Confessions of a British Doctor

About the Publisher (#litres_trial_promo)

Disclaimer

Dr Benjamin Daniels is the pseudonym of a doctor currently working for the NHS.

The events described in this book are based on my experiences as a new doctor. For obvious reasons of privacy and confidentiality I have made certain changes, altered identifying features and fictionalized some aspects, but it remains an honest reflection of life as a young doctor in Britain today. This is what it’s like. These things really happen!

Who am I?

Humans have a universal desire to be listened to and share their stories of pain and suffering. My job as a doctor is to listen to those stories. Sometimes I interject with some suggestions or medications, but more often I am simply a passive observer of the soap operas that are people’s lives. With regular appointments, I watch the characters develop and the narratives unfold. Although some of my patients have an over inflated view of my significance, I really am just a walk-on part in their lives. I’m like an extra in a soap opera who tries his best to play a small role in one or two of the storylines, but in reality rarely affects the progress of the plot or the big ending. The advantage I do have is that I get to watch the story unfold from a unique and fascinating angle. Being a doctor gives me a privileged insight into the more private and often bizarre aspects of human life and, with that in mind, let me share some slices of my working life with you.

I love my job and have no regrets about choosing to become a doctor and then specialize as a primary care physician. This is quite fortunate really, as my decision to study medicine was made as I chose my school exam subjects at the tender age of 16¼. At this time my only real reservation against becoming a doctor was the knowledge that I would have to endure studying chemistry. I couldn’t really think of any other reason why I shouldn’t be a doctor. What could be better than swanning around a hospital full of beautiful nurses and ‘saving lives’? People would think I was great and ultimately this would lead to me finally getting a girlfriend. As an awkward 16-year-old with bad skin and greasy hair, most of my career aspirations were based on what profession would give me the best opportunity of gaining me some interest from the opposite sex. I had accepted that my carnal ambitions would ideally be achieved by being in a boy band or playing Premiership football, but unfortunately my lack of talent in both these departments led to the inevitable choice of medicine. I chose a career in medicine in the year that ER first arrived on our screens. A poster of George Clooney in a white coat was on every girl’s wall. Of course I wanted to be a doctor!

On my university application form, I had the good sense to not write that I wanted to be a doctor so I could ‘save lives and hence get laid’. I scribbled down something about my love of ‘working as part of a team’ and my ‘fascination with human sciences’. To be fair, I suppose these statements were also true, but it is so hard to pick a career aged 16. The real world of work is always such a mystery until you enter it. When my mate Tom applied to teacher-training college, he wrote that he wanted to ‘help young people flourish and fulfill their true potential’. After a five-year tour of duty in an inner city school, like us medics, he is just trying to get to the weekend without being punched or sued.

Although I now work as a family physician, my training required me to spend many long years working as a hospital doctor. I completed five years at medical school and then spent several years working in various hospital posts gaining the experience needed to become a family physician or as we call ourselves in the UK, a General Practitioner (GP). I was a resident doctor in surgery, psychiatry, ER, pediatrics, gynaecology, geriatrics and general medicine. I also broke up my training with a three-month stint working in Mozambique. All in all I loved working as a hospital doctor but have absolutely no regrets about leaving it to work in the community.

Introduction

I can still fondly recall the first diagnosis I ever made. As with many others that followed, it was spectacularly incorrect, but it still holds a special place in my heart. In my defense, I was just a mere boy at the time, wet behind the ears and only a few weeks into my first term at medical school. I was sitting in the local Kentucky Fried Chicken and spotted a man slumped unconscious in his plastic seat. A wave of excitement flooded over me. This was what it was all about! This was my vocation! With the limitless enthusiasm of youth and inexperience, I bounded over to undoubtedly save his life with my new-found wealth of medical knowledge.

It didn’t take me long to conclude that this gent had suffered from a spontaneous pneumothorax. This was not based on clinical signs and symptoms but more that this was the condition that we had learnt about that morning in a tutorial and so was the first and only diagnosis that sprung to mind. With an air of self-importance, I explained to the KFC manager my diagnosis and instructed him to call urgently for an ambulance. Looking thoroughly unimpressed, he wandered out from behind the counter and roughly manhandled the unconscious man from his seat and threw him out of his restaurant. My first-ever patient spectacularly regained consciousness, uttered a few obscenities addressed to no one in particular and staggered off down the street. The KFC manager in his far superior wisdom had, in fact, made the correct diagnosis of ‘drunk and asleep’ and prescribed him a swift exit from his premises.

