Confessions of a GP

I also found myself feeling very judgemental during a child protection case conference. I was in a meeting with social workers, health visitors and other professionals discussing what should be done with an unborn baby belonging to one of my patients. I knew the mum-to-be well and, quite frankly, I thought she would make an absolutely terrible mother. She was rude, aggressive and always in trouble with the police. The dad wasn’t on the scene and her own family had disowned her. I just didn’t believe that she was the right person to give that baby the best start in life. Everyone in the meeting was very professional and positive. They were looking to implement extra support for the mum to help her with her new baby. I tried to be positive, too, and I do think kids are best off with their real parents, but a big part of me wanted to take that baby away at birth. I wanted to give him to the nice couple who kept failing with the IVF. I just felt that the child would have a better future with them than with its real mother.

Deep down I knew that I had no right to pass judgement on who would make better parents. I see my patients for ten minutes at a time and don’t have the right to decide if someone should have their child taken away. What do I really know about parenting anyway? Would I like someone passing judgement on what sort of dad I am? Back at the case conference we all agreed that once born, the baby would be put on to the child protection register but stay with the mum and be closely monitored. I hoped I’d be proved wrong and that the new mum would do a great job. I know it is not my place to judge my patients but it can be very difficult sometimes.

The examination game

There is a lot of drama in medicine. As a doctor much of what I do is a performance rather than an attempt to actually gain important medical information. The examination is perhaps the most evident example of this. Examining patients is obviously important and sometimes I even find something abnormal…But a lot of the time the examination is a bit of a fraud. It is all part of my attempt to add mystique and importance to my job.

An example of this is when I visit one of my patients called Mr Briggs. Mr Briggs is well into his nineties and very frail. He has lots of things wrong with him, but unfortunately, they are mostly because of his excessive years and there isn’t a great deal I can do about them. I’m fairly certain that Mr Briggs is going to die within the next year and my main objective is to make sure he remains as comfortable as possible and that I provide reassurance and support for him and his wife. Whenever I visit Mr Briggs, I check his blood pressure. I check it every visit and it doesn’t change much. Even if it was raised, Mr Briggs has already said he doesn’t want to start any new medication and certainly doesn’t want to have any tests or investigations if he becomes more unwell.

Ultimately, I am not examining Mr Briggs for his physical health but for his emotional health. He is expecting me to examine him and by going through the motions, I am offering reassurance. Human-to-human contact is comforting. I am English so I don’t give Mr Briggs a hug. Instead, I use a blood pressure cuff and a stethoscope to reach out and make some soothing physical contact with this dying man. ‘Strong as an ox,’ I often say after listening to his heart. It sounds patronising written here but I know that Mr and Mrs Briggs are reassured by my words. ‘I wish the rest of my body was as strong as an ox,’ Mr Briggs will reply as I shake his hand on leaving. Sometimes I wonder whether my examinations of Mr Briggs are actually as much for my benefit as for his. If I didn’t have the extra gimmick of my stethoscope and blood pressure machine, how could I justify my visits? They are the instruments that define me as a doctor and without them I could simply be a visiting neighbour or the local vicar.