Other People

This was an article on Pulse Today today, and it annoyed me so much that I thought I’d rewrite it, showing instead a model of how the same theoretical appointemnt would go as an “ideal interaction” as a patient.

 

I’ve reproduced the full text of the original at the bottom, in case it gets mysteriously deleted.

 

My version goes here, keeping the same title for continuity’s sake;

Treating a Chronic Sense Of Self-Entitlement

She’s new to the surgery, so I’ve booked her a long appointment, knowing that a change of practice means that I’ll get a whole flood of complaints and ongoing issues that need chasing up from her last doctor. I know that I should have read at least the brief precis of her notes before she got here, but they’ve not been uploaded yet, so I’m going to have to wing it.

She launches straight in as soon as she arrives, knowing that a fifteen-minute appointment isn’t much time in which to cover everything;

‘I need a prescription for all my usual meds plus some extra sleepers. And supplies of milk for the baby. My sickie’s overdue and I need a letter from you to help my appeal. How can I work with these knees? I need them X-rayed. And you need to do something about my weight. And while you’re doing the prescription, you can put on some nicotine patches,’ she pauses for breath, ‘And you can do me a rehousing letter. I need a ground-floor flat coz for some reason they’ve put me on the second floor and the lift never works.’

I lean back a bit in my chair, slightly taken aback by the machine-gun fire patter (She’s evidently been running the list over in her head for a while) and start sorting things out in my head.

“Hang on a minute” I say “That’s a lot to take in at once – If we can’t cover everything in this session, can you book a second one for…” I click through my calendar, finding a few slots in the next fortnight “…Either Monday at 9am, or Thursday at 3.45?”

She nods at one of these, which I quickly grey-book.

“Right, sorry. Admin. Which is the most important to you then, that needs to be done today?”

She takes a deep breath.

“Sick note first, my manager has been harping on for a week to get it up to date, and if I don’t get it today, I’m out of work.”

I nod, and queue up the form to type a sick note.

“What exactly is the problem then?” I ask “Is that your knees?”

Assent, again. I ask how long they’ve been bothering her, and to describe the problem a bit. She does so, saying that they affect her ability to work, and I surmise that this is why she wants a flat on the ground floor. I book her in for the community physio, warning her that the first thing they’ll do is to tell her to lose weight and eat better, which will help her weight as well as taking the stress off her knees, and book her in for the aforementioned imaging as well – An x-ray at the walk-in within the week, and a waiting list for an MRI.

I give her an exercise prescription card and, remembering that she said she had a baby, tell her which of the council leisure centres nearby has a creche.

And then I print out the sicknote, saying in half a dozen words that her knees are in pain and are being investigated by her GP.

 

I do a mental checklist. That covers “ My sickie’s overdue“, “I need them X-rayed” and “do something about my weight“. What’s left…

 

“You asked about a repeat prescription – Have you got an old slip on you?”

She has, so we look through it together, and she tells me how each of the medications help her, and what their side effects are. Together, we work out two medications that could be streamlined into one, one which she stopped taking months ago but forgot to stop refilling, and one where she’s happy to try a different medication in the same family since it has a slightly gentler set of side effects.

“You mentioned needing extra sleepers” I say, reading the exact medication off the list “Do you ned more of the same, or a different one?”

She shrugs, and I realise that I should have known that she wouldn’t know, because she’s not a doctor and might not even know how they work. I ask a few questions – Have they stopped working? Do you need more to get the same effect? Have your sleep problems got worse? Did they just not work very well in the first place? And quickly work out what she actually needs, and amend her prescription accordingly, making sure that she can pick up the whole new prescription on the way home (Nobody likes having their medications out-of-synch).

I look up at the clock – Ten minutes left, we’re actually doing well for time, and this is what long appointments are for.

“Nicotine patches, you say? Are you quitting smoking?” She nods proudly, and I smile, more than happy to help.

I dive back into the questions – Have you tried to quit before? How much do you smoke per day? And offer her the “smoking cessation” booklet that I know has all the information in that I don’t have time to share, along with advice to ask her pharmacist for more advice if she needs it, a prescription for her first course of patches, an invitation to come back in a month to see how she’s doing, and a hearty wish of good luck and goodwill.

I ask her again what’s left on her list, since I can’t remember all of it, and she’s more likely to remember what’s troubling her than I am.

