GPs are the ‘free spirits’ of medicine and it takes a lot to make them angry — but just don’t tell them what to do, writes Dr Pat Harrold
You can call in, doctor, on your way home.’
GPs are free spirits. If all the consultants and public health doctors and SHOs and interns make up a great army, divided in their many ways into cavalry, infantry and cannon fodder, then the GPs are the scouts.
They roam the war-torn landscape as they will, talking to all and sensing the mood of the country. They wear no white-coated uniform as they move among the indigenous populations, speaking the language of the army or the people as the situation or their humour sees fit.
It takes a lot to make them angry.
A GP will see more madness, stupidity, nobility; more humour, self-sacrifice and downright dishonesty on a Monday morning than most people see in six months. They tend to be tolerant, they see the big picture, and they make allowances for all sorts of factors that the hospital doctors don’t see. They can read tracks, see signs and avoid danger.
They certainly don’t go in with guns blazing every time. No, they stare at the horizon with narrowed eyes, listening to some far away sounds on the wind (coming from the direction of the ICGP office) and hold their counsel. But there is one thing that will make their tempers flash and have them draw their weapons.
You don’t tell a GP what to do.
GPs don’t often refer to it, but they were once in the army too. They trudged through the wards pushing trolleys with bowed back and sunken head. They went ‘over the top’ in case conferences, and many a grizzled general surgeon has to thank a GP in training for a timely swap or a whispered blood result in the heat of a ward round when they were a subaltern. After many years of service (maybe three, but it seemed like a lot at the time) they threw the white coat into a gully and rode away, making a vow to the stars and the mountains. Never again will the GP obey orders.
They decide which direction the army will go and how the army will treat the native. It is all up to the GP whether you get your liver inspected, your head examined or your knee scanned. They can set a urologist or a psychiatrist on you or leave you your freedom.
So when a patient or a nursing home matron requests a house call after a hard day on the trail, when such things could have been easily attended to earlier, and follows the demand with: ‘You can call in on your way home’, you can expect shooting to start.
Why do they presume that you are going home? You might be going to the pictures, or driving to the airport, or going to someone else’s home. How do they bloody well know where you live at all? Is it any of their damned business? The house may have been repossessed, or you may have been kicked out because you are never there, driving around on unnecessary house calls when everyone else is having their tea or sitting on a high stool giving out about the healthcare system. ‘Another pint there James, good man. There goes the doctor in a hurry, would you look at the face on him, the cranky old bastard and the money he’s making.’
It is on a par with the SHO’s letter from outpatients. ‘Dear Dr Bloggs’, he starts, but about three lines down he forgets who he is writing to and says ‘GP to do bloods’. With that goldfish-like concentration, you would wonder how he ever manages to conduct a Mini Mental State exam.
There he sits, surrounded by phlebotomists, nurses and students and demands that you be his intern. ‘He also has a mild case of eczema and wax in ears. GP to arrange Dermatology OPD and ENT. GP to arrange NCT and his daughter’s wedding and four tickets for the Munster final.’
‘You have to fill this in now.’
This has probably been sitting on a shelf for a month but ‘has to be in by 5’.
‘While I’m here.’
‘Don’t tell him I told you that.’
‘What time will you be out?’ (That, I know, is a question but it can be incredibly bossy if said with the right tone. Go on, try it).
‘It is the only tablet that works on me.’
‘I never got notification that the clinic was on.’
The gunshots echo around the hills. The army marches by, raising a great cloud of dust, in the distance. The scout wheels his horse and gallops off into the sunset, the villagers gather around, their hats in their hands, staring after the lone horseman. Into the sunset. Under the stars. Free.