Further Confessions of a GP

‘So, Dr Daniels, what medication had you been prescribing him? Did you start him on any new medication just before he died?’

Bloody hell, I hadn’t even thought about that. Could some wayward prescribing on my part have contributed to his death? Suddenly, I sharply switched back into self-preservation mode. The medications I had prescribed to Mr Dawkins were all fairly common, but as the coroner was hinting, they could have all potentially killed him: the aspirin could have caused a bleed from his stomach; the diabetes medication could have dropped his blood sugar causing him to die of hypoglycaemia; the blood pressure tablets might have caused him to faint and bash his head; and the combination of his cholesterol tablets and excessive drinking might have given him liver failure.

I carefully explained all the medications to the coroner, and as I put the phone down I sat quietly stewing in a light sweat, again wondering about my potential influence over another man’s life. I took another good look through Mr Dawkins’ notes. Much as I was annoyed by the computer record’s constant flashing up of targets, one number did jump out at me from Mr Dawkins’ records. His risk score of dying in the next 10 years was 47 per cent. Clearly a stupid statistic to remain on the records of a man already dead, but basically the computer was working out the risk of him having a heart attack or stroke based on his weight, blood pressure, smoking history, diabetes, cholesterol and age. The statistic was basically stating that despite being young, his other risk factors made dying not that unlikely. I was still a bit worried that the medications I had prescribed might have killed him, but I was now also considering that perhaps his death had resulted in me not having treated his risk factors aggressively enough.

I took a good look through his notes and was reassured by the amount of time the doctors and nurses at this surgery had spent advising him to stop smoking and lose weight and take better control of his diabetes. We were constantly trying to get his blood pressure under control and, to be honest, I’m not really sure what more we could have done for him.

I still had a nervous wait for the result of the post-mortem. When it came, it was no surprise to learn that he had died from a massive heart attack, but I can’t pretend that my initial reaction wasn’t relief that I had played no untoward part in his demise. In some ways we should consider it a success that we now see the death of a man in his 50s as such a shocking event. It didn’t used to be, and it is because doctors and patients have got better at reducing the risk factors. I phoned up his poor widow to offer my condolences and support and she asked me if she could book into our stop-smoking clinic.

Mr Goodson

‘HELLO MR GOODSON. CAN YOU HEAR ME? IT’S THE DOCTOR.’

I was kneeling on a doorstep in the pouring rain shouting through a letter box.

I had received a phone call that morning from Mr Goodson’s worried niece. She had been receiving increasingly odd letters from him over the past few months and wanted me to go and make sure he was okay. At this point, I wondered whether as his closest relative she might want to demonstrate her concern by visiting herself, but she gently pointed out that she was phoning me from her home in New Zealand, so as his GP responsibility for his wellbeing fell to me.

Mr Goodson doesn’t have a phone and he had previously always communicated by writing kindly letters to his niece in New Zealand. Recently the letters had been becoming increasingly paranoid in nature, warning her of a conspiracy regarding a dangerous network of computers controlled by the British royal family and the Kennedy family in America. According to him they were plotting to control the world by placing a grid of electromag-netic energy around it that would have power over our minds. In the most recent letter she had received, Mr Goodson had accused her of being part of the conspiracy too, and it was at this point that she decided to give me a ring.

I hadn’t met Mr Goodson before. He had been registered at our surgery for years but, despite being 73 years old, his computer records suggested that he didn’t have any health complaints. He didn’t answer our letters advising him to come in for flu jabs and health checks and so up until now we had always respected his choice to keep away and left him in peace. The phone call this morning changed all that and I couldn’t ignore his niece’s concerns. It would appear that his paranoid thoughts were likely to have been ongoing for some months now, so there wasn’t any real reason to rush round that same day, but just last month I’d discovered that one of my patients had lain dead on his sofa for four months without anyone realising. I didn’t want another of my patients to suffer the same fate, hence the situation I now found myself in, shouting through a letter box in the pouring rain.