A festive tale of digital overdiagnosis in north London by Dr David Mummery
It was a bright cold day in December and the clocks were striking midday. Dr Henry Jekyll was sitting in his freezing north London consulting room; he felt tired. Outside he could hear some Christmas carols being sung in the church next to the tube station, and the beautiful singing was filtering through the doors and windows of the medical centre. The Christmas tree in the waiting room was glistening in the artificial lights of the dilapidated waiting room, and someone had just left a box of Ferrero Rocher under the tree with a label marked ‘to the lovely nurses’ sellotaped to the reindeer wrapping paper.
He glanced at his computer screen as he was sifting through the enormous number of e-consultations that had appeared in his inbox since he had arrived at the surgery at 7am. As another e-consultation metronomically arrived in his inbox, one after another, after another, he sighed and muttered to himself as he pressed a blue biro nib hard against his hand, leaving a blue-coloured dent in his palm.
‘I need to get out of this dump…’ he continued to whisper to himself, as he took a sip from his flask that was next to his computer screen.
He had already spoken to 20 patients over the phone and seen another 17 face-to-face and he was now nearing symptom overload. Normally he managed to pop over the road to get a coffee at lunchtime, but today wasn’t looking good. The locum had already left, and Hastie, one of his GP partners, had already headed off to the ‘crucial’ Islington ICS meeting at the town hall, where he was due to speak about the ‘granular integrative analysis’ he had done of health inequalities in the area. Hastie was always going around speaking at these meetings.
Dr Jekyll clicked on to the next in the long list of e-consultations: it was a young chap, a Mr Hyde, who he hadn’t met before. The e-consultation read, ‘I’ve got a tingly feeling sometimes in my little finger.’
‘This shouldn’t be too difficult,’ Dr Jekyll thought to himself, having already seen a stroke, likely breast cancer, Lyme disease, pneumonia, peritonitis as well as two suicidal patients, plus many others with numerous other ailments that morning. He picked up the phone receiver and dialled the number.
‘Is that Mr Hyde?’ Dr Jekyll said, as the phone was answered.
‘Jekyll is that you?’ a man shouted back down the receiver. ‘I’ve been waiting for this call, why didn’t you f**king phone me earlier? I’ve read the news… Have you GPs finally started seeing patients yet?’
He continued screaming, but Henry couldn’t make out the rest of what he said, it being distorted by the unbelievable level of aggression being directed down the phoneline.
Dr Jekyll was taken aback: he’d spoken to a lot of angry and aggressive patients recently, but this sounded on another level.
‘Err… We are seeing patients,’ said Dr Jekyll quietly. ‘How can I help you, Mr Hyde, I got a message that you had a problem with your finger?’
‘Yeah I have, not that you lot give a toss,’ Mr Hyde continued raging down the phone. ‘And by the way I’m standing outside the front door of your surgery.’
Henry went out of his room and went past reception, who had heard the shouting and were looking nervous. Niamh, one of the receptionists, came up to him.
‘Shall I call the police?’ she whispered to him as he walked towards the front door.
‘Not yet…’ Henry whispered back.
He walked up to the front door and Mr Hyde was standing there, occasionally pacing up and down to one side of the pavement and back. He looked agitated and angry, although he was wearing a mask, so it was difficult to it make out clearly. The body language was predatory, but also wounded.
‘At the hospital, when I was in A&E recently, they were saying how crap GPs are,’ he hissed.
‘So, are you going to look at my finger?’
Mr Hyde pushed past Dr Jekyll and headed straight into his consulting room.
Dr Jekyll felt a burst of adrenaline and cortisol start coursing around his body; his vision had narrowed; his heart was pounding.
‘Mr Hyde!’ he exclaimed, as he followed him into his consulting room. ‘I’m sorry you can’t just…’ before he could finish, Mr Hyde, who was by now sitting on a chair in Dr Jekyll’s room, fixed him with a stare and started speaking:
‘I Googled it and it said it might be Leprosy… Then I checked again on my health app and it said the same thing.’
‘Leprosy?!’ Dr Jekyll said back, incredulously.
‘Yes, LEPROSY!’ Mr Hyde said as he glowered at Dr Jekyll.
‘Well, it’s just not really prevalent in Islington,’ Dr Jekyll said. ‘What made you think it might be Leprosy?’
‘Dr Google, who’s a much better doctor than you lot,’ said Mr Hyde.
‘Usually a tingling finger is from a trapped nerve, either at the elbow or sometimes neck,’ Dr Jekyll explained patiently, as he examined the finger.
‘I can organise a scan and some blood tests for you to check what might be the cause… But I think Leprosy is highly unlikely. Have you been anywhere, abroad or unusual recently, or eaten anything different?’
‘Not really,’ Mr Hyde said. ‘Although I think I had a dodgy pizza when I went to Woking recently.’
‘Pizza Express?’ Dr Jekyll enquired.
‘Yep,’ said Mr Hyde.
‘Any other symptoms, Mr Hyde? Have you had any sweats? Or memory problems maybe?’
‘Nope,’ said Mr Hyde, who by now was staring at the floor.
‘OK, Mr Hyde, I’m going to organise the scan, and if you can book in for the blood tests on your way out….’ Dr Jekyll said softly.
Mr Hyde got up and made his way to the door. As he put his hand on the door handle he turned around and looked at Dr Jekyll. They made direct eye contact.
‘If I die it’s your fault,’ he said as he left the room slamming the door.
Dr Jekyll leaned back in his chair, his heart still pounding and forehead dripping with sweat; his stomach was rumbling and he needed a wee urgently.
He looked at the next two e-consultations who had both been allocated face-to-face appointments, and who were both now sitting outside in the waiting room. It was for ‘itchy teeth and a pain in the neck’, from a Ms Truss, followed by ‘halitosis and feeling very windy after eating something unusual’, from a Mr Hancock.
‘Aaaaaarrrrrgggghhhhhhhh,’ Henry involuntarily exclaimed, his brain now having kicked into full-on survival mode. He took another quick swig from his flask.
‘Niamh,’ Dr Jekyll shouted, ‘PLEASE CALL THE POLICE!!!!!!!!’
