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As a GP you learn to expect the unexpected



With a neck thick enough to support a Corinthian capital, head shaven as smooth as a second-hand billiard ball and fists the size of hams he didn’t look like the sort of guy who would see the funny side of a spilt vial of anabolic steroid.

No machine will be able to replicate what we do

‘How can I help you?’

A moment of menacing silence passed and then he broke eye contact. The stony mask thinly veiling his angst shattered and he uttered his opening gambit.

‘It’s the violence at home, I can’t stand it anymore.’

A dozen scenarios and management plans fought vigorously for prominence in my head.

Violence to whom, his partner?

Does he have kids? Can I get hold of social services this time of evening?

I scrolled down his notes desperately looking for any record of mental health problems, drug or alcohol abuse.

He looked up again and of all the possible things he could have said next, what he actually said I would have placed just below him requesting a referral for gender reassignment surgery.

‘It’s me missus, she abuses me,’ he uttered, with thick salty man tears forming in his eyes.

He went on to explain how his wife had a violent temper and frequently this turned physical. He showed me bruises and scars where he had been hit with various household objects over the years. He told me how he had been brought up never to use violence against women and how the cowering defensive position he adopted during one of her attacks served merely to inflame her further.

After a long chat I gave him some phone numbers for domestic abuse support groups.

One of the reasons many of us became GPs is for variety, not knowing what will come through the door next. The beautiful, complex unpredictability of humans, only another human brain can unravel.

Computer geeks talk about the rising superiority of ‘bits’ over ‘atoms’. Well maybe that is the case in some walks of life, but in medicine we ‘atoms’ still reign superior. Throw as many computer flow charts and algorithms as you like at healthcare, no machine will be able to replicate what we do. 

Dr David Turner is a GP in west London