Further Confessions of a GP

I do agree with the Olympian/nurse analogy on one level. You could throw as much money, coaching and facilities at me and I could never become an Olympic athlete. However hard I trained and ‘strived for excellence’, I would never win an 800-metre Olympic gold medal. I’m just not designed for it, in much the same way that Mo Farah might make an awful nurse. Health care is not the career for everyone; there are doctors and nurses who perform poorly not because of facilities or funding but because they are in the wrong profession. I think we need to accept this early on in the training stage of medical careers and make sure we don’t let people work in the NHS who will never be able to offer patients the compassion and expertise they deserve.

Thankfully, despite these poor performers often being the headline grabbers, there are thousands of nurses with the same compassion and dedication Sian has. Her Olympic moment for me was won when she missed her daughter’s 10th birthday in order to sit with a grieving relative. She won’t be offered an OBE or a lucrative sponsorship deal, but in my opinion she is just as deserving of a gold medal.

Paradise

It was absolutely pouring with rain, but it was our wedding anniversary and we had promised ourselves a rare midweek night out. After we’d made a mad dash from the car to the local Indian restaurant, a waiter opened the door for us and showed us to our table. As we took off our sodden coats, we watched as the drains on the street outside overflowed and an impressive stream of surface water ran down the road. We were the only ones who had ventured out on such a wretched evening.

‘Miserable out there, isn’t it? Like a bloody flood,’ I commented to the waiter as he came to take our drinks order.

‘No, sir. This isn’t a flood. I am from Bangladesh and we have real floods there. Many people die.’

‘Oh, well, yes, of course. Erm… I just sort of meant it as a turn of phrase.’

As if I didn’t feel humbled enough, the waiter continued, ‘Every day I am thankful to live in this paradise here in the UK.’

Looking out at the dark grey empty high street with the rain bucketing down, it was hard to try to picture this as paradise. There were no golden beaches or palm trees, but I knew what the waiter meant. Simply living in the UK makes us among the luckiest people on the planet. Regardless of the constant talk of economic downturns and double-dip recessions, we still live in a time and place in which the vast majority of us have food, shelter and safety almost guaranteed. I must admit that I felt slightly taken aback by the waiter’s comments, but I can understand how it might feel to listen to English people complaining about the weather as they leave unwanted food on their plates and then return to their warm dry houses.

During a short stint working in Africa, I witnessed some dreadful things, which put my life into perspective. On the day I returned home I promised myself never to take anything for granted ever again. Under no circumstances would I complain or moan or whinge, and I would absolutely never ever say ‘I’m starving.’ Of course, I broke my promise and I do all of those things. Sometimes it requires a little reminder like this that really I shouldn’t.

At work there are days when the majority of what I see is unhappiness. In the context of the ‘paradise’ our waiter saw in our homeland, it does seem a little obtuse. Of course, unhappiness and depression are complicated, and just because we don’t live in a war zone, or suffer famine or natural disaster, it doesn’t mean that there aren’t some fairly horrendous things happening within my patients’ lives that cause them great distress. Some patients tell me they feel guilty for how low they feel because they know objectively how lucky they are. Depression is a disease and for some of my patients it is a matter of trying to adjust brain chemicals or using therapy to deal with past traumas. But for people like me, who sometimes just get a bit grumpy about the minor inconveniences of life, I wonder if simply watching the news and gaining a bit of perspective might be more in order.

Yes/No

Often when my patients ask me for my advice it is with the expectation that I will be able to give them a quick Yes or No answer. I frequently disappoint them; the great majority of decisions made in general practice are a shade of grey as opposed to black and white.

For example, one patient might ask me if she should take a cholesterol-lowering drug, or another might ask me whether he should have an operation on his knee. The patient hopes I’ll simply say yay or nay, but in both cases I’ll actually drone on endlessly about the pros and cons. I’ll recite boring facts, such as risk statistics, drug side effects and surgical complications. Eventually, after imparting my wisdom, I’ll turn the question back to the patient and explain that it is their body and their decision.