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I, the consultant’s handmaid

So why do consultants view general practice as a dumping ground? Copperfield has found out

How do hospital consultants survive their journey home? After all, getting in the car, negotiating the road and stopping off for a bottle of Bolly all require that they function in the community. Judging by my contact with them, the community is not a concept they can cope with: it’s alien and toxic.

Perhaps it’s because their lungs have had to adapt to the nitrous oxide hospital managers pipe in through the air-con to boost morale – so they asphyxiate whenever they venture into the normal atmosphere and will have to evolve gills to breathe. Or maybe they’re just arrogant tossers. No, it can’t be that. It must be the gill thing.

Whatever. The result is that anything requiring action outside the DGH – no matter how trivial or tiresome – consultants dump squarely in my lap. So I’m not just a fully frazzled GP, I’m a default community houseman, too.

For example: ‘Admitted with confusion, MSU result unavailable by time of discharge, GP to chase up.’ And: ‘This lady’s HVS shows candida, please prescribe clotrimazole.’ And – my favourite, from a cardiologist: ‘This man’s teeth are terrible, GP to refer him to a dentist.’ Rational replies would be, respectively, ‘Chase it up yourself, you lazy sod’, ‘You took the test, so you’re responsible for the treatment’, and ‘Shall I clean his windows while I’m at it?’.

So why do hospital doctors suffer the delusion that, once the patient has re-entered the community stratosphere, they are no longer able to communicate or treat? They can contact me, so why not the patient? Why not just pick up the phone, write a letter or send a script?

This GP-abuse is a slow-drip torture: the sense of grievance grows until, inevitably, we blow a gasket. Which explains why

I found myself screaming at a transcribed telephone message the other day. It read: ‘Consultant rang to say this lady’s calcium is low. GP to contact her to arrange a repeat.’ Brilliant. I don’t know the result, the indication, the urgency or the follow-up arrangements. I don’t know why the consultant couldn’t have sorted it herself. All I do know is that it’s now my problem.

I phoned the consultant. ‘Why,’ I demanded, ‘do you view us GPs as your community handmaidens? Why? Why?’ And again, because I was starting to sound enjoyably unhinged: ‘Why?’

I wasn’t expecting an answer. But I got one. ‘Because,’ she explained, ‘you have a special relationship with the patient.’

And, suddenly, I felt rather humbled. With that simple response, she gave me a real insight into my role in the community and how my attitude, over time, has been corrupted. It’s true. We have that special relationship. I know all my patients personally. We’re on first-name terms.

We go out for coffee together. We chat on Facebook. In fact, some weekends, all 2,001 of us link hands and walk, in soft focus, through fields of corn, singing ‘We are the world’. And she has a point. Because, of course, you do need that special kind of relationship to be able to convey exactly where to stick a clotrimazole pessary.

‘Sick Notes’ by Dr Tony Copperfield is out now, available from Monday Books.

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