Copperfield feels it is not his place to judge whether patients are fit to do their jobs
I have been known to take potshots at consultants who stray beyond their field of expertise. You know the type: orthopaedic surgeons who suggest I bung Mrs So-and-So some Prozac because she’s miffed that her operation went so badly wrong. Ear, nose and throat surgeons who ought to know better than to dabble in the management of conditions that don’t actually affect the ear, nose or throat.
I swore I would never be so gauche as to blunder aimlessly across the primary care pitch markings and into the specialist outfield labelled ‘Here Be Dragons’. This was drummed into me by a barrister who smiled gently as I voiced my opinion for some minutes about the treatment a patient had received for heart disease before stopping me dead – well, not quite as dead as the patient was – with, ‘Ah, but Dr Copperfield, you aren’t actually a cardiologist, are you?’
‘Er, no, I’m not. Actually.’ And that, m’lud, was the case for the defence right there.
So, I am NOT, NEVER, NOT EVER going to make the same mistake again. Not even when I’m sitting down to complete a shiny newfangled ‘fit note’ with its enticing section titled ‘comments’.
I’ve completed about two dozen of these so far and none of them, not one, has included any observation, encouraging or otherwise, regarding the ‘functional effects of the patient’s condition’.
Some afflictions have effects so dysfunctional that they are obvious to even the casual onlooker (for some reason an image of a one-legged man applying for the role of Tarzan springs to mind here). And if that’s the case, why does the man at the DWP need me to spell it out for him?
More often, though, I cannot and will not venture an opinion about the effects of an illness on a patient’s ability to do a particular job. Not because I don’t know enough about the illness, but because I don’t know enough about the job.
Spin things round for a moment. How many of your patients have the vaguest idea what being a GP involves? Exactly. Even supposedly educated folk like Government ministers patently have no idea, given the ideas they come up with – like fit notes. What next? Shorter consultations and Sunday opening?
Now, spin things back. As the dizziness wears off you’ll realise you have no idea what your patients do from nine to five. Not just the milkman who wrote ‘nutritional calcium supply supervisor’ on your patient questionnaire, but the ones who have real jobs with weird titles, or weird duties, or both.
Some of you look after ‘welcoming agent and telephone intermediaries’. In fact you work alongside them every day but probably refer to them as receptionists.
One GP’s ‘wet leisure assistant’ is another GP’s lifeguard. And some of you must come across skull grinders, mother repairers, ecdysiasts and branding supervisors – because they all get ill once in a while.
The only tactic is to adopt a regal, ‘And what do you do?’ And then, obviously, to ignore the answer completely. Because they’re bound to exaggerate to get a sick note.