Confessions of a GP

To try to swing the encounter in my favour, I have developed a battle plan. The first thing that I do is try to empathise and say how the child definitely does have a very bad infection — be it a cough or ear infection or sore throat, etc. I sympathise about how hard it is for the whole family when a child is up all night coughing and crying, etc. Vital is me then telling the parents what a great job they are doing with regular paracetamol and lots of cuddles. My aim is to make them feel that I am on their side and that I realise how exhausted they are with no sleep and a miserable child. Then I explain why antibiotics aren’t appropriate to treat viruses, but still offer them as an option. If I’ve done my job well, they say no, but feel that it is their decision. Finally, I make sure that they will come back and see me if they are concerned and tell them about the worrying symptoms of meningitis to look out for.

If I’ve succeeded, they don’t come back, as the parent feels more confident and the natural course of these viruses is that the child gets better. Ideally, they also feel a bit more confident about managing the child at home next time they are poorly. When these consultations go well, they are great. When they go badly, they are a disaster and usually either end up with the child getting an inappropriate prescription for antibiotics or an anxious parent getting very upset and dragging their child to A&E.

Uzma

It’s 6.30 p.m. and my last patient has just walked in. I’m running on time and I’m due to meet a few friends for a drink after work. Working in offices, they have been in the pub for ages and have a pint waiting for me. If I can just get through this last patient quickly, whizz through some paperwork, I’ll be in the pub by seven.

Uzma comes in. ‘I need the repeat of my pill, Doctor.’

Happy days! Contraceptive pill checks are a boring part of general practice but quick and easy. I do a speedy blood pressure reading, ask if there are any problems, which invariably there aren’t, and then the patient is out of the door within a few minutes.

Just as I’m generating the prescription, Uzma seems to be welling up. I’m torn now. I am a nice sympathetic doctor. Honest! It’s just that I’m tired and drained and I can practically taste my pint. I really don’t fancy spending the next half-hour listening to a weeping 16-year-old. I contemplate pretending not to have noticed, but it’s too late. The tears have arrived. They are unmistakable, especially as they are now dripping onto my blood pressure machine. I sink into my seat and prepare myself for a long evening.

‘So Uzma, you seem a bit upset?’ Not exactly reading between the lines, given her quiet sobs have now turned into loud wailing.

‘I can’t go home tonight, Doctor; they all hate me. Everyone hates me.’ More wailing and tears. ‘They blame me for everything and always take my brother’s side.’ Wail wail. ‘My parents don’t understand me. We’ve had a massive fight. There’s no way I’m going home tonight. No way!’

Uzma’s parents are from Pakistan. Perhaps they are forcing her into an arranged marriage or trying to make her drop out of school? I saw a Tonight special with Trevor McDonald on this sort of thing. Perhaps I can really help this young woman. I’ll need to get social services and the police involved tonight and find her a place of safety.

‘Uzma, are your parents very strict with you? Are they trying to make you do things you don’t want to do? Do they hit you?’

‘Hit me? God no.’ Uzma looks at me like I’m an absolute idiot. ‘They all just hate me ’cause they’re losers. My sister Nadia, yeah. Oh my God, she’s such a bitch. Only because she’s jealous ’cause she’s got a big arse and no boys fancy her and my mum is always moaning at me about doing my homework and she never says nothing to my brother. He does whatever the fuck he likes.’ Like the tears, the words are now unstoppable. There are no breaks for punctuation, but only the odd pause to wipe her tears and blow her nose before the next torrent of adolescent anguish is released.

My interest is diminished again. There aren’t going to be forced marriages or honour killings. This is just an ordinary 16-year-old having a hissy fit after a row with her parents. Uzma’s mum and dad seem fairly liberal all in all. They probably wouldn’t be too happy if they knew she was shagging Darren who works in the garage but then that’s not a cultural thing, nobody would want their daughter shagging Darren from the garage.