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Gold, incentives and meh

Dear patient: It's not you, it's me

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I was young and idealistic when we first met. Fresh out of medical school, my hope and enthusiasm for life was obvious to you. I’ve still kept all the thank-you cards you sent back then, and I look at them when I’m having a bad day.

But soon, all the late nights sitting on your hospital bed allaying your fears were taken for granted, and those cards started drying up. They were replaced by letters of complaint about failing to diagnose your appendicitis, which presented as gastroenteritis, or failing to prescribe you the pill when it was unsafe for you to take it. 

Yet I tried even harder to please you.

I booked you at the end of my surgery so I could spend an hour talking about your marital problems. I wrote letters of support so you could be rehoused and your kids could attend the school of your choice.

I expected nothing in return other than a little appreciation and respect, but got none.

The control started quite subtly, which is why I didn’t recognise it at first. You booked monthly appointments and consulted for half an hour, but became agitated if I ran late by more than 10 minutes. You started demanding same-day phone calls, which I made because I didn’t want to upset you. You began shouting when you didn’t get antibiotics or sleeping tablets, and because you threatened to harm yourself, I gave them to you. 

Then things got ugly. I developed a DNA policy because you were not attending 20% of your appointments. After you received a letter about this, you made slanderous comments about me on the NHS Choices website. When I was reluctant to continue prescribing your vast quantities of diazepam, you falsely reported me to the GMC for sexual inappropriateness, and I was suspended for nine months pending an inquiry. 

At group therapy I was amazed to see how many other GPs were in a similar situation. But I do not blame you because I also played a part. If I was not so keen to be adored by you, maybe I wouldn’t have let things go so far.

And if the Government was not fuelling your demands and the media was not indoctrinating you about how useless I was, maybe you wouldn’t have behaved the way you did. We both need to take personal responsibility.

I still love you, but I will not be abused. I will be there if you genuinely need me: if you are diagnosed with a life-changing illness, or need holistic care for your many co-morbidities, or if you have little time left in this world to enjoy. But I will also remember the words of Paulo Coelho, which formed part of our 12-step programme in therapy – ‘When you say “yes” to others, make sure you are not saying “no” to yourself’. 

And I will no longer say ‘no’ to myself.

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (29)

  • Beautifully put. That describes how are our job has changed perfectly.

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  • oh god im depressed now. patients arent like this in Canada.

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  • I like. The patient has become the customer in the biggest UK business.

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  • This is a beautifully written, and extremely perceptive Shaba. You could be writing my own life story. Keep up the good work!

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  • Brilliant

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  • Wow Shaba - well put!
    It is amazing how easy it is to be drawn into the 'pleasing' role and I'm sure that the majority of GPs have been there.
    As a newly qualified GP I hope to join a local Balint group. I hope (and have been assured) that these are very useful in this respect and discussion with peers may help to avoid being drawn into a manipulative co-dependent relationship with a (possibly personality disordered?) patient/ family.

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  • Una Coales. Retired NHS GP.

    Nicely written Shaba. What is the cure for helper syndrome?

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  • Legend. enough said

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  • Messiahs get crucified and quite rightly so.

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  • Quite simply, perfectly put

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  • Kevin Hinkley

    Beautiful and haunting. Thank you.

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  • Juliette- a psychologically disordered practitioner will be unlikely to receive a diagnosis of personality disorder - those who consult somebody with a psychological problem will not necessarily understand why the relationship seems 'wrong' or unhealthy Such a medic can create havoc in individual/families lives whether a need for others to depend on them an enjoyment of power or influence in other's lives or other needs ...it may be an idea for all who work in health field to have a psychological well being test from time to time. Balint groups are not the answer - not all personaL issues will be revealed there - they can be and have been used defensively and manipulatively by individuals drawing in unwitting peers.

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  • Brilliant piece. Well said!

