Further Confessions of a GP

Under normal circumstances regular HIV tests are to be commended, but in Nathan’s case I was worried that by giving him a test I was colluding with his health anxieties. Nathan’s irrational fears about his health weren’t new. A few months earlier he’d been convinced that his very benign looking mole was skin cancer and wouldn’t be reassured until I sent him to see a dermatologist. He had also recently convinced himself he had a heart problem because he was sometimes aware of his heartbeat and so kept coming to see the nurse and demanding an ECG. In fact looking through the notes, Nathan was in the surgery almost every week.

We all worry about our health sometimes, but most of us have a sensible threshold as to when we need to seek medical help for our ailments. We are able to look rationally at our symptoms and decide how potentially serious they might be, and can usually reassure ourselves when they are obviously benign. Nathan doesn’t seem to possess this ability. He could be called a hypochondriac, although this seems a slightly crude, old-fashioned description. I would say he has health phobias. He has an irrational fixed fear about his health that often takes over his life and is very debilitating. When Nathan presents with yet another ailment, my gut reaction is to attempt to reassure him. He knows that he worries excessively, but his overwhelming health fears trigger a niggling doubt in me. Like the boy who cried wolf, perhaps at one point Nathan will genuinely have something wrong that needs treating and I’ll be the one that misses it.

Nathan and I became trapped in a folie à deux, in which he came to see me for reassurance and I encouraged his behaviour by offering him a test that gave him a brief respite from his fears when the result come back as normal. Round and round we went, but I decided it was going to stop today.

‘Nathan, you don’t need an HIV test because you don’t have HIV. You’re a healthy 17-year-old lad and you need to stop worrying about your health.’

‘I reckon I’d just stop worrying if you gave me an HIV test.’

‘I’m going to refer you to a therapist. To address your excessive health concerns. You need help to find ways to stop worrying about your health so much.’

Nathan looked at me blankly and then quietly left my room. He didn’t ever go to see the therapist I referred him to, but instead went and got an HIV test from the walk-in sexual health clinic. I guess that I ultimately failed in my plan to break the cycle, but on a more positive note Nathan does seem to be coming in to see me less frequently. Perhaps he’s better at dealing with his health phobias. Or perhaps he’s just given up on me and is sitting at home terrified that he is about to die from the latest of his perceived ailments.

Army medical II

It was a year after I had completed the army medical for Lee. He still looked like a young boy, but something had changed in him.

‘I’m due to go back for my second tour in Helmand, Dr Daniels, but I don’t want to go. Can you write something to say I can’t go back?’

‘I guess I can try. Was it really bad out there?’

‘It was terrible. All my friends back here keep asking me is if I killed anyone. I don’t even think I ever saw a Taliban to shoot at, let alone kill. All I saw on patrol were kids and women and old people, but every step you’re wondering if a sniper is going to get you. Every time you see a kid you wonder if they’re going to blow themselves up. They look at you like you’re scum and the women shout at us in their language and spit at us. Being in the vehicles was even worse. Imagine being in a vehicle that gets blown up by an IED [improvised explosive device] and catches fire. You either stay inside and burn or you try to get out and a sniper shoots you.’

He went on: ‘My mates think it sounds exciting, but I was scared the whole time even though most of the time nothing happens at all. Even during down time I couldn’t relax. All the worrying made me ill. My bowels were all over the place and I barely slept. Some of the other guys in the battalion took the piss out of me, but I know they were scared as well. I just can’t go back there. Since I’ve been back I’m just angry all the time. Please don’t make me go back.’

‘Lee, I can try writing something, but ultimately it’s the army doctors who get to decide, not me.’

I wrote a long letter stating that I believed Lee had post-traumatic stress disorder. They might dismiss it outright given that Lee hadn’t really even seen much action, but he did have all the symptoms. He couldn’t sleep, was having flashbacks and experiencing continually high levels of anxiety.