Confessions of a GP

The interesting thing for me is how many of the more difficult, needy patients respond well to her. One of my patients is an addict whose alcohol and Valium use I had been trying desperately to reduce for some time. To my amazement, she responded much better to being given a good telling off by Dr Arbury than by my softly-softly sensitive encouragement. The advantage of being a patient in a big practice is that you can choose the GP who suits you. As new GPs, we are often warned not to be too nice and fluffy or we’ll get all the clingy needy patients latching on to us. Some difficult, needy patients often avoid seeing tough doctors like Dr Arbury because they don’t get the sympathy and attention they crave. It sounds a bit patronising but sometimes I think that a firm word and some home truths can do us all a lot of good. Sometimes, my patients need a sympathetic ear and a bit of genuine empathy. At other times, like all of us, they need a good kick up the backside. The difficult part is getting the right balance.

Body fluids

Patients often take it upon themselves to bring in various samples of their body fluids for my perusal. I would like to emphasise that this is normally not appreciated. A pot of urine is generally not too bothersome. Often in a jam jar, I hold it to the light, stroke my chin and let out a ‘hmmm’. I like doing this as it makes me feel like an old-fashioned doctor from the nineteenth century. Apparently, they were keen on diagnosing all sorts of illnesses by looking at the urine and then tasting it! Unlike a nineteenth-century doctor, I look but don’t drink. I also hold back from prescribing leaches or a tonic of mercury, but instead dipstick the urine and usually offer some antibiotics for a urine infection. If you are going to use a jam jar to hold your urine sample, please wash it out first. I once tested a urine sample and broke the news to the patient that it was full of sugar and therefore a diagnosis of diabetes was possible. Fortunately for the patient, it turned out that the urine was full of sugar because the jar still had a bit of strawberry jam swimming around in it.

Other body fluids that have been brought to my surgery include:

1. A condom full of semen — the patient was worried that it was a funny colour.

2. Various samples of vaginal discharge on tampons and one miscarriage wrapped up in a tissue.

3. Lots of poo. One woman brought in a week’s worth of her baby’s soiled nappies. Each was neatly labelled with a time and date and she lay them out on my surgery floor in chronological order. ‘As you can see, Dr Daniels, last Thursday morning is considerably more yellow and viscous in consistency than Saturday afternoon’s.’ I spend a lot of time convincing first-time mums it is normal for baby poo to be a bright mustard-yellow colour.

My only true body fluid aversion is sputum. I just can’t bear the stuff. Every time I view sputum, I get a flashback to a particularly long ward round in which I was involved as a medical student. I was extremely hung over and after several hours of traipsing around hot and smelly wards, we finally got to our last patient, who I will call Mr Phlegming. He was an old guy with emphysema (knackered lungs from smoking) and spent his days coughing up gallons of sputum and collecting it to show us on the ward round. As we arrived, Mr Phlegming enthusiastically held out a plastic cup full to the brim with sputum. It had a plastic lid on it and clearly none of us including the consultant was particularly keen to examine its contents. Medics are a hierarchical lot and the pot got handed down from consultant to registrar, to senior house officer to house officer and then finally to me. As the medical student, I was clearly at the bottom of the food chain and as I held the cup in my hand it felt unfeasibly heavy. ‘Come along, take a look,’ my consultant barked impatiently. Opening the lid, I was greeted with a swirling mass of muck. Not quite green and not quite brown. Not quite liquid and not quite solid. It had a colour and physical state all of its own. I began to feel my stomach gurgle and then made my excuses, just reaching the toilet before spewing. Give me shit, piss, blood and vomit any day.

Racism