The best thing about herbal medicine, though, is that it provides an ideal dumping ground for frequent attenders who make GPs want to resign whenever we see their names on our appointment lists – people who refuse to accept that there’s nothing really wrong with them, for whom diverting them into the arms of a complementary therapist who won’t actively harm them offers a solution.
Which rather raises the question: why does the mention of tincture of variegated Tasmanian clover leaf evoke in me (and most average GPs) a feeling normally reserved for when I’ve just trodden in something unsavoury?
First, because herbalism is generally taken far too seriously. We’ll acknowledge that a few herbal treatments do the business if you’ll admit that the rest are a load of nonsense.
Second, let’s cut out all that annoying pseudoscientific, quasi-religious baggage, shall we? Apparently, many herbalists treat ‘the whole person’ by ‘stimulating the body’s natural healing powers’ using cures derived, typically, from the ‘mystic east’. Curing a snotty nose with a decongestant dispensed by a chemist in Herecaster clearly does not carry the same gravitas.
And third, let’s recognise that, at times, herbalists do spout garbage at the gullible. For example, their cop-out treatment, when the random-herb-generator fails them, is always the same: listen to a herbalist for long enough and, inevitably, he will recommend camomile tea. This, it seems, cures everything from piles to psychosis.
Of course, the real issue with herbal treatments is that we GPs simply don’t know enough about them to feel comfortable, or sound authoritative, with our herbivorous patients. Not through ignorance, or disinterest – it’s just that the evidence required to give sensible advice isn’t available.
While the British National Formulary bails me out of any standard prescribing conundrum, Dr Hessayon’s Vegetable and Herb Expert still leaves me clueless on the beaded and be-hooped Mrs Garland’s question of whether tincture of variegated Tasmanian clover leaf is OK.
Maybe it is, but I doubt it’s as good as camomile tea.
CONCORDE
MRS Mann visited me yesterday, dragging her embarrassed husband with her. He sat in the chair opposite me, looking like a Bassett hound caught peeing on the carpet, while she talked on his behalf.
‘It’s his snoring,’ she said. ‘It’s driving me round the bend. I haven’t had a good night’s sleep since… well, since I don’t know when. He sounds like Concorde. You’ve got to do something about it before I brain him.’
‘Like Concorde?’ I said, sceptically.
‘Like Concorde,’ she said, whipping out a mobile phone as she spoke. ‘I knew you wouldn’t believe me, so I recorded him last night. I’ve set it as my ring tone.’
She pressed a couple of buttons, and the sound of Mr Mann’s night-time rumblings issued forth. It did, indeed, sound like Concorde. My eyes widened in surprise.
‘Told you,’ she said, switching the phone back off and returning it to her handbag. She shot a withering glance at the man of her dreams. ‘Now, what are you going to do about him?’
I looked at Mr Mann. He was approximately the size and shape of a walrus; therein probably lay a large part of the problem.
‘Does he snore constantly at night?’ I said.
‘No,’ said Mrs Mann. ‘He snores for a few minutes, then he snorts and wakes up, and then he goes back to sleep and starts snoring again. Then he snorts and wakes up again. And that goes on and on. All night long.’ She punctuated her speech by slapping her hand on my desk. ‘I’m going to do him a bloody injustice one of these nights.’
‘Hmmm,’ I said. ‘And is he tired during the day?’
‘Is he tired during the day?’ screeched Mrs Mann in indignation. ‘I’m the one who’s bloody tired!’
I decided to address Mr Mann directly. ‘Would you say you’re tired during the day?’ I said.
‘Tired?’ he said. ‘I’m too knackered to be tired.’
He eyed his wife nervously. She was looking at him with a venom bordering on the psychotic.
‘Well,’ I said, in my best, cheery let’s-all-get-along voice. ‘I think Mr Mann may be suffering from a thing called sleep apnoea. A lot of really serious snorers do. It’s a condition in which the muscles and tissue of the throat relax as the patient falls asleep, closing off the airway momentarily. The brain gets starved of oxygen, and sends frantic messages which wake the person up. He splutters back to life and the whole cycle starts again. It can be quite deleterious...’ Mrs Mann shot me a suspicious look. ‘...that is to say, quite bad, for the sufferer.’