I can see why the professor chose to teach us innocent medical students about a spontaneous pneumothorax that morning. It is, in fact, a wonderful feel-good condition for doctors. An otherwise healthy person collapses with a deflated lung and then the clever doctor diagnoses it with his stethoscope and sticks a needle between their ribs. With a triumphant hissing sound, the lung inflates and the patient feels much better. The professor was trying to help explain the normal functioning of the lung and what could go wrong. He was also trying to encourage us to embrace the wonderful healing abilities we could have as doctors. Back during those early days of medical school I believed that most of medicine would be that straightforward. Someone would be unwell, I would do something fabulous and then they would get better.

Funnily enough, despite a spontaneous pneumothorax being the first medical condition I ever learnt about at medical school, I have, in fact, never actually seen one since. Looking back, I wonder if actually a far more useful and accurate introduction to being a front line doctor would have been a tutorial on how to remove a semiconscious drunk man from a waiting room:

‘Would everyone please welcome our guest speaker today. He has a long and celebrated career working in numerous late-night fast food outlets and will be giving you his annual demonstration on how to prepare yourselves for spending your futures working in the British health system. Do take notes on how he skillfully removes the inebriated gentleman while remaining entirely unsoiled by any body fluids and simultaneously evading drunken punches. You will be tested on this in your end-of-year exams, so do pay attention.’

When I think back to that KFC, I can still recall my shock at what I perceived to be the terrible ill treatment of this poor man. The callous, heartless actions of the restaurant manager only increased the feeling that my true vocation was to become an amazing doctor in order to cure just such vulnerable people who needed my help …

Ten years later, after a long day of inner city general practice, my brain was heavy with the multitude of sufferings that I had encountered. Chronic pains, domestic violence, addiction, depression, self-harming and a fairly big helping of broad-spectrum misery were the principal orders of the day. After many hours of putting my heart and soul into my patients’ problems, I knew that my competency that day would be judged not on my diagnostic skills or my bedside manner, but by how many targets I had reached from the latest pointless government directive. While finishing the day reading the latest newspaper headline about how doctors were lazy, incompetent money-grabbers, it was almost a relief to receive an emergency call from reception to tell me that a man had collapsed in the waiting room.

Rather than springing up into life-saving action, I heaved myself out of my blissfully comfortable chair and ambled down to the waiting room. Over the last ten years that limitless enthusiasm had been gradually broken down and replaced with a defeated resignation. I took no satisfaction in this time getting my diagnosis spot on. Still waiting for that spontaneous pneumothorax to heroically cure, I was greeted instead by one of our local street drinkers in a drunken stupor in the children’s play area of the waiting room. Using the expertise I perfected during endless Friday and Saturday night shifts in the ER, I skilfully escorted the intoxicated man from the surgery back on to the street.

In a wave of sad nostalgia I wondered what that naïve 18-year-old me would think about what he had become. Would I have even bothered to have gone on to study medicine if I could have foreseen how so much of that initial hope and optimism would drain away? Not even out of my twenties yet, I began to wonder if being a doctor was anything close to the career I thought it was going to be. As I returned the drunk homeless man on to the street, I offered him an appointment to come back and see me the following morning when he was sober, explaining about organising an alcohol detox. ‘I’ll be there, Doc,’ he told me as he shoved the appointment card into his pocket. We both knew that he’d miss that appointment, but at least we were mutually left with a faint glimmer of hope for something better.

Please don’t imagine that this book is about me looking for sympathy or commiserations about my broken dreams, or assume that I have lost my empathy and respect for the people who expectantly seek my help or advice. I guess it’s just that the often grim reality of practising inner city medicine is not quite what I had expected it to be. I no longer dream of miracle cures and magic bullets and I have definitely given up waiting to dramatically re-inflate that collapsed lung. Instead, I acknowledge that my role is to listen and share the pains, concerns and sufferings of the people who sit before me. I offer the odd nugget of good advice and provide some support at times of need. Perhaps just occasionally I even make a small difference in someone’s life. The intention of this book is simply to give an honest but light-hearted insight into some of the joys, frustrations and absurdities of being an inner city doctor in modern Britain. I hope you enjoy it.

