Posted by: Tony Copperfield31 January 2014
So, you have a headache, pain in your chest, spasms in your stomach and sore feet,’ I say, with what I think is admirable patience. ‘Can you tell me which is bothering you most?’
She thinks, but only for the briefest moment. ‘My head. And my chest. And my stomach. And,’ she adds, ‘my feet.’
I doubt we’ve reached the half-way point of this consultation. It’s not been going well. She presented with a tale of innumerable recent out-of-hours contacts for her innumerable problems resulting, of course, in innumerable treatments: an antibiotic, then another, then loperamide for the diarrhoea they’d provoked, then a PPI for the indigestion caused by her not eating because of the diarrhoea resulting from the antibiotics, and so on.
‘But why,’ I ask, innocently, ‘didn’t you contact us?’
She replies, as if to a simpleton: ‘Because no doctors here don’t never give me nuffink.’
Hmmm. I always have trouble working through those double negatives. What’s the rule? An odd number means the proposal is as stated, an even number cancels it out. That’s correct, isn’t it? Or, at least, not incorrect?
I needn’t have bothered. One look at her face tells me everything I need to know: bristling Essex rage and entitlement. The situation may still be as clear as Thames Estuary mud, but we’ve obviously reached the point where I’m supposed to do something.
These consultations seem depressingly familiar – especially after weekends and bank holidays. Although the new contract falls short of re-imposing out-of-hours on us, thank Gawd, we still have to cope with the out-of-hours fallout. And that fallout is increasing in coverage and toxicity.
This is hardly surprising – there was once a time when a patient’s thought process went: 1) I have a medical problem; 2) My surgery is closed, so I have to make a rational decision whether this is urgent enough to call out-of-hours; 3) I will call out-of-hours.
At least some used to fall asleep or get distracted during step 2. Now it’s straight from 1 to 3.
Add to that an out-of-hours service where expediency leads to reflex prescribing, and you have dysfunctional patient behaviour reinforced to the point that… well, here I am.
So what I decide to do is nothing. Which, as all GPs know, is a lot harder than doing something. I carefully explain my reasoning to her: she’s had a lot of medication, she’s probably suffered a variety of side-effects, we need to give her body a rest from treatment, some judicious ‘waiting and seeing’ will enable us to see the wood for the trees, I’ll review her in a week, etcetera.
And, incredibly, she seems to understand; her hostility melts away, she nods, she even smiles. Job done. We say our goodbyes. At least, I do. But she’s not taking the cue. Her face darkens with realisation. ‘So ain’t you giving me nuffink?’ she asks.
‘Yes,’ I say. ‘Or rather no.’
She’s probably calling NHS 111 right now.
Dr Tony Copperfield is a GP in Essex. You can email him at firstname.lastname@example.org and follow him on Twitter @DocCopperfield.