Sick Notes: True Stories from the GP's Surgery by Dr Tony Copperfield

Author:Dr Tony Copperfield
Language: eng
Format: epub
Publisher: Monday Books
Published: 2010-09-18T14:00:00+00:00

MR ENDELL AND HIS CORNUCOPIA OF ILLNESSES

HAVING MADE IT this far, you’ll be able to guess how this story develops. But I’m going to tell it anyway.

Mr Endell, an elderly patient with diabetes, heart failure, atrial fibrillation and renal impairment, sat and cried in my surgery today. Not for the first time.

It wasn’t his cornucopia of illnesses; this, in itself, is actually not a particularly remarkable combination.

It wasn’t the fact that diabetes is depressing for him (and me): these days, diabetic care is like playing the stock market, in that we invest heavily in the disease, my interest rate falls, and their GFRs¹ and ejection fractions² eventually crash.

It isn’t a general preponderance to tears, either. Mr Endell is a stoical sort, and very uncomplaining. (His compliance with treatment is impeccable, despite the fact that his drugs are administered with a shovel.)

So what is it that regularly drives this long-suffering, multipathological and polypharmaceutical man to despair?

Correct: the big building down the road staffed by white-coated clever docs.

He is currently expected to attend five different outpatient clinics.

This means that, instead of spending what remains of his life enjoying himself as best he can, he is wasting most of it travelling to, sitting in, returning from or pondering over outpatient appointments. So many and varied are his hospital interactions and their various epiphenomena that he no longer has a social diary. He has an appointment book.

Every time he attends the hospital he winds up being seen by a different junior doctor, usually an earnest and enthusiastic trainee with one eye on him, one eye on that pretty blonde nurse and a third eye on the pub, who will never see him again and who randomly changes his medication. As a result of which, I’ve given up rewriting Mr Endell’s repeat prescription card. Instead, I’ve just scrawled on it, ‘Lots of drugs, PRN’. (From the Latin pro re nata, meaning ‘when necessary’.)

Each hospital appointment generates another test which is carefully arranged so that the results won’t be available for his follow-up visit. Or, if they have miraculously appeared, then his notes are missing, so the outcome is the same: a further follow-up appointment arranged by a hospital doctor who’s annoyed at having had his time wasted and who doesn’t mind letting my entirely innocent patient know.

Each clinic consultation is a mess of non-sequiturs, partial explanations, dysfunction, repetition, omission and miscommunication. I used to think that patients enduring secondary care suffered because the right hand didn’t know what the left was doing. Now it’s much worse. The hospital has turned into an octopus, and none of the eight arms have a clue what the other seven are up to. They only work in unison when they engulf the patient and drown him in ‘care’.

I suspect people have been driven to murder for less. Frankly, if I were Mr Endell, I would hire a light aircraft and drop napalm on the consultants’ car park. (Though, given that it’s not entirely their fault, but that of the system they work in, maybe I’d strafe the managers’ canteen, too.

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