In fact, people with sleep apnoea are so zonked out that they have an alarming tendency to fall asleep at the wheel, so in the long run evolution will wipe them all out. On the downside, they’ll take quite a few of us with them.
‘There are various types of sleep apnoea,’ I said. ‘Some are worse than others. In some cases, surgery is required, but I think you probably have a less severe form, Mr Mann. Do you drink?’
‘A bit.’
‘How much?’
‘Say five or six cans a night. While I’m watching the telly and that.’
‘Hmmm. I see. And do you smoke?’
‘A bit.’
‘How much?’
‘About twenty a day.’
‘Hmmm.’
‘And you’re 58 years old? Well, people of your age, particularly men, and particularly men who smoke and drink and are overweight, are the main sufferers of sleep apnoea. So here’s what you need to do. You need to stop smoking if you can, or at least smoke less and not in the evenings. You need to drink less and, again, not in the evenings – that will also stop you getting up in the night to the loo.’ He had developed a glazed look, so I turned to his wife. ‘Does he do that, Mrs Mann?’
‘Twice a night, every night.’
‘OK, the other thing you need to do is lose a bit of weight, Mr Mann,’ I said.
He was 5ft 8in tall and 16st 10lb. Although my dog could tell he was obese, I worked out his Body Mass Index. The fat walrus came in at a BMI of 37 – thoroughly obese. Not quite morbidly so, but not far off.
‘Yes,’ I said, shaking my head ruefully. ‘It’s as I thought – you do need to lose a few pounds. It shouldn’t be too hard – walk to the shops, eat a little less, drink a little less. If you do that, and you cut out the smoking and drinking in the evenings, the apnoea should disappear. It’ll be sweet dreams all round.’
‘How long will that take?’ said Mrs Mann, sharply.
‘Well, it shouldn’t take too long if he follows my advice.’
‘So what happens to me in the meantime? I need some sleepers.’
Ah, sleepers. In some ways it would be nice to dole out the flurazepam or zolpidem, just to get the Mrs Manns of this world out of the surgery, so I can edge closer to my coffee break. But while sedating the punters into submission has its attractions, it’s not really on.
‘Well,’ I said, ‘the thing is, sleeping pills are addictive and they have quite a few dodgy side-effects. Do you drink?’
‘A bit,’ she said, slightly defensively.
‘How much?’
‘A few glasses of Lambrini, maybe.’
‘A few glasses?’ exploded Mr Mann, swivelling round in his chair. The worm was turning. ‘A few glasses? You don’t want to listen to a word she says, doctor. She drinks a bottle a night. At least.’
‘I do not!’ she said.
‘You do!’ he said.
‘I do not!’ she said again.
I stepped in. ‘OK, well, either way… And do you smoke?’
‘A bit.’
‘How much?’
‘About twenty a day.’
‘Hmmm. Yes. And are you a big fan of daytime TV?’
‘I like Cash In The Attic. And Bargain Hunters. Sometimes Jeremy Kyle.’
‘And in the evenings?’
‘Well, I like to watch Murder She Wrote. It’s always on UKTV Drama.’
‘And The Inspector Lynley Mysteri
es,’ said Mr Mann. ‘Come on, let’s have the truth. And Bergerac. And A Touch Of Frost. And Brit Cops: Zero Tolerance. And bloody Magnum, PI. She loves that Tom Selleck.’
I intervened before things turned nasty. (Or nastier.) ‘So you’d admit that you sit around quite a lot watching the box? You see, that’s perhaps part of the problem, particularly if it’s late night telly, it gets your mind whirring. You know what, Mrs Mann, I think you’d benefit from taking a little more exercise, too. You could go for walks together.’ She bristled. ‘Well, it doesn’t have to be together. But just turn the telly off, go for a walk, and when you get back home, drink a little less Lambrini and cut the smoking out. I think you’ll soon find you sleep a lot better. Try and get to bed at the same time each night – routine really helps. And you could always buy some earplugs, too.’
