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Gold, incentives and meh

Haslam's view: And while I'm here, doctor...

Yesterday I held a routine surgery, with ten minutes per patient.

My first consultation was with a 57-year-old lady whom I hadn't met before. It all seemed entirely straightforward. She had just been discharged from hospital following abdominal surgery, and she simply wanted to talk about what was going to happen next and what the implications were for her work.

And then she said, ‘There's another thing. After I came home, my son came to look after me. He was just great, changing my dressings and everything. But last night he telephoned me out of the blue to say that he had just plucked up enough courage to tell me that, firstly, he was gay, and secondly, he was HIV positive. I just didn't know what to do – which is why I've come to see you.'

Ten minutes to deal with this. What a joke! It was an understandably worrying situation for her, and it took me quite a while of failing to explore her ideas, concerns, and expectations before

I discovered that her main worry seemed to be that his touching her wound might have exposed her to HIV. And – as you might guess – she had a few other worries too.

So I was running rather late when the second patient came in: nothing complex, just a blood pressure check.

And then he said, ‘I don't suppose it's anything really, but a couple of my friends have suggested that I'm not quite myself at the moment.'

I asked him to go on, and within a few seconds the tears were running down his face as he told me of his overwhelming depression.

Consultations with middle-aged men with depression are not a problem that any sensible doctor will rush through; and are not made easier by the middle-aged doctor forgetting exactly which depression rating scale we are supposed to be using this week.

And so, by the time I was able to see my third patient, I was already running 25 minutes late and quietly praying for a DNA or an otitis media.

But patient number three had chronic undiagnosed abdominal pain, for which she has already consulted more specialists than there are specialties. She had brought me a four-page printout of how she was feeling.

You can guess just how I was feeling.

A week or so before all this happened I had been at a meeting that had actually made me feel even worse. A very senior hospital physician, from a very distinguished hospital, was talking about how we needed to ensure that endoscopists provide a good enough and safe enough service.

As he reminded the audience: ‘We mustn't forget that nurses do this procedure and GPs do this procedure: it isn't just doctors who do it these days.'

As you might imagine, I rather objected to this extraordinary comment, and delicately reminded him that we GPs are doctors too.

He was flustered, and said it was just a slip of the tongue; but, let's face it, Sigmund Freud knew something about the reasons that we make such slips.

After all, there are days when I realise that no medical specialty can possibly be as complex as general practice. Yesterday was one of them.

And so, when the fourth patient came in, I was ready for the worst.

A six-year-old with molluscum contagiosum. Heaven!

I waited for his mum to say ‘and while I'm here, doctor…', but she didn't. All she wanted to know was whether she need worry about the spots and if he could still go swimming.

You see, this job is a doddle.


Professor Haslam Author

Professor David Haslam CBE
GP, Ramsey, Cambridgeshire; President, Royal College of General Practitioners; national clinical adviser to the Healthcare Commission; and visiting professor at de Montfort University, Leicester

By the time I saw my third patient I was quietly praying for an otitis media

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