Confessions of a GP - Benjamin Daniels [89]
Smoking
Regardless of why a patient comes to see me, I am required to ask them if they smoke and if they say yes to give them ‘smoking cessation advice’. I do this because it is probably a good idea that my smoking patients give up. I also do it because it earns the practice points and we all know what points mean.
Personally, I’ve never been that convinced about giving smoking cessation advice. I have tried various techniques and am not sure any of them really work. Here are a few of my best efforts:
‘Smoking is bad for you’ (patient probably knows this).
‘Smoking will kill you’ (patient probably knows this, too, and now I’ll have put their blood pressure up, which will mess up my hypertension targets).
‘Smoke if you want to, I really couldn’t give a monkey’s’ (reverse psychology – maybe they’ll give up to spite me).
‘Stop smoking right now!’ said in an authoritative paternal doctortype way (patient would probably laugh because I’m not very good at being authoritative – ask my cat).
As with all addictions, beating them is only possible when the addict is really ready to give up, hence I only give smoking cessation advice when it is the patient’s idea. Sometimes I’ll give my smokers a bit of unsubtle prompting: ‘Hmm, you’ve had a fair few chesty coughs this winter. Why do you think that is?’ If the 40 per day smoker insists that it is because of an allergy to the neighbour’s rabbit or the office’s air-conditioning system, I don’t bother with stop-smoking advice. If they recognise that smoking is harming them and genuinely want to give up, I am only too happy to give as much help, encouragement and nicotine patches as humanly possible.
Angry man
Angry man is red in the face and if I didn’t know it was medically impossible, I wouldn’t be surprised to see steam billowing out of his ears in a cartoon-like fashion.
‘You need to give me some diazepam to calm me down, Doctor. I’m on edge. I feel like I’m going to hit someone!’
‘Why are you so upset at the moment? Would you like to talk about it?’
‘Look, Doctor, I’m not here to talk about my problems. I need you to give me something to calm me down.’
‘I’m sorry but I don’t prescribe diazepam for anger. We need to find a better way of dealing with the problem. I know of a very good anger-management course I could put you in touch with…’
I didn’t think angry man could get any angrier, but I am wrong. He starts beating the desk and he pushes his face next to mine.
‘Look, if you don’t give me something to calm me down, I don’t like to think what might happen. I could really fly off the handle and hurt someone. You could be responsible for someone really getting hurt.’
‘If you hurt someone, you need to take responsibility for that yourself.’
Angry man stands up menacingly and, for a moment, I think he is going to hit me. I cower inwardly and wish my nose wasn’t quite such a large target. Angry man calls me a fucking disgrace to the medical profession and then he leaves. I actually think that my complete lack of physical presence is a great advantage in these situations. I look about as menacing as an anorexic kitten playing with some cotton wool and this seems to deter even the most threatening of would-be nose breakers.
As the door slams, I give myself a few moments to compose myself and then carry on with the afternoon surgery. The rest of the day continues uneventfully and after Mrs Gibson’s exceptionally large haemorrhoids and yet another ‘funny turn’ from Mr Polucovski, angry man’s outburst is but a distant memory.
Two hours later I am standing at the checkout in Sainsburys, having stopped off on the way home from work. The boy on the checkout is particularly slow and I am regretting that I didn’t pick the next queue over which seems to be travelling at twice the speed. The man behind