HOME VISIT
AFTER THE HORROR of the Manns, I picked up my bag and headed out to the trusty Nissan on a home visit to a lady with stomach pain.
But, you say, surely GPs don’t do home visits any more?
Not strictly true. Yes, we try to avoid them, but sometimes circumstances conspire against us: I might be on my way to the surgery when a call comes through requesting an urgent home visit for a 22-year-old male who is ‘vomiting and dehydrating’ and who lives a minute’s drive away. I can almost guarantee that the sufferer will be a hung-over piss artist who half-reheated some week-old pizza last night. All he really needs is a routine ‘take some clear fluids and see me in the morning’ phone call, but I might as well give him ‘Gastroenteritis for Dummies’ face-to-face, rather than bump up my mobile bill.
Besides, until you’ve felt the soles of your shoes stick to a hallway floor, skirted around piles of pet droppings on the stairs and pulled a curtain rail off the bedroom wall to allow sunlight to enter for the first time in years, you’ve no business calling yourself a front-line medic. I recall one trip to a flat on the edge of civilisation, where – somewhere in the stygian gloom, under a duvet held together only by the crusty stains of bodily fluids, among the beer cans, ashtrays and black T-shirts – lurked a sickly Goth youth with a stiff neck and an aversion to light, the strength of which was unusual even for him. Alongside, watching with a quizzical eye, lay an iguana: this was my first case of reptile-poo-transmitted salmonella meningitis.
I put my collar up against the spitting rain, dashed across the surgery car park and got in to my car. I looked at my watch as I started the engine. Just gone 6.15pm. The patient lived on the right side of town for me, so it wasn’t too painful; I could deal with her stomach pain and then head home for a well-deserved glass of something dry and white, and the latest Jack Reacher novel.
I trundled out onto the road and headed off to Market Way. Fifteen minutes later, I was outside the house – a 1930s semi with a caravan in the driveway and a ridiculous leylandii blocking out the sky. I knocked on the door. It was opened by a harassed-looking woman in her early 40s.
‘Mrs Peecher?’ I said. ‘Dr Copperfield.’
‘Oh,’ she said, with less enthusiasm than she might have shown. ‘Yes. Can you wait in your car for half an hour? Only, he’s here at the moment and I haven’t got room for both of you.’
‘Who’s here?’ I said.
‘You know,’ she said, nodding in the direction of a van parked across the road. ‘The telly man. That’s why I called you out.’
I looked at the van. ‘I’m sorry,’ I said, ‘but I don’t understand. You called me out because the telly man’s here?’
‘Yes.’
‘Eh?’
‘He’s come to install our Sky. They don’t give you an exact time, you see.’
‘But what has the TV man got to do with… wait a minute. Are you saying that you called me out – as opposed to coming in to the surgery to be seen – because you had the man from Sky TV coming round and you couldn’t leave the house because he couldn’t say when he’d be here?’
‘Yes, that’s right,’ she said. ‘He’s nearly finished. Can you wait in the car?’
‘Look,’ I said, ‘home visits are for patients who are genuinely ill and who can neither make their own way, nor be brought, to the surgery by someone else. I don’t care if you’re waiting for the man from Sky, the man from Atlantis or the man from Del Monte.’
I didn’t wait in the car. In fact I didn’t wait at all. No one keeps Reacher waiting.
STUPID DOCTORS
SADLY, PATIENTS AREN’T alone in their stupidity.
Over the years, I’ve been responsible for many cock-ups, many of them actually occurring on home visits.
Usually it’s merely mildly embarrassing – I’ve lost count of the times I have been unable to retrace my route from a patient’s bedroom to the front door, so that I’ve been found some time later by a relative, as I wander around the place like a retarded rat in a maze. On one occasion, I coaxed a rather mangy dog from out of the front garden back into a patient’s house and up the stairs on to his sickbed. The idea was that the sight of his threadbare mutt would cheer the chap up. Unfortunately, it wasn’t his dog.
