Posted by: Shaba Nabi4 June 2014
Like many doctors, I have a habit of underplaying the symptoms of serious illness amongst family members. We have all heard of stories of GPs’ kids being marched to school with a broken arm and surgeons’ passing off appendicitis as a bit of D&V. We may have experienced every symptom in the book as a medical student, but as professionals, we do not wish to portray the image of a neurotic parent.
So when my three-year-old baby was unwell recently with a high fever and cough, I practiced what I preach on a daily basis, which was to give her three-hourly alternating paracetamol and ibuprofen.
In fact, I did it with such due diligence that I must have gone through an entire bottle of each as she was being dosed like clockwork, day and night. My only ‘assessment’ of my daughter was to take her temperature every four hours and be mildly concerned that it was not coming down below 38 degrees.
After four days of this, I decided to remove the GMC fitness to practice shackles and actually assess her. To my horror, she had a rapid respiratory rate and all the signs of pneumonia. In fact, I think this was the first time I had actually listened for whispering pectoriloquy since being a medical student.
Thankfully, she is now on the mend with a good dose of antibiotics, but the whole experience made me reflect on why I was so hesitant to assess her properly. The main reason is the plethora of publications and guidelines coming from the BMA and GMC with the general theme of ‘do not heal thyself’. The GMC’s Good Medical Practice guidance advises that doctors ‘wherever possible … should avoid providing medical care to anyone with whom [they] have a close personal relationship’. Of course, this mainly refers to treatment and prescribing but it is sometimes hard to define the provision of medical care.
Twenty years ago we were all at it. I remember taking my own wound swab on a ward and then obtaining the required antibiotics from the hospital pharmacy – no questions asked. Many of my colleagues would be on industrial strengths of ranitidine to counteract the heavy drinking and long on-call stints.
It is interesting that at a time when we are encouraging patients to adopt greater self-care skills, we are disempowering doctors from assessing and managing their loved ones appropriately. We offer patients rescue antibiotics and steroids for their COPD, give them repeat prescriptions for their UTIs and thrush, encourage them to invest in thermometers, teach them how to take their own pulse when they suffer from palpitations and also teach parents how to identify the signs of respiratory distress in their children.
Yet, I was reluctant to use my knowledge, skills and experience or any of the tricks in my toolbox, because I was so mindful of the recent GMC fitness to practice guidance. I would like to think that those doctors facing disciplinary action were those who had self-prescribed controlled drugs, but I could not stop this hysteria over self-prescribing from affecting my ability to look after my child.
The bottom line is that we can’t erase what we are, and if we try it can lead to denial and negligence.
I am a mum, and I’m also a GP with a knowledge base and skills. To deliberately ignore my medical skills is a bit barmy and reflects the way we are becoming increasingly scrutinised as a profession.
Dr Shaba Nabi is a GP trainer in Bristol.