Confessions of a GP - Benjamin Daniels [3]
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 surgery 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 £250,000 to put me through my medical school training, they are now paying my high GP 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 NHS a small fortune. Her heart scan, blood tests and hospital appointments all cost money and we GPs 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 GP 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