Confessions of a GP

Whenever I visit Jackie she wants me to try her on a new painkiller. Giving out a quick prescription is the easiest option for me as it is the quickest way that I can get out of the house. The problem is that I know that whatever I prescribe won’t work. She has tried every painkiller I can think of and now the only step up from here is morphine. I really don’t want to be responsible for making her a medicalised heroin addict; besides I know her kids will steal it and either take it themselves or sell it on the estate. Perhaps if I could just help her take some ownership of her condition and recognise the psychological element to it, maybe I could genuinely help her.

‘Jackie, why do you think you’re having all this pain?’

‘I dunno. You’re the doctor.’

‘It looks like you have had quite a hard time over the years.’

‘You can say that again.’

‘Some people find that going through large amounts of stress and upset can contribute to having physical pains and low energy.’

‘You think I’m making it up, don’t you. This pain is real, you know.’

‘I don’t think you’re making it up, Jackie. The pain is real but I just think that perhaps all the stress you’ve been through might be a big component to your symptoms.’

‘Nobody believes me. You doctors are all the same. You can’t leave me like this. I need something for the pain. I’m only 39 and I’ve not been out of the house for weeks. That can’t be normal, can it? You have to help me. I need something for the pain!’

‘I’m sorry, Jackie, but research has shown that fibromyalgia doesn’t really respond to painkillers. Some people find that gradually increasing activity levels and exercise can help. I could also refer you for some specialist talking treatment called cognitive behavioural therapy. There have been some studies to suggest that this can be useful.’

‘So you’re basically doing nothing for me.’

‘I’m not sure what more I can do, Jackie. I’m sorry.’

In my career as a doctor I’ve probably seen about 20 cases of chronic fatigue and fibromyalgia. In all the cases, after delving deeply, the one common factor that seems to link all the sufferers is ‘shit life syndrome’. Maybe in the future I’ll meet someone who is struck down with the condition without any predisposing psychological problems, but I doubt it. Doctors tend to deal badly with patients like Jackie. By simply organising more tests and giving more drugs, we are positively reinforcing the idea of the sufferer having a physical illness that is the responsibility of the medical profession to treat. The years of hospital out-patient appointments and specialist referrals encourage the idea that the person is sick. It is a role that they subconsciously fill and become dependent on. Being labelled as ‘ill’ is a distraction from the fairly miserable social and emotional problems that are the underlying cause. In some cases, being ‘ill’ is also a way of exerting some control on the people around them.

What would be more useful is if we could encourage patients like Jackie to take some responsibility and ownership of their condition and try to gently persuade them to start thinking about the connection between their physical and emotional health. This is easier said than done and my best efforts to do so clearly failed miserably.

The next time Jackie requests a doctor she specifically asks to see any doctor other than me. I know that this means I have failed, but I have to admit that it is a real relief to know that I won’t have to stand awkwardly in her lounge feeling helpless as I watch her suffer. One of my colleagues visits her instead and starts her on morphine.

Mrs Briggs

It is 3 a.m. on a Sunday night and I’m working on call for the ‘out-of-hours’ doctors. I get a call through to do an emergency visit. Before I arrive, I have only minimal information about what to expect. All I know is that I’m visiting Mrs Briggs who is in her seventies and has breast cancer.

When I arrive, five or six family members greet me at the door. I’m ushered upstairs in hushed silence and shown into a dimly lit bedroom. In front of me lies a skeleton of a woman. Pale and semi-conscious, she is quite clearly dying. In my years as a doctor I’ve seen many people die. In hospital it is all quite clinical. It is easier to think of them as the ‘stroke’ in bed 3 or the ‘lung cancer’ in cubicle 2, rather than as a real person. In the patient’s own home it is less easy to protect yourself from the enormity of somebody’s death. Surrounded by belongings and pictures of them looking healthy and contented during happier times, the dying person feels overwhelmingly real.