Demand for policy change
Way off target
My 'hero' patient was a target for enemy fighters now he's targeted by the NHS
Mr Johnson came into my room and sat down. Carefully, he placed a Sainsbury's carrier bag on the desk in front of me. It appeared to be full of boxes of drugs. 'What in the wide world of sports,' he asked me, 'is all this about?' Mr Johnson had just been released from the clutches of The Cardiologists. And The Cardiologists like to give people tablets.
Mr Johnson is my favourite patient of all time. He is literally the only punter in my practice whose occasional visits I actively look forward to. He is under strict instructions that he is not allowed to see any other doctor than me. Only I can give him his flu jab. Nobody else is allowed to check his blood pressure. When he eventually gets an illness, I'm the only one who can deal with it.
Mr Johnson was a pilot in World War II and he flew a Lancaster bomber on 47 missions into Germany. He took part in the bombing of the battleship Tirpitz, and afterwards counted 120 bullet holes in the wings of his plane. Once, he crash-landed his Lancaster in a potato field in Yorkshire when the undercarriage wouldn't come down, without breaking a single bone in any of his flight crew. He's too modest to mention it himself, but his wife told me that he's got a Distinguished Flying Cross in a drawer in the sideboard. This man is the real thing.
With an amused forbearance, he has come to realise that any consultation with me is going to consist of 10 minutes talking about his medical problem, and another 20 of me grilling him about what it was like to dodge flak. About what it felt like to fly for eight hours with ice forming on the inside of the windows, the sight of German Me109s circling up to meet him, the noise a bullet makes when it smashes through the fuselage, the upward surge of the plane when the bombs are released. About how it felt, as he took off on each mission, to know that he had a one in 12 chance of not coming back. He's been very patient about this.
One night last week Mr Johnson got a pain in his chest, and called NHS Direct. Within an hour he found himself in hospital. The pain had gone by the time he was admitted, and his ECG and cardiac enzymes were normal. They gave him an exercise tolerance test, and the treadmill gave up before he did. Two days later he found himself out on the hospital steps, clutching a big bag of drugs.
'What are they all for?' he asked me. So I explained. 'Well, that one is to thin your blood a little bit, that one is for your blood pressure, so is this one, that one there is for cholesterol. This one is an angina tablet, and that spray is for moving the pain up from your chest to your head. And this one, I dunno, beats me. Maybe I can tell you in three months when they send me a letter.'
'But you've always said that my blood pressure and cholesterol are fine.' And I have always told him exactly that, because they are. 'So, have I got heart disease then?' he inquired. I shifted uncomfortably. 'Well, put it like this; you've got an 87-year-old heart.'
Mr Johnson has a disconcerting habit of being very direct. 'Why do they want me to take all these drugs?' I decided to be honest. 'Mr Johnson, are you familiar with the concept of targets?'
'I should be,' he said. 'I've missed enough of them in my time. Tell me Doctor, if you were me would you take all of these tablets?'
My silence was eloquent. Wordlessly, I pushed the waste paper basket towards him with my foot. Wordlessly, he dropped his Sainsbury's bag into it.
'Have you been watching Big Brother on the telly?' I asked him, as he was preparing to leave. 'I've caught it once or twice,' he replied. 'You fought for that, you know,' I told him. 'I know I did, son,' he said with a dry smile. 'I know I did.'
Dr Phil Peverley is a GP in Sunderland