I have been doing this job for 3 years and I genuinely love it. I like the variety and getting to know my patients. I find it challenging and rewarding. Sometimes I even make a diagnosis and cure someone! I’m currently working as a locum which means that I work in different parts of the country, covering other family doctors when they are away. I also still do some shifts as an ER doctor from time to time. Some of my posts have just been for one day, others have been for over a year and I get to see the good, bad and ugly side of doctors, patients and the British National Health Service. I love my job and think that it is one of the most interesting out there. I hope that after reading this book you might agree with me, or if not at least realise that it isn’t just about seeing coughs and colds.

Mrs Peacock

Like parents, doctors are not supposed to have favourites but I have to admit to being rather fond of Mrs Peacock. She is well into her eighties and her memory has been deteriorating over the last few years. Most weeks she develops a medical problem and calls up the clinic requesting me to visit. When I arrive, the medical problem has been resolved or at least forgotten and I end up changing the fuse on the washing machine or helping her to find her address book, which we eventually locate in the fridge. As I tuck into a milky cup of tea and a stale coconut macaroon, I reflect that my medical skills probably aren’t being put to best use. I imagine the grumbling taxpayer wouldn’t be too pleased to know that having forked out over $350,000 to put me through my medical school training, they are now paying my high wages in order for me to ineptly try to recall which coloured wire is earth in Mrs Peacock’s ageing plug.

Mrs Peacock needs a bit of social support much more than she needs a doctor so when I return to the surgery I spend 30 minutes trying to get through to social services on the phone. When I finally get through, I am told that because of her dementia, Mrs Peacock needs a psychiatric assessment before they can offer any social assistance. The psychiatrist is off sick with depression and the waiting list to see the stand-in psychiatrist is three months. I’m also reminded that Mrs Peacock will need to have had a long list of expensive tests to exclude a medical cause for her memory loss. Three months and many normal test results later, Mrs Peacock forgot to go to her appointment and had to return to the back of the queue.

Through no fault of her own, Mrs Peacock has cost the health service a small fortune. Her heart scan, blood tests and hospital appointments all cost money and we doctors don’t come cheap, either. Mrs Peacock does have mild dementia but more importantly she is lonely. She needs someone to pop in for a cup of tea from time to time and remind her to feed her long-suffering cat. It would appear that this service is not on offer, so, in the meantime, I’ll continue to visit from time to time. When the coconut macaroons become so inedible that even the hungry cat won’t eat them, I’ll think again about trying to get Mrs Peacock some more help.

Tom Jones

The term ‘presenting complaint’ is what we use when we describe what the patient comes in complaining about – i.e. the patient’s words rather than our diagnosis. Normally as a doctor the presenting complaint will be ‘back pain’ or ‘earache’ or ‘not sleeping’. Elaine Tibb’s presenting complaint was different. When I said, ‘Hello Miss Tibbs. What can I help you with today?’ she said, ‘I’m having pornographic dreams about Tom Jones.’ Her words, not mine.

For the more common presenting complaints, most doctors will already have a check list of questions in their heads. For example, a female patient says, ‘I’ve got tummy pain’ and I say, ‘Where, and for how long?’ and ‘Have you got any vaginal discharge?’ When faced with the presenting complaint of pornographic dreams about a celebrity, I was left hopelessly speechless. When discussing Elaine’s sexual fantasies, I was very keen not to know where, for how long and if there had been any vaginal discharge. Unfortunately, I didn’t get a chance to point this out to Elaine before every minuscule aspect of the dreams was described in surprisingly graphic detail.

I am rarely left speechless by a patient’s opening gambit, but as with Elaine, there are always a few that do leave me at a complete loss. My personal favourites are:

When I eat a lot of rice cakes, it makes my wee smell of rice cakes;

I masturbate 10 to 15 times per day – what should I do?

