Further Confessions of a GP

‘So, why do you think everyone is contaminated?’

Mr Goodson went on to describe in some detail his fears about global plots and bizarre conspiracies. Such was the intensity of his paranoia that I knew that there would be no benefit in trying to challenge his beliefs. Mr Goodson needed to have antipsychotic medication and ideally be admitted to a psychiatric unit where he could be safe and looked after until his delusional paranoia settled. I gently introduced the subject of him taking some medication to help make the unpleasant thoughts go away, but he wasn’t having any of it. As far as he was concerned, he was the only one who accurately understood the truth and it was the rest of us who were unwell.

Sectioning is not a decision that anyone takes lightly and it really is used as a last resort, when there are no other feasible options available. Some people manage to stay living independently at home with quite marked chronic delusional symptoms, but Mr Goodson’s symptoms were such that it was preventing him from being able to look after himself. Once someone’s illness leads to the potential to harm themselves or others, the person can be judged as unwell enough to be admitted to a psychiatric unit against their will. Sensibly, such a grave decision isn’t one that I’m allowed to make alone. It requires the joint decision of a GP, a psychiatrist and a specialist social worker, and so when I returned to the surgery I made some arrangements to return the next day with the cavalry.

The following day I met the psychiatrist and social worker outside Mr Goodson’s house. They looked a little surprised when I took from my bag a bottle of Johnson’s baby oil that I had taken from my own bathroom cabinet that morning. When we knocked on Mr Goodson’s door, he made me push my bottle of baby lotion through the letter box. After it passed his careful inspection, it was posted back out and he intently watched all three of us smear ourselves with the stuff before letting us in.

My biggest fear at that point was that Mr Goodson would point-blank refuse to be admitted to hospital, leaving us no choice but to get the police involved to forcibly detain him. In his paranoid state, this would be terrifying for him, and he was in such a physically frail state that if he put up a fight I was scared he might get badly injured.

Fortunately, the social worker was brilliant. She had a very calming way about her, and without either colluding with his delusions or openly refuting them, she managed to persuade Mr Goodson that he would be safer and better off under the care of the mental health team. It took some time to reassure him about levels of contamination in her car, but eventually off they went and he was able to get the care and treatment that he needed.

Psychosis is a terrifying condition for the sufferer. The strange thoughts and paranoid ideas that can seem ridiculous to us feel absolutely real to the poor person with the condition. The antipsychotic medications available aren’t perfect, but they do help clear away the delusions and return people to reality. Since starting these drugs, Mr Goodson is much better. He is still undeniably eccentric, but the tin foil has been taken down from the windows and I no longer have to smother myself in baby oil in order to gain entrance to his house. Most importantly, he feels safe again and is able to live something resembling a normal life.

Mr Raymond

As a patient Mr Raymond asked little of me. He rarely came into the surgery and when he did he was courteous and undemanding. He had spent some time in prison for child sex offences and each time I met him, I had to try to force myself to be professional and not let the fact that he was a paedophile cloud the way I treated him. My job as his doctor was to treat him with impartiality and compassion as my patient, rather than judge him as a person. This sounds straightforward enough, but I will admit that I found it difficult. He had recently been diagnosed with diabetes and was a model patient, attending all his appointments and sticking to his new diet and medication regime.

‘So what can I do for you today, Mr Raymond?’

‘Well, the nurse mostly looks after my diabetes, Doctor, but I was too embarrassed to mention this little problem I’ve been having to her.’

‘What’s that then?’

‘I think the diabetes is affecting my erections. I can’t seem to get them any more and I was wondering if I could try some Viagra?’

The diabetes may well have been affecting his erections. There were other possible causes too, but Mr Raymond was aware that now he had been diagnosed with diabetes he was entitled to free Viagra on the NHS. I asked a few more questions and even examined him, but overall his complaint was fairly standard. With most of our diabetic male patients, I wouldn’t have thought twice about prescribing some Viagra or something similar, but for obvious reasons, I had reservations with Mr Raymond.