see that he isn’t buying a baseball bat and a book about serial killers. Instead, his basket holds a bunch of fair-trade bananas, some extra soft toilet paper and a Harry Potter book. Suddenly, angry man isn’t the big scary man that he was a couple of hours ago. This opportune insight into the man behind the fury warms me to him slightly. I consider trying to find a few words to break the ice, but our super-slow checkout boy has finally managed to scan all my items and it is time for me to pay. As I leave, not-so-angry man gives me an awkward nod and I wonder if our next encounter in the surgery might be a little less heated.

After practising medicine for some time, the average grumpy doctor will have seen many thousands of patients pass before him or her. In the early part of our careers we greet every medical condition with genuine intrigue and gusto, but as the years pass it can become harder and harder to muster up the enthusiasm to keep ourselves awake during slow afternoon surgeries.

Having said that, there are a few ways in which you, the patient, can grab the attention of even the most indifferent of doctors:

1. Have a rare condition . Your diagnosis should be common enough that we learnt about it at medical school but rare enough to be something that we have never actually seen before in the flesh. Be warned, however, that if it is so rare that we can’t recognise it or have never heard of it, our feelings of incompetence will lead to frustration and resentment, which will most likely be taken out on you.

2. Have a diagnosis with a good name . I love the way molluscum contagiosum rolls off the tongue. The delightful Latin words entertain me so much that I have forgiven the fact that the condition they describe is an extremely mundane skin lesion that I have seen many hundreds of times.

3. Make me laugh . I will pardon a boring medical condition if it was obtained in a comical fashion. Sprained ankles are very dull but you will be entirely absolved if you managed to achieve your sprain by trying to do the moonwalk in a kebab shop while dressed as Scooby-Doo. If you actually just sprained your ankle by stepping awkwardly off the kerb, make up a more entertaining story and your doctor will view you in a better light.