Confessions of a GP

Poor Ed was eventually allowed to start work and he survived his first year as a doctor. His next job was as a casualty doctor and, unfortunately, his first day was equally disastrous. We have a system where, at the beginning of August, we all swap jobs overnight. Often a doctor will be on call in one hospital one evening and then start work in a hospital in a different part of the country the next day. This is what happened to Ed. After finishing a shift at midnight, he woke up at 4 a.m. to drive 100 miles to a new hospital to start work in A&E. Ed didn’t know the area and was driving around town lost, trying to find the hospital. Unfortunately, the combination of being sleep-deprived and lost resulted in him crashing his car on a roundabout. He wasn’t badly hurt but the paramedics wanted to play things safe and he was wheeled into the A&E department where he had been due to start work, strapped to a spinal board and wearing a neck brace.

Being ill as a doctor is always a difficult experience, especially if you end up being admitted to the hospital in which you work. During my first year as a doctor, I was admitted for an operation on my ankle. It was very odd being on the other side and quite an eye-opener. My friends, of course, saw it as an excellent opportunity to stitch me up. They managed to find my drug card and thought that it would be hilarious to write me up for all sorts of unnecessary medications that would mostly have to be inserted up my backside. Still dopey from the anaesthetic, I had to fend off a particularly enthusiastic Filipino nurse who was determined to carry out all the doctors’ carefully written instructions.

Camouflage man

Camouflage man is frightening when you first meet him. He has a big bushy beard and wears head-to-toe army camouflage gear, complete with balaclava and army cap. He is homeless and carries all his belongings in a large holdall on his back that he secures to his body with a long chain that is wrapped around him several times and locked with a big padlock. Camouflage man has paranoid delusions that he is being followed and people are trying to attack him and steal from him. These thoughts are partly because of his mental illness and partly because life on the street is tough and he regularly gets beaten up and robbed. You would probably cross the road if you saw camouflage man walking towards you, but now that I know him I realise that he is much more afraid of you than you are of him. His real name is Nigel.

Nigel is mentally ill but because he doesn’t fit nicely into one neat category of mental illness, no one has really taken responsibility for him. Nigel has had schizophrenia since he was a teenager but because he is also an alcoholic and homeless, no one is very sure which team should be looking after him. Nigel won’t take any medication and won’t attend any psychiatric appointments. He often disappears for a few months at a time, but he always resurfaces and as his GP, I am perhaps the only healthcare professional with whom he regularly has contact.

He often tells me about his psychotic and frightening thoughts. They have been going on for years and are worse when he smokes cannabis. He sometimes becomes violent when he drinks and he has spent some time in prison. You might think that someone like Nigel should be in a psychiatric hospital and, 20 years ago, that is where he would have been. However, people with mental illness aren’t locked away indefinitely these days as they are treated in the community instead. Care in the community works well for some people with mental illness, but not for Nigel. He is a ‘revolving-door’ patient. He becomes quite mentally unwell and often then ends up being compulsorily detained by the police and brought into hospital. He is forcibly given a drug- and alcohol-detox along with antipsychotic medication. For a period of time, he remains relatively well, but he can’t be locked up for ever and eventually he is discharged and goes back to his old addictions and stops taking his medication.