Further Confessions of a GP

As Simon aggressively declared his innocence, I discreetly tapped his name into Google and read the local newspaper’s record of events. According to witnesses, he had had a dispute with a taxi driver, who he had pulled out of the car and punched unconscious. Several witnesses stated that as his victim was lying face down in the road Simon continued to kick him in the head while calling him a fucking dirty Paki. Clearly everyone is innocent until proven guilty, but I was struggling to find empathy with the man sitting in front of me. He was still blaming everyone else rather than showing any remorse and he certainly wasn’t expressing a genuine desire to address any underlying mental health issues he might have.

‘Look, Doctor, I could lose everything here. If I get done for this I’ll lose my job and I’ll have a criminal record for life. I could go down for two to three years.’

I managed to resist the overwhelming desire to tell him that he should have thought of that before he decided to kick a man’s head in. I could feel my blood pressure rising and a little voice at the back of my head told me that I was letting my emotions get in the way of the consultation. I needed to treat this man with impartiality and without judgment. A legal declaration of his guilt or innocence was yet to be made and as his doctor it was my duty to treat his medical needs regardless of anything else. I took a deep breath, and blocking out any personal feelings of dislike I had towards him, I returned to thinking about the primary medical needs of my patient. He wasn’t unwell physically and although it could be argued that anyone with such violent tendencies must have some underlying mental health issues, these clearly weren’t currently something that he had any desire to address. In summary, I could justifiably tell him to bugger off.

‘I’m not going to be able to refer you to see a psychiatrist on the NHS. The psychiatrists have got a really busy caseload as it is with lots of very mentally unwell people in this town. I would only refer you to see a psychiatrist if your mental health merited it, not because it might help you in a court case.’

‘Look, the court case is tomorrow. Once I get off the charge I won’t even go to the appointment. I just need to have a letter from you stating that I’ve been referred.’

‘I’m sorry, but it’s not going to happen.’

For the first time I saw Simon losing some of his cocky swagger – and he displayed his fear by becoming angry.

He leaned forward in his chair, his face reddening and his eyes bulging.

‘Look, you slimy little jobsworth, if you don’t fucking write me that referral I’ll smash your fucking head in.’

I tried to remain calm although inside I was absolutely wetting myself. I had rapidly lost control of the situation and all of a sudden there was a very real chance that I was going to get hit. A confused 90-year-old lady once took exception to my attempting to perform a blood test and tried to bite me. Fortunately for me, her complete lack of teeth helped avoid any serious injury. Other than that I had managed to avoid ever being harmed by a patient. My run of good luck looked to be coming to an end though and unfortunately Simon looked like he could be capable of causing me some considerable injury.

‘Look, Simon, you’ve got a court case to prepare for tomorrow and the last thing you need is another assault charge hanging over you.’

I would like to think that I spoke calmly and confidently to Simon, but I probably sounded like the gibbering wreck that I truly felt.

Simon looked me up and down as if weighing up his options. Clearly giving me a good beating was one of them, but thankfully instead he opted to storm out muttering ‘wanker’ audibly under his breath.

A few days later I read in the local newspaper that he had been found guilty of racially aggravated assault and given a three-year prison sentence.

Removing patients from lists

According to a recent report in the press, there has been an increase in complaints about patients being unfairly removed from general practice lists. If the tabloid reporting of the situation is to be believed, these decisions are left up to heavy-handed receptionists and managers, who act like overzealous doormen and will boot you ‘off the list’ if you dare tut at the nurse running late or are unfortunate enough to suffer from the wrong sorts of ailment.