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GPs buried under trusts' workload dump

Nothing like a GP’s touch

Phil recalls a rewarding consultation that proves the enduring value of the family doctor

Phil recalls a rewarding consultation that proves the enduring value of the family doctor

There is a very nice bottle of whisky sitting in front of me. It's a little early for Christmas, but I can't find it within myself to fault my patient's precipitate gift distribution.

It's the third year in a row that he has been so generous, and as on the previous occasions I find my mind going back to one of my more memorable consultations, in the summer of 2005.

My patient was, at the time, an utter prat. Forty years old and still living with his elderly parents, he was making their lives a complete misery. An only child, he was out of work and our practice's oldest teenager. Petulant and moody, he had somehow acquired the label of ‘depression' (not from me) and was living the diagnosis to the full.

His depressive symptoms consisted of unpredictable, violent and excessive alcohol binges lasting anything up to a week. He would go out to buy cigarettes and turn up in Keswick four days later with a fractured clavicle in a farmer's barn. His father would take the inevitable phone call from the police and wearily climb into the Rover. The next day this sorry pair would appear in my consulting room, each asking what I could do to help.

For several years, I didn't have an answer. He had already had several antidepressants, and I gave him several others. He had already had counselling, and as I regard counselling as so much wasteful chin music, I am ashamed to say I offered him some more. He absorbed money and care and resources like a sponge, and yet still he sporadically fought and drank his way round the UK.

One morning he turned up as an urgent extra with his parents in tow, after a late-night rescue from Scarborough beach. He still had sand in his hair, and I remember the tears in his father's eyes.

‘What can I do, doctor?' he asked.

‘Don't go out and get drunk'.

‘Well, it's easy to say that,' he said, ‘but you know how it is.'

He turned his palms upwards and gave me what he imagined was the winning shrug of an incorrigible scamp, and that's when the red mist came down.

‘You selfish, thoughtless sod, how the hell could you do such a thing?'

I expanded on my theme, and although the details of what I told him have become somewhat blurred, I remember I told him he was an oxygen bandit and a waste of space and that my 12-year-old sons had more of a sense of responsibility than him. If I had been on Just A Minute I would have scored top points. Without hesitation, repetition or deviation I told him that one more similar episode would result in his arse being unceremoniously kicked out of my practice, and that I was sure his parents would do exactly the same soon after.

After a while I realised I had been striding about and waving my arms. A cowed figure sat in front of me. I sat down. ‘Go away,' I told him. ‘Come back in a week and we'll talk about this some more.'

Instead of making the expected complaint, he came back in a week and we talked about it some more. He's never had a drink since and he now has a job. His parents have stopped me in the high street, several times, to shake my hand.

I wouldn't recommend this technique to everyone. It's a bit risky. But I asked him some time ago why he changed after that consultation, and his answer was: ‘You cared'. Of course, next week we might be back to square one. But, ladies and gentleman, the first time someone in the reputed future of primary care - the walk-in centre, the nurse practitioner or the polyclinic, can pull off a consultation that effective, I'll eat my bloody hat.

Phil

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