One of the nice things about working at the coalface of primary care is that, in the right light and with a bit of imagination, we can sometimes make out something in the rock formation that looks exactly likethe health secretary’s face, which we can then legitimately attack with a pickaxe.
One of the less nice things about being a GP, though, is that our sweat and toil is routinely met with indifference by most punters.
It’s not that I’m doing this job to elicit gratitude, of course. It’s just that it’s embarrassing when my appraiser, having waded through this year’s ‘complaints’ section of my appraisal folder, finally reaches my ‘compliments’ file and is obliged to invert it and give it a hopeful little shake. I’m not bitter, though. I don’t blame the patients.
Why would they thank me? I spend most of my working life persuading them to start/persevere with/recommence statins and antihypertensives, to reduce their cardiovascular risk.
Preventing a cardiac event is less tangible than defibrillating a patient out of one, and so is unlikely to trigger any outpouring of thanks – particularly when those efforts leave my pill-poppers with aching muscles, bloated ankles and limp sex lives.
Besides, if they were going to reward me with a bottle of Bolly, they wouldn’t know when to give it, exactly – at least not until cardiovascular risk predictors become so advanced that they can specify the precise date that, on account of my heroic actions, something didn’t happen. Or, to put it another way, we GPs all too seldom make people feel better.
Spare me the fluffy guff about ‘care not cure’ or I’ll be obliged to vomit. I understand all that. But sometimes, real doctors need real results. Patient walks in ill. Patient walks out better. That sort of thing. How often does that happen? I can think of only three specific situations:
1 Ear wax. This is a gift. The patient is helplessly deaf and distressed. The diagnosis is made in an instant. And the treatment is safe, simple and leads to an immediate and complete cure. Behold my syringe-based superpower! I am a GP god! Hear me cure! So what do we do? We delegate the job to nurses. Are we insane?
2 Pulled elbow. Dad has accidentally pseudoparalysed junior’s arm by swinging him around in a parenty way. He’s anticipating a permanently disabled child and a grilling from social services. You perform a mystical manipulation. There’s a frisson as the traumatised toddler screams. Then dad’s face transforms from ‘you heartless monster’ to ‘you miracle worker’ as the monoplegic moppet makes that Lazarus-like recovery, or at least his subluxed radial head does. Awesome.
3 Polymyalgia. Doesn’t really count as it involves steroids and a time lag of couple of days. Still bloody impressive, though.
Have I missed any? Nope. That’s it. No wonder job satisfaction’s at rock bottom.
Our spectacular triumphs are a trickle against a flood of well-intentioned futility. Our rescue fantasies are overwhelmed by the mundane reality of the day job.
Our hopes are dashed against... hang on a sec, just shine your torch over there, would you? Can you see that?
Pass the pickaxe.