Back in the days when we did a lot of out-of-hours visits, patients with emergencies like a slightly runny nose or a bit of a headache could call me at home and get me to drive out to them to hand them the paracetamol which was sitting on the bedside table two feet away. It was great fun. I remember arriving home one night at gone 7.30pm, after a particularly trying day of vomiting, incontinent kids and smelly old folks, with plans to do nothing but veg out on the sofa and watch the whole of series one of The Office.
I found Mrs Copperfield luxuriating in a tub of Radox and belting out her rendition of Nessun Dorma – a rendition, I must say, that Puccini would not have recognised.
‘Two calls,’ she trilled, a little too gleefully for my liking.
She always insisted on helpfully taking their details and promising on my behalf that I would ring them back immediately on my arrival.
I grabbed the notebook by the phone and looked at the first page. Hah! Toothache! Sorry, wrong profession. Try again when you pop your appendix.
I turned the page for the second message. ‘Mr Brown,’ it said. There was a number, and nothing else.
‘Mr Brown?’ I hissed, as the caterwauling continued from upstairs, oblivious. ‘You could have got a bit more detail.’
I punched the handset and waited for it to ring, tapping my fingers on the table and thinking about my priorities: a shower, supper and David Brent.
‘Hello?’
‘Ah, is that Mr Brown?’ I said.
‘Yes, it is.’
‘It’s Dr Copperfield, here. I’ll just take a few details. Your first name?’
‘Eh?’ he said.
‘Your first name?’ I said. ‘Can I have it? Your first name? Come on, come on, I haven’t got all night.’
‘Why do you want to know my first name?’ he replied, with more than a hint of suspicion.
‘Well, isn’t it rather obvious?’ I said.
‘Not really,’ he said. ‘I mean, is it important?’
No, I thought. I’ll just hand whatever pills you need to you out of a big bag. Who needs to keep records?
‘Well, of course it’s important.’
Not least because I don’t visit people called Wayne or Kyle.
‘But why?’
‘Look,’ I thundered, ‘you’ve called the doctor, right? Don’t you think you might at least extend me the courtesy of giving me your name? You know? Hmmm? For my notes?’
There was a pause.
‘I did call you,’ he replied. ‘But that was a month ago. And it was about your guttering. You had a problem with a leak.’
I looked down at the message book. I had turned over two pages. ‘Wrong Mr Brown,’ I said. ‘Terribly sorry to have disturbed you. Good night.’
Then I slammed the phone down, broke into the bathroom and turned the cold tap on full.
But today I managed to top all of these humiliations.
I to
ok a call from one of our local nursing homes for a lady who was ‘off her legs’. Such calls elicit an unpleasant Pavlovian reflex, for the simple reason that they’re almost always crap. The symptoms of the barely sentient are Chinese-whispered amongst only slightly-more-sentient staff, to be presented to the doctor by someone who learned their logic and clarity at the School for Railway Tannoy Announcers – and who knows to end every message with, ‘Straight away please.’
Given the interruption to afternoon surgery, and the likely shambles ahead, I managed to work myself up to a nicely explosive pitch of irritation en route. So Dr Copperfield had a menacing look as he strode purposefully and pompously into the nursing home.
I barked at the nearest member of staff. ‘Where’s Mrs Skiffins?’ I’ve been called out urgently to assess her?’
My lips curled nicely into a sneer with the word ‘urgently’, and I spent the next few moments refining my ‘I’m an important doctor in a hurry, and you’re a bunch of tossers’ expression.
The staff looked at each other in confusion. One was eventually brave enough to speak. ‘I’m sorry Dr Copperfield, I don’t know anything about this. And I don’t actually know where Mrs Skiffins is.’
I snapped. Two decades’-worth of suppressed, nursing home-induced vitriol erupted. ‘Bloody hell!’ I roared. ‘This really takes the sodding Rich Tea! You drag me out of surgery for an emergency and you don’t even know where the sodding patient is! You should be ashamed of yourselves, sitting around on your fat backsides while the rest of us are trying to hold the NHS together. This is a load of... of...’ I scrabbled frantically for an appropriately blistering, expletive-loaded and irrefutable phrase. ‘It’s a load of arse,’ I said, finally.
Sick Notes: True Stories from the GP's Surgery Page 13