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  • Ah.the article makes your anger more understandable.....even if a bit hard to believe all of it. But it's just a case of growing up and learning from experience which takes time in all professions...people don't need you to love them Shabi.they want and deserve a professional relationship which doesn't get as messy, doesn't breach boundaries in the way you describe. where did you learn that was necessary or appropriate?

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  • Chilling yet unfortunately accurate account of the cultural climate in which we practice. Well done for writing this.

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  • It is our GMS Contract - no definition of workloads or what is proper or right or fair.
    Consultation rates have doubled in 15 years and will go up and up.
    We need to change our Contract, we need to control our workloads, define our safety levels.
    It is up to us GPs and the GPC. Define our Contract - what we will do and for how much.
    If we do not define these parameters and leave it wide open to - all you can eat off an a la carte menu - don't blame the patients.
    They can hardly define safety or appropriate behaviour until they pay per contact ?

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  • Trevor Fossey

    The paternalistic culture of clinicians and GPs within the NHS discourage patients and people to take responsibility for their own wellbeing?
    If all were empowered by being given online access to their own health and care records, most patients would accept the responsibility to be involved with their own wellbeing.
    GPs seem to be giving two contrasting messages, as follows:
    1. We want patients to take some responsibility for their own wellbeing, BUT
    2. We want you to do it in a 'vacuum' of personal information!
    GPs need to meet patients' exspectations, and allow them online access to their full record

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  • This is also happening to other health care professions and has been for many years. Nursing, psychology, dieticians, speech therapists, social workers....... have all been downgraded yet had their caseloads & responsibilities vastly increased. We all serve the public and therefore we need to accept there will difficulties like you described. Adjusting is difficult and there are days when the public do not appreciate us, but many days they do. Working privately can also flag up situations like you described where patients feel they have a right to certain meds and just because they are paying it doesn't stop them being rude. I think we can cope better with this if we feel valued in other ways, which at the moment none of the health & social care professionals feel valued.

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  • Please don't take a job as a Co-pilot on an airbus! ! You seem to need WAY too much love & admiration for the Cockney Rhyming Slang Minister NHS.

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  • It has been my experience that the patients that you do the most for, will kick you the hardest. We are disappointed, the long term patient will see it as entitlement.

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  • "If I was not so keen to be adored by you . ." says it all really. How can you expect to look after patients properly if you haven't finished growing up yourself.

    And sorry, therapy - group, ABT, psycho-whatever, will only fuel your narcissism and insecurities ...

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  • To "Anonymous | 27 March 2015 10:22am"
    Can you please write in English?

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  • Well done, Shaba, for coming out with such an honest and straightforward description of the problem. The political correctness in this country has got out of hand and it's good to read articles like yours to show us we're not alone in feeling this way.

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  • Anon 10.22am can you please engage your brain with the debate. this is not a forum for teaching the english language to professional from all over the globe we don't all practice in the leafy suburbs f me me land

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  • for all the posters who don't seem to be able to understand satire, wtf r you doing on here?

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  • 12.12pm if only it was all just satire... being sarcastic..get it? The forums are more valuable than simplistic empty comments from those who don't engage their brains in actual debates

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  • Wow, sorry to hear you went through so much, hope it all turns around for you

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  • Hi Shaba, this is so well written, an iron fist of a message in a velvet glove of prose.
    I find it amazing that the government are increasing our workload and reducing our protection and earnings and that contract negotiators are letting this go on. There can be no other profession that does this.
    I wonder if so many years of education and grading has groomed us to love our graders (government, patients) in some sort of Stockholm Syndrome!
    Perhaps the resilience training you blogged about a while ago may not be such a bad idea and might help us to say no!

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  • Very well written Shaba. Patients are not going to change whatever ` educating ` is used by the GPs. Its time for the GP to face reality and change. Work from 9 am to 6 pm max and only do what can be done in that time. Lack of money in the system and lack of enough GPs etc is not the problem of other GPs to be honest. Agreeing to be a door mat is the problem that is causing a lot of muck to be wiped on our heads.

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