This site is intended for health professionals only

From the cradle to the grave

It is almost never a good idea to lie to your patients and it is difficult to imagine a situation when doing so would have a good outcome. As family GPs, we have a duty of honesty.

But I had to tell a lie the other day, and it’s troubling me. I went out on a home visit to see an old gentleman patient of mine, who has been gradually dying of an unknown primary cancer for several months. It’s not been a bad illness, as these things go. He’s been OK on the whole, in the circumstances.

I had got into the habit of visiting every week and, as usual, I parked my car and walked around the corner to his house.Where, to my horror, I found him being loaded into a hearse by six blokes dressed as extras out of Oliver Twist; top hats, black coats, the works. The only things missing were the black-plumed horses. His daughter dashed over. ‘Oh doctor, how good of you to come and pay your respects! Dad would have been so pleased!’

Dilemma! Seconds before I had been expecting my usual chat with my patient about Rommel and Montgomery (he had been a Desert Rat) and now suddenly I’m in deep doo-doo.

Do I tell the truth? (‘Sorry love, I didn’t know he was dead. I wish you’d let us know earlier. I’ve got a lot of paperwork back at the surgery, I could have been doing that.’)

Or do I lie? (‘I couldn’t let him pass without seeing him off. You must all be devastated. How are you? Can I do anything to help?’)

I’ll let you guess which option I chose, on the spur of the moment, but I’m bloody glad she didn’t notice the doctor’s bag I was carrying and ask herself just why I would have brought that to a funeral.

‘Would you come to the crematorium with us doctor? And then back here afterwards? Dad would have been so pleased!’

I politely declined and skedaddled, but the incident set me thinking. Actually, I would have liked to attend his funeral; he was, I think, the last proper World War Two veteran under my care, and his passing was the passing of an era, for me.

And I genuinely liked him and enjoyed his company. Why should I have to forgo an act of genuine respect just because I’ve got a pile of bloody insurance forms to fill in? Which, in the long term, is more important?

In practical terms, we just can’t do three funerals a week (the average in our practice), even though the savings in mini pork pies and sandwiches with the crusts cut off would be significant. Time just does not allow. But I like the idea. Bevan’s vision of cradle-to-grave healthcare would be realised, in very literal terms.

But then again, not all my patients are like the Desert Rat. Some funerals I would be honoured to go to; some would just be a profoundly irritating and hypocritical waste of time.

How would you choose? Would a two-tier ‘deathcare’ system develop, with some patients blessed with their GP’s attendance at their funeral and others not? Would we end up with a bloody funeral rota? 

Maybe some things are best left the way they are.

Dr Phil Peverley is a GP in Sunderland