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Do unto others…

A builder came to me as a patient lately. He wanted his skin mole removed for histology so that he didn’t have to worry about it being cancer. I explained the benefits and risks and left the decision up to him.

The builder decided to go for it, so I decided to do the procedure in his home, for his convenience. I put the local anaesthetic in his skin and waited for four minutes for it to work. In the meantime, I got a mobile phone call from another patient, a judge who lived down the road. It was now three minutes since I put the anaesthetic in but I explained to my builder patient that I had another job to go to and that I would be back shortly. His mouth was open when I left the room. Maybe he was going to say something. But you just can’t deny work, the way things are today.

The judge was in severe pain in his bed at home. It might be an appendicitis, I thought, but you can’t be sure of these things, so I told him I would call a court — sorry, medical — recess (I have been taught to speak in language and metaphors of my clients). I said I would get back to him because I had to get expert advice on this conundrum. I promised that I would be back in two minutes.

I was on my way back to the builder when I got a call from the after-hours service reminding me that I was on call that evening. Had I forgotten and was I on the way over? I felt bad and headed straight over, but first I had to call into my surgery to pick up my other medical equipment and fresh clothes for tomorrow. A man has to look well in this day and age. Anything less is unprofessional.

I saw three patients in 10 minutes, rather than 10 minutes each, in the after-hours surgery, to catch up on my delay. The builder now rang me and wondered where I was and I said that I would be right over. But I couldn’t be right over because I just remembered the judge was in bed and in pain.

It was then that I got a call from a man who said he was the Minister for Health. Who are you to believe these days?

I apologised to the judge for being delayed more than two minutes and explained that my experts were due to get back to me about his abdominal pain but they felt the paperwork I had submitted was not done according to convention. They threw the application for their second opinion out until the right application procedure was received by them.

It was then that I got a call from a man who said he was the Minister for Health. Who are you to believe these days? The stories people make up to get seen first in the queue. I said that I was due to see 20 under-six patients in the after-hours yet and I was well behind schedule.

He said that he had no problem himself but that another member of his PR team had rectal bleeding. The Minister, a doctor, explained that he was not legally covered to treat the man, as he had suspended his medical registration and medical indemnity. As Minister, he just did not have time for CME and medical meetings.

The Minister asked whether I could see his man in general practice, as the waiting time in casualty was very long and anyway, it would be unseemly for the Minister and his PR mate to be waiting in casualty. If they were seen first in casualty, there would be talk of favouritism and if they waited in casualty like everyone else, then there was the risk from violent and erratic patients. It would be undignified. Sure, Joe Duffy would have a field day, he exclaimed.

I explained to the Minister that these were very unusual circumstances but if he brought his man to the house of the builder, one of my other patients, then we might be able to fit him in.

I rang the judge and told him to get his bum (and abdomen) over to the builder’s house. As soon as I saw the judge, I could see that he was much sicker and probably now had a burst appendix. My expert opinion had said that it was likely that it had been an appendix alright. But the delay had made things worse. I had to put an IV line up, while at the same time I started to remove the mole from the builder on the other bed, even though the local anaesthetic had now partly worn off. In the third bed, all I could do were temporary measures for the PR’s bleeding, using whatever towels were available.

It was not perfect, you have to admit. I felt I had to deal with all the individuals as best I could, given all the circumstances. Okay, the appendix of the judge burst, but it was really important to not trust my own judgment and to get a second expert opinion, because this is what the legal system does.

Okay, the PR’s bleeding stopped but it was messy. PR people love to present life as simple and not messy, but for frontline reality practitioners, life and medicine is messy.

Builders sometimes create great things but they ALWAYS leave their dirt behind for me to clean up. So I left the syringes, blood and the towels behind because my job is only to fix things, not to be cleaning up.

So remember, do onto GPs as you would like your GP to treat you.

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