Cajoling a patient to take his antihypertensives sends Copperfield's blood pressure soaring. Luckily, he'll soon be seeing less of his patients
‘So why,' I ask, like I care, ‘Did you stop taking your blood pressure pills?'
‘I couldn't see the point, doctor,' he replies. ‘I felt all right.' If I had a pound for every time I've heard that, the battle cry of the hypertensive insouciant, I'd be proof that the Daily Mail's doc-horror headlines about our ‘inflated' earnings were spot-on. More importantly, I wouldn't need to bother feeding the QOF monster by creatively accounting my blood pressure readings.
I don't give up yet, though I might as well. Instead, I decide to speak his language. ‘You wouldn't stop filling your motor with petrol just because it's running OK, would you?'
‘I don't fill my car with petrol,' he says, triumphantly. ‘No point. Some bastard's nicked its wheels.' He sits back, smugly, as though he's said something incontrovertible rather than irrelevant.
I try again, this time using Sky TV as my analogy. ‘So what you're saying, doc, is if I don't pay my subscription…' ‘Get your prescriptions, yes…' ‘I might lose my signal…?' ‘Yes, have a heart attack or stroke.'
There's a dramatic pause while I let this sink in. It's like first contact with an alien. The tension's unbearable.
‘But I feel all right.'
Oh, for f***s sake. By this point, I'm probably the one most at risk of a cerebrovascular accident. Something makes me plough on. I explain that blood pressure is a risk factor, not an illness. That treatment is an investment for the future. That the pills aren't supposed to make him feel better. That side-effects are possible, but unlikely and surmountable. That it's his choice whether he takes them or not but that he needs to be led by facts, not myths. Jeez, I could have been doing my MRCGP all over again – except such was my performance that I'd have been offered not just a pass, but the sodding presidency.
I finish, spent but satisfied.
His eyes have that look I recognise in patients at the local nursing home who sit in front of daytime TV awaiting the next dose of a pointless cholinesterase inhibitor and who don't blink or move when the set is switched off.
Finally, he speaks. ‘Anyway, doctor, could you take a look at my toenail?'
His greatest danger is no longer hypertensive complications, it's strangulation. Worst of all is the knowledge that, when he subsequently sees some other GP who asks why he's defaulted on his blood pressure treatment, he'll insist, and I quote: ‘My last doctor didn't tell me nuffink.'
Increasingly, this is what our surgeries are like. Almost imperceptibly, our consultations have been appropriated to pursue the public health, rather than the patient, agenda. For hypertension, read cholesterol, or smoking, or obesity, or the whole ghastly vascular screening package. We will spend increasing amounts of our time cajoling people who aren't really bothered to take drugs we don't necessarily believe in, to stave off something that probably won't happen or won't be prevented anyway. And we'll do it by banging our heads against a brick wall of perplexed patient resistance while the fun part of our job – treating sick people – withers on the vine.
‘So why,' asks my patient, ‘are you going part-time, doctor?'
Because I don't see the point.
Copperfield