“Milk, for the baby” she says, and I wonder why she needs prescription milk – Again, the notes aren’t through yet, so I ask her what the prescription milk is, and determine if it’s something that we can actually supply or not, and check that she’s got an appointment with the New Mothers’ clinic, which does basic health checks for both the baby and the parent, and ask if she wants some literature for the new parents’ group that the clinic runs.

I rack my brains, to see what’s left.

“You said you needed a letter for rehousing?”

She replies;

“Yeah, I’m on the second floor, the lift’s always broken, and it’s playing havoc with my knees.”

I think quickly; If this is only a temporary problem, she won’t need to be rehoused, but it’s definitely worth getting on to the council to get them to fix the lift. I bring up her address, look up the number for buildings maintenance on the council website, and tell her to phone them, writing it down clearly on a piece of paper along with the words “Reasonable accommodation”. If this is a permanent problem… Hmm. I’m already going to see her again in a month, but I tell her to book a long appointment for then as well, to cover both her knees – which since she’s off work and unable to climb stairs are evidently really affecting her quality of life – and her smoking.

 

I look back up at the clock. Three minutes to go.

“Does that cover everything?” I ask. She counts on her fingers;

“Bad knees, weight loss, milk, housing, sickie, smoking, repeat prescriptions.”

I reply;

“On the physio waiting list, booked in for imaging within the next month, got the gym card, booked in for the mother and baby class, you’re going to phone your landlord about the lift and I’ve given you the number, you’ve got your sicknote there in your hand, we’ve gone through your prescription and changed a few things – including giving you nicotine patches – and you’re coming back in a month to tell me how the physio and the quitting are going, and to see what your x-ray has brought up.

“Sorry, I know it’s a lot to remember, but everything that you need to remember is in one of those papers in your hand, and you’ll get a letter from the Trust to tell you when your appointment is once it’s booked. Is that all all right?”

She smiles, looking honestly relieved;

 

“Yes, thank you. Right, see you in a month.”

 

I wish her good-bye, and off she goes. As she gets to the door she says;

 

‘Any chance of a prescription for Calpol?’

It clicks – Prescription for milk, prescription for Calpol; She’s struggling financially, both of these being things that you can buy comparatively cheaply, but that (If you get free prescriptions due to being on an out-of-work or low-earnings benefit, which she may well be since she’s ben sick for long enough to need more than one sick note) a doctor could prescribe. And being on half-pay for sickness, or possibly even needing to take the sicknotes to the jobcentre, will wreck anyone’s sense of financial stability. Thankfully, the council have some advice leaflets and a service to phone to get a foodbank referral and help from the local credit union, and the Citizens Advice Bureau can do the rest. Along with the prescription for Calpol, I give her that information.

 

 

***

Am I naive in thinking that’s both a much nicer interaction, and not completely above-and-beyond the call of duty? The GP sees someone who’s “learned helplessness” and “sufferring from a chronic sense of self-entitlement”, based solely on the idea that they’re working class, have poor social graces, are fat, and are concerned about their weight and joint pain, and seem to be at a loose end financially. I see someone who’s trying to quit smoking, trying to manage their weight, trying to get to the bottom of a health problem that’s bothering them and has stopped them from both working and sleeping, and is running up against an obstreperous GP who won’t even point them in the right direction. This is a GP who sees someone who is in pain and distressed and decides it’d be “fun” to call them names.

I’m baffled by the idea that going to your GP with a long term health-problem is “Being entitled to anything and everything”.

 

 

Treating a Chronic Sense of Self-Entitlement

“She’s sunburnt, elephantine and heavily tattooed. Which may or may not be relevant, but is a fact. She’s also new to the surgery.

Waiving all the conventional niceties, she launches straight in: ‘I need a prescription for all my usual meds plus some extra sleepers. And supplies of milk for the baby. My sickie’s overdue and I need a letter from you to help my appeal. How can I work with these knees? I need them X-rayed. And you need to do something about my weight. And while you’re doing the prescription, you can put on some nicotine patches,’ she pauses for breath, ‘And you can do me a rehousing letter. I need a ground-floor flat coz for some reason they’ve put me on the second floor and the lift never works.’I take a step back mentally if not physically, though the latter’s tempting. This, I reckon, could be fun.

‘I think I can see the overall problem here,’ I say, ‘You’re suffering from a chronic sense of entitlement.’ She narrows here eyes, but I plough on, ‘You’re confusing wants with needs, and because no-one has ever explained the difference, you’ve developed a learned helplessness and dependency which you’re locked into. I suspect no one has ever had the time or inclination to liberate you, but that’s what I’m going to do. Your freedom lies in one word, and that word is, “No”. So that’s what I’m saying. No. To everything.’