I ate four Easter eggs this morning and now I feel sick;

My husband can’t satisfy me sexually;

When I was in church this morning, I was overcome by the power of the Lord;

I think my vagina is haunted.

Elaine is a classic example of someone that we doctors see fairly regularly. She was odd and eccentric, but not quite mentally ill. She was slightly obsessive and delusional but not really harming herself or anyone else. Admittedly she didn’t work, but she functioned reasonably well from day to day and didn’t really have any insight into the fact that other people found her to be a tad unusual. Instead, Elaine generally saw most of the rest of the world as slightly peculiar and felt it was just her and, of course, her darling Tom Jones who were the only normal ones. Looking through her patient records, I noted that she did once see a psychiatrist a few years back. He diagnosed her as having ‘some abnormal and obsessive personality traits but no active psychosis’. This is psychiatry speak for ‘slightly odd but basically harmless’

‘He does love me, you know, Doctor. If he met me, he would know it straight away. We’re made for each other.’

‘Isn’t Tom Jones happily married and living in California?’

‘No no no! He loves me, doctor.’ Elaine would have happily spent all afternoon telling me about her Tom Jones fantasies, but I felt that we needed to move things on. I used the classic doctor phrase that we pull out of the bag when we feel that we’re not getting very far. ‘So Elaine, what are you hoping that I’m going to do for you today?’

‘Well, doctor, I need you to write Tom a letter. It would sound better coming from you. He’s a doctor as well. Well, not a real doctor, but I’m sure he’d be a wonderful doctor if he wanted to be. He’s very kind you know and oooh so gorgeous and anyway, I’m sure if you just explained everything he would see sense, I know he would.’

Basically, I was being asked to stalk Tom Jones on Elaine’s behalf. I could imagine the letter.

Dear Tom,

Please will you leave your wife, family and LA mansion and move into a run down 1 bedroom apartment with a slightly odd woman with straggly hair and a duffel coat that she has been wearing since 1983. It will make my life slightly easier as she won’t keep coming to the surgery and annoying me with her graphic descriptions of your imaginary sex life.

Best wishes,

Dr Daniels

Stalking is defined as a ‘constellation of behaviours in which an individual inflicts upon another repeated unwanted intrusions and communications’. Elaine probably would have quite liked to have stalked Tom Jones, but I don’t think she really had it in her. For Elaine, her problems with relating to everyday folk had resulted in her focusing all her energy on an imaginary relationship with a person whom she would never meet. I guess this was a good way to protect herself from the struggles and potential rejections of real-life relationships. Whatever the psychological explanation, I’ll never be able to listen to ‘It’s Not Unusual’ in quite the same way again.

First day

I can still remember my first day as a doctor very clearly. It is something that I had been looking forward to since I first made the decision to study medicine eight years earlier. Now the actual day had finally come I was absolutely shitting myself and wondering if I wanted to be there at all. We spent most of the first day having induction-type talks. These consisted of a fire safety talk and an introduction from a medical lawyer on how best not to get sued. Not particularly confidence boosting.

As the induction day drew to a close, most of the other new doctors went to the pub. Not me though. I was doing my first ‘on call’ on my first-ever night as a doctor. This may have been the short straw for some but, although frightened, I was excited and keen to get my first on call over with. This night would be the making of me, I thought to myself. By this time tomorrow, I would be feeling like an old pro and be regaling heroic stories of my lifesaving antics to my admiring colleagues in the pub. It was going to be like losing my virginity all over again. My brand-new shirt was ironed and although a couple of sizes too big, my white coat was starched and gleaming. I had a sensible haircut and a stethoscope round my neck. I looked at myself in the mirror astounded that I really was a doctor!

I picked up my pager at five that evening and sat there looking at it timidly. This small black box would come to be hated by me during my future years as a hospital doctor. This box would wake me from sleep and interrupt my meals. When completely overloaded with work and feeling like I couldn’t cope, this small inconspicuous little box would bleep and tell me that I had another five urgent things to deal with. Of course I was unaware of all of this on that first innocent evening. Instead, I had a naïve excitement that I was finally considered important enough to have my own pager and that it might actually go off. I had been practicing how I should best answer it: