Confessions of a GP

I spend quite a lot of my time telling my patients that I don’t really know what is wrong with them. This sometimes disappoints them terribly or at least makes them think that I’m a rubbish doctor, but the reality is that I see hundreds of patients with the odd ache or pain or tingle or discomfort and often I don’t really know what is causing it. This isn’t because I’m a rubbish doctor, it is just because we all get the odd funny ache or pain now and again and eventually it almost always goes away on its own. One of my colleagues tells his elderly patients that if they wake up one morning without any aches and pains, they have almost certainly died in the night! When I am faced with my patients’ mysterious aches and pains, I am often tempted to make something up and prescribe a placebo, but gone are the days where we could completely bullshit our patients and get away with it.

My brother is not medical and went to the doctor recently because one part of his arm was a bit red. His GP stroked his chin and then wisely stated that he thought my brother had a mild case of erythema. My brother was initially very impressed with this diagnosis. He didn’t know what the word meant but it sounded like a convincingly rare skin disease. He then went home and ‘Googled’ erythema only to find out that it means red skin. My brother had told his doctor that he had ‘an area of red skin’ and the doctor then cleverly diagnosed him with having ‘an area of red skin’. Using a Latin word to make ourselves sound intelligent does work briefly, but the internet now means that our jargon can be rapidly exposed as the bullshit it really is.

Most aches and pains that I see get better on their own with a bit of time. Coming to see me tends not to make a great deal of difference to this. You might think I’m talking myself out of a job but I’m not. If a 20-year-old woman has a bit of a tingly ear from time to time, then I’ll probably not know a cause or find a cure. However, a 60-year-old smoker with a tingly left arm might think his discomfort was equally trivial, but actually be having symptoms of a heart attack. This is where I come in. My job is to reassure the young person with a bit of a tingly ear but send the man with a tingly arm to hospital, as his heart might be about to stop.

If my healthy 20-year-old patient took her tingly ear and saw 100 doctors, healers or alternative therapists around the world, they would probably each come up with a different diagnosis. This is not because they are cleverer than me and know the real cause, but simply because they are being paid to give a diagnosis. If they can come up with a believable diagnosis, then they can sell a treatment. Telling someone that you don’t know what is wrong with them and that they’ll get better on their own is not a good way of making money if you work in a private health service. Fortunately for us, we have the NHS. GPs make money by jumping through hoops and reaching government targets, but not by making up diagnoses and then flogging you placebos.

Gary

I always found Gary to be slightly overbearing. He was a salesman of some sort and always shook my hand very firmly and maintained eye contact for a little too long. I was scared that one of these days he was going to talk me into buying a photocopier. This day he was a little more bashful.

‘I need your help, Dr Daniels. I had a little mishap at the Christmas party with one of the girls in the office. It was just a bit of drunken fun, but she’s just told me that she’s got chlamydia. I’ll be honest with you, Doctor, I’m fucking terrified. If my wife finds out, she’ll leave me. I’m already on my last chance. We’ve got two kids.’

‘Well, the best people to deal with this sort of thing are the doctors in the sexual health clinic. I could give you their telephone number.’

‘I’m not going to the clap clinic, Doctor. If somebody sees me there, I’m a dead man. I’ve had a look on the internet and I just need some of this antibiotic called azithromycin. One tablet does the job and we can just sort this out here and now.’

‘Well, it’s not ideal. Really, it would be better to test you. Have you had any symptoms? Burning when you pee? Milky discharge from your penis?’

‘I’ve had nothing like that but I’m not taking any chances and I’m not having you stick a swab down my little guy. I just need a prescription for the one-off antibiotic…and one for my wife.’

‘Have you told her?’

‘God, no! She’d leave me. Now this azithromycin stuff, would it dissolve in her tea? I was thinking about crumbling the tablet into a pasta sauce but was worried that the cooking process might damage it.’

‘Look, I can’t encourage you to be secretly drugging your wife with antibiotics. What if she has an allergic reaction? It’s my name on the prescription. I would have to take responsibility.’