Friday, 26 October 2007


This week my mood changed overnight. On Monday I was stressed by work and overwhelmed and fatigued by every extra thing that had to be done. On Tuesday and Wednesday I was on top of my game and got pleasure out of dealing with all the things that cropped up during the day. The situations were similar, the only difference was in the view that I took of them. I think the main reason for me cheering up overnight was the family celebration on Tuesday, but I want to do all I can to maintain a positive view of the job. By nature I am a bit of an Eeyore, always ready to see the gloomy side and forget my successes. So today I am going to list some of the things that have gone well in the past few days.

I saw a patient who had just been given a suspended sentence after pleading guilty to theft. When I last saw him he had been very worried that he might be “sent down”, and I had provided a report for the Court outlining his psychiatric problems. When defence solicitors write to request such reports they always invite you to “lay it on with a trowel”, to try to persuade the judge that the poor patient can't really be held responsible for his actions, and how disastrous a prison sentence would be. But a medical report ought to be impartial, to inform the Court rather than trying to twist its arm. So I had written a clear account of my patient's psychological and psychiatric difficulties to try to clarify the context in which he had offended. I worried after sending the report that it had not been sympathetic enough. But today I was happy with what had happened: the judge had been well informed and had made a wise decision. That is the best you can hope for in this imperfect world.

Another patient complained of flying phobia. After exploration it became apparent that these symptoms were really secondary to a depression for which there were plenty of causes. He was happy to accept a prescription for antidepressants and a follow-up appointment. That consultation took a little time, and I was alarmed to see that the next patient was someone for whom I had prescribed antidepressants a few weeks ago for long-standing insomnia. Being naturally gloomy I assumed that the antidepressants hadn't worked, that he would be annoyed with me for prescribing them, and that I was about to have another lengthy consultation concerning his intractable insomnia. But no, the tablets had worked extremely well and please could he have some more?

Finally, I received a lovely compliment from one of my favourite patients. She described me as “a shot in the arm” and “very reassuring”. Recently she had seen my younger partner for a flare-up of one of her chronic illnesses, but she told me “although he is very good at explaining, he's not good at reassurance”. I was very pleased by her opinion of me, for like most doctors I try “to cure sometimes, to relieve often, to comfort always”.

While Googling to ensure I had remembered this quote correctly I found a good article by Dr William Cayley who suggests three things that can help us be good comforters:

  • seek to understand our patients' agendas

  • stand in their shoes

  • strive for “I-thou” (i.e. an authentic human encounter)

I think one secret of my success with this patient is that we trust each other, and our consultations are indeed authentic encounters. I knew that she would be familiar with W H Auden's poem, which I mentioned as a joke.
Give me a doctor, partridge-plump,
Short in the leg and broad in the rump,
An endomorph with gentle hands,
Who'll never make absurd demands
That I abandon all my vices,
Nor pull a long face in a crisis,
But with a twinkle in his eye
Will tell me that I have to die.
But I don't think that she knows the wicked parody by Marie Campkin (a retired London GP) that so accurately depicts the less acceptable face of British general practice today:
Give me a doctor underweight,
Computerised and up-to-date,
A businessman who understands
Accountancy and target bands.
Who demonstrates sincere devotion
To audit and to health promotion -
But when my outlook's for the worse
Refers me to the practice nurse.
I shall prepare a copy to give her at our next meeting.


Kelly said...

I always enjoy reading your blog. Your words are invariably wise and remind me often to remember that life isn't always perfect but to try and see the positives in both what I have done and what I have. Thank you for that.

And I loved both of those little poems! Second one was fantiddlyastic! (Am I already getting cynical when still a med student/GP wannabe?!)

Elaine said...

As usual, an excdllent, insightful post. Enjoyed both poems, though hope the second one is not becoming the norm.

Anonymous said...

What a fantastic post! A delight to read and "very reassuring"!

And I thought at first (when I saw your heading) that maybe you were having more thoughts about your meat-eating habits!

Janeway said...

'This week my mood changed overnight.'

And you don't even have hormones you can blame!

Anonymous said...

Going by physical appearance, my GP is somewhere between the two extremes (I saw him mountain-biking the other day, so it's obvious he's not quite happy with the status quo). One thing I can say with complete confidence though is that he's not one of life's optimists.

cogidubnus said...

Wonderful post...I am reassured that there are still such caring people in today's NHS

A. said...

I have been lacking in my visiting of other people's blogs recently but delighted to come back to this one.

We have returned to the UK because my mother's health has taken a very decided turn for the worse, but I can say that, although her doctor is most definitely not "partridge-plump", the practice is looking after her as well as I could possibly wish. And the nurse is wonderful too.

I'm so glad you're feeling in good form, and I hope the fledgling has settled well (and you aren't struggling too much with the empty nest).

And as a PS, I think if we all strove to stand in each other's shoes, the world would be a much better place.

Dr Andrew Brown said...

Thanks everyone for your comments. Auden was obviously a big success, so I shall have to quote him again sometime. :-)

'O stand, stand at the window
As the tears scald and start;
You shall love your crooked neighbour
With your crooked heart.'

Anonymous said...

Well, as Dr Marie Campkin's daughter, I'm sure she'll be delighted to see that the poem's still out there and amusing people. I'll have to show her this website.

And am more and more grateful that I myself became a veterinary surgeon. The veterinary profession isn't heading quite so fast down the slippery slope (though there are some nasty warning signs)

Dr Andrew Brown said...

Many thanks for commenting. I hope your mother doesn't mind me quoting her delightful parody which I have long admired. Please send her my regards.

And what a sensible career choice you made. :-)