Further Confessions of a GP

The reality is that, for the vast majority of practices, taking someone off their list is a rare occurrence and a last resort. I had been a GP for several years before I even knew that such a drastic measure was an option. It only crept into my consciousness when a patient suggested he was going to forcibly remove my testicles from the rest of me and then encourage me to ingest them. His language was more colourful, but you get the idea. I had refused to write him a letter that stated he was too unwell to attend his probation appointment that afternoon and it hadn’t been a popular management decision. To be fair to him, he hadn’t carried out his threat despite the fact that my room is frighteningly soundproof and exceptionally well equipped with scalpels and tongue depressors. I was regaling the consultation details to an amused colleague when the practice manager overheard and felt it suitable grounds to ‘off list’ him. I was quite surprised; after years of working in A&E and inner-city GP practices, I had become well-accustomed to receiving threats and abuse at the hands of patients and fully accepted it as just being part of the job.

The only other patient whom we have threatened to kick off our list recently is a serial non-attendee. She makes appointments and then doesn’t turn up. When this had happened 10 times in an eight-month period, we explained that it wasn’t fair on other patients and that wasting her appointments was increasing waiting times for everyone else. When she missed two more appointments in the following month, we threatened to take her off our list. It is the only weapon we have in our armoury to try to prevent her recurrent non-attendance, but my dilemma is that I don’t really want to kick her out. She and her family have been at our surgery for years and they have a lot of problems, both social and medical. The practice and our staff are one of the few constants in her otherwise chaotic existence. I also know that by throwing her off our list, I am basically just passing one of our most difficult patients on to another of the local practices. That practice would be unlikely to thank us and could take revenge by off listing a couple of their problem patients who would in turn come to us. The tit-for-tat patient dumping could last for generations. So far we have kept her on our books, but if anyone has any good ideas for encouraging her to keep her appointments, they would be much appreciated.

Far more common than forcibly eliminating patients from practice lists is patients voluntarily removing themselves. Doctors are human and you will get on better with some than others. Often patients shop around until they find a GP or a surgery that suits them and this system seems to work well enough the majority of the time. If I ever reach the point where I am regularly removing handfuls of patients from my list due to minor complaints or disagreements, it is probably time to hang up my stethoscope and find a different job. If you as a patient have just been forcibly ejected from your sixth GP practice in as many months, it is probably time you booked onto one of those anger management classes everyone keeps telling you about.

Bravery

Standing up to mildly threatening patients who are larger and better at fighting than me is about as bold as I ever have to be at work. Whereas other emergency services have to valiantly risk their lives fighting fires or arresting dangerous villains, medics are rarely required to face great personal risk in the line of duty. However, just occasionally there is an exception.

Karla Flores was a Mexican seafood vendor who was minding her own business selling seafood at the roadside in her home state of Sinaloa. Like many parts of Mexico, turf wars between rival gangs often result in violent street battles and, unfortunately for Karla, she was inadvertently caught up in one such skirmish. After hearing an explosion, she was knocked unconscious. She awoke in hospital to discover that she had been hit by a live grenade shot from a grenade launcher. The grenade was lodged between her jaw and the roof of her mouth. It was a miracle that it hadn’t exploded, but it was very much live and could go off at any time.

Were the grenade to explode, anyone within a 10-metre radius would almost certainly be killed, and so understandably the Mexican doctors weren’t exactly falling over themselves to take on Karla’s care. Eventually four brave medics stepped forward and agreed to operate on her. In order to avoid the very real possibility of blowing up the entire hospital, it was decided that the operation would take place in an open field some distance from any civilisation.