Benjamin Daniels - The Complete Confessions of a GP

28 Large brown stool ambulating in the hall.

29 Patient has two teenage children, but no other abnormalities.

30 The patient experienced sudden onset of severe shortness of breath at home while having sex, which gradually deteriorated in the emergency room.

31 By the time he was admitted, his rapid heart had stopped, and he was feeling better.

32 Patient was released to out patient department without dressing.

33 She slipped on the ice and apparently her legs went in separate directions in early December.

34 The baby was delivered, the cord clamped and cut, and handed to the paediatrician, who breathed and cried immediately.

35 When she fainted, her eyes rolled around the room.

Please don’t bring a list of problems when you see your GP. I understand that you might not get to the surgery very often. Perhaps you have to sweat blood to get an appointment. Maybe you had to plead with your boss for the morning off and then beg our receptionist to squeeze you in. In fact, it is probably so difficult for you to get an appointment with your doctor, you’ve saved up all your niggling health queries that have been building up for the last few months and thought it would be better to get them all sorted out in one visit. Please don’t!

We have ten minutes per appointment. That isn’t very long, but we GPs pride ourselves in dealing with even quite complex problems during that short period of time. We have to get you in from the waiting room, say hello, listen to your concerns, take a history, examine you, discuss options, formulate a plan, write up your notes and complete any necessary prescriptions or referrals … all in just ten minutes! It’s amazing that we ever run to time. However, if you have saved up four problems to sort out, then that leaves just 2.5 minutes per problem. That isn’t very long and we’ll either spend 40 minutes with you and annoy the rest of the morning’s patients by running very late, or we’ll only half-heartedly deal with each problem and probably miss something important. This is clearly bad for your health and our indemnity insurance premiums.

If you do have a list of several problems, please warn us from the start and tell us what they all are. I’ve frequently had patients tell me that they are here to talk about their athlete’s foot and then after a leisurely ten minutes casually mention their chest pains, dizzy spells and depression on the way out of the door. If you have got several problems you want addressing, try booking a double appointment or decide what problem needs to be dealt with that day and book in another time for the others. Moan over. Ta.

I see the ten-minute appointment as the patient’s time to use as they so wish. Most patients will fulfil the time in the conventional way with a discussion of a health problem that we then try to collectively resolve. However, any GP will tell you that not all consultations run like this. For example, one of my patients uses the time to tell me about the damp problem in her spare room and another about the affair that she is having with her boss that nobody else knows about. I have one patient who comes into my room, sits down and strokes a toy rabbit in complete silence. Initially, I desperately tried to engage her in conversation, but I have long since given up and now I get on with some paperwork, catch up with my e-mails and check the cricket score on-line. When her ten minutes are up, she gets up and leaves. She doesn’t even need prompting, a perfect patient!

Some people would consider these patients time-wasters but I don’t have any reason to judge a person’s motives for coming to see me. I’m not working in casualty. You don’t have to have an accident or emergency to see me. I’m a GP, which basically makes me the arse end of the NHS. If you turn up on time and leave after ten minutes, I’ll let you talk about anything. In fact, the three above-mentioned patients are among my favourites. My patient with the damp trouble has been updating me on her ongoing problem for months now. She enters my room agitated and upset and then erupts into a monologue on the woes of damp and the turmoil it is causing her. I do very little during the entire consultation other than pretend to look interested and reassure her that it is all going to be just fine. I do gently point out to her when her ten minutes are up or she would stay all afternoon. She is always eternally grateful that I have listened to her and insists that I have made her feel much better. She then happily goes to the desk to book herself in to see me at the same time next week. I also now know the difference between rising damp, penetrating damp, internal damp and condensation!

As for my patient who is having an affair with her boss, I always enjoy her visits. She is a solicitor’s secretary in her early twenties and has been shagging the much older married solicitor for some time. Each visit I get the latest instalment in graphic detail and I am left with an EastEnders -type cliffhanger to keep me in suspense until the following week. During the last visit she told me she was pregnant. The solicitor offered her £5,000 to have an abortion but she really loves him and wants his child. What was she going to do? Ten minutes come to an end – cue EastEnders closing music: dum … dum … dumdumdum … Okay, so yet again not exactly a great use of my expensive training and broad medical knowledge, but I like the intrigue.

I am not completely anal about only spending ten minutes with each patient. Some things take more than ten minutes to sort out and if it is urgent and important then I’ll just have to run late. Last week I saw a young woman who had been sexually assaulted by her uncle. She wanted to talk to someone about it and for some reason she chose me. I listened for nearly an hour because that is how much time she needed. My subsequent patients were annoyed by my lateness, but she was by far the most important patient I had seen all week and the sore ears and snotty kids had to wait.

It’s a Sunday and I’m working a locum shift in A&E to make a bit of extra money. I used to work in A&E during my hospital training and quite like going back to work the odd shift. It helps keep me up to date with my A&E skills and also makes me happy that I’m not a full-time A&E doctor any more. I pick up the notes for my first patient of the shift, open the curtains and lying on a trolley in front of me is Alf.

‘Oh bloody ’ell. Not you. You’re bleedin’ everywhere, you are.’

Although these were Alf’s words, they also very closely reflected my own thoughts.

I had been visiting Alf at home all week as his GP and then I turn up for a shift in A&E to get a bit of excitement and escape from the daily drudge of general practice … and there is Alf lying in front of me.

Alf is in his late eighties and lives alone in a small run-down house that he can’t really look after. Alf’s notes state that he has had 23 A&E admissions in the last five years, which qualifies him to reach the status of ‘frequent flyer’ in A&E talk. If hospital admissions could earn you loyalty points, Alf would be able to cash his in for two weeks of dialysis and a free boob job. Unfortunately, all Alf’s hospital admissions have actually earned him is a bout of MRSA and a collective groan of disappointment from the A&E staff when they see him being wheeled into the department.

Given the large amount of time Alf spends coming in and out of hospital, you would think that he had a huge list of complex medical problems but, in fact, Alf doesn’t really have much wrong with him physically. His admissions have been almost purely ‘social’. This means that Alf is admitted to hospital costing a large amount in time, resources and money, because he can’t really look after himself at home. When they talk about bed crises and patients on trolleys in corridors, it is because patients like Alf are lying in hospital beds that they don’t really need.