I sit back and wait for the fallout. The fact that I’ve folded my arms really isn’t a sign of smug self-satisfaction. It’s actually self-protection. So’s the tin hat.

She leans forward, looks me in the eyes, and begins: ‘I think I can see what you mean, doctor. You’re saying that over the years, I have developed the attitude, perhaps reinforced by health professionals, that I’m entitled to anything and everything. In turn,’ she continues, ‘This has undermined any vestigial ability or inclination I might have had to sort out my own problems, with the result that I’ve developed this unrealistic level of expectation and intractable passivity. The fact that everyone has bowed to my demands has simply, in the long term, led to my own disempowerment. I’ve become a victim of those who have tried to help me, because they have effectively rendered me helpless. So I understand why you’re saying “no”. Indeed, I appreciate the irony that your refusal is, after all, simply a reflection of your own entitlement, as a responsible professional, to tell what you see as the truth. I respect the stand you’re taking and will try to move on from here. I bid you good day.’

With that, she got up to leave.

 
 

Hand on doorknob, she turns and asks, ‘Any chance of a prescription for Calpol?’

‘Sure,’ I say.”

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

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12 thoughts on “Other People

  1. Percy, you might want to correct the information on Calpol. It can safely be given to babies from 2 months. https://www.calpol.co.uk/our-products/calpol-infant-suspension.

    Here our CCG seems to control what can and cannot be given on prescription – so Mike’s Ensure was withdrawn on their say-so, even though his eating disability from cancer is life-long. GPs here do not have complete autonomy to prescribe whatever they like to their patients!

  2. As far as I know, ‘normal’ infant formula is not available on prescription. If a baby needs a specialist infant formula, then that would be a different situation. There seem to be local NHS guidelines on that.

    So anyone demanding a prescription for regular infant formula from a GP might well be met with very raised eyebrows!

    I’m not arguing with the spirit of what you have written, just saying the detail is actually quite complicated.

    • True – I suppose I assumed that if she was asking for formula from the GP, it would be because she’d got it from her previous one, and that it was because of some specialist need of the child’s.

      I shall do a quick edit. I honestly can’t remember writing any of this, I was completely knackered last night and can only vaguely remember what I wrote.

  3. The crude and offensive stereotyping is still crude and offensive though, irrespective of the details.

    • Oh absolutely. The whole original piece just reads like an advert for why some people – however intelligent – just shouldn’t be GPs.

      It should shock literally nobody that if you’re working in a poor area, where a lot of people are vulnerably housed or in precarious employment, they’re going to have social concerns that butt up pretty closely against their health problems.

  4. Was going to comment on Calpol, but see that’s already been mentioned! Other than that, your version is so much more professional and humane. Coming from a long line of doctors on my mom’s side, I totally agree some of them really more suited for other work. Need compassion as well as medical knowledge.

    • It’s all the fault of stuff like House, and the long line of “Heartless genius; He hates everyone, but he fixes them anyway and is Always Right” narratives.

  5. What a horrible article that Pulse one was. When life gets complicated, it’s difficult to keep track of everything sometimes and I know I’ve blurted out lists of half a dozen things I need my GPs help with at times because more things I’d been putting off have just kept popping into my head.

    Irregardless, here is a woman trying to quit smoking and wants to lose weight. Any GP should be overjoyed to be asked for help with someone taking positive steps to improve their health. And patients certainly shouldn’t be blamed for the intersection between the NHS and the DWP and the NHS and the counail housing department, they didn’t set up the system to function like that.

  6. I can imagine that if someone came into my surgery and gave me that long list of things which needed fixing, I would be annoyed. This is one of the many reasons that I am not a GP! It would not make me nearly so annoyed as reading about a GP imagining brushing off yet another entitled woman who happened to have many needs. It’s knowing that some doctors think like this which makes it hard for me to visit the GP. (As many of my health problems are probably imaginary, this is probably the best thing. I only hope I’m right about which ones are real!)

    I think that I am basically just ranting about that article, but in a much less eloquent and satisfactory manner than you did. Because you didn’t rant, but proposed an alternative. I’m always glad to visit doctors who seem to understand that patients are human and therefore imperfect, and enjoyed you talking your patient round from a bit annoying (to me) to co-operative, listened to, empowered, and put into a better position. Thank you for writing that!

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