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Are you busy these days?” is a question often asked of GPs.
“Very” is the usual reply, mentally computing patients seen, referrals made and reports written. All important, measurable activities.
However, if you ask the question, “What did you do today to make a difference?”, another story emerges. One that captures the essence of consultations that flow like an intricate dance between patient and doctor, leaving us with a sense of accomplishment that is difficult to define or measure. Every GP has a bank of such stories.
The woman sitting across from me looked tense and anxious. A ghost-like fear accompanied her into the consulting room. Guiding her to her seat, I began to breathe slowly and deeply to prepare myself. I would need to be 100 per cent present for this consultation, to ignore the clock on the desk, and turn away from the computer screen with its list of people still to be seen.
“Doctor, I’m here about my daughter,” she said, “I think she has anorexia.” As a younger doctor, I would have said something like “I’m sorry, why do you think that?” while frantically trying to think what services are available.
I quietened the voice in my head that criticised the scarcity of mental health services for eating disorders and thought instead of what this mother needed to help her daughter
Today, I said nothing, knowing her story would unfold at its own pace without my interruptions. “I have looked it up,” she continued. “She has all the signs and yet I don’t believe it. Her dad and I have always done our best for her. We love her so much and thought we had protected her, but we didn’t. Something terrible must have happened to make her this way. I don’t know what to do. Anything I say seems to make things worse. Can you help me? Am I wasting your time?”
I still did not speak but nudged the box of tissues closer to her as she had started to cry. She resumed her story: “I asked her to come with me but she refused. She said I was the one who needed a doctor.
“Maybe she is right. Maybe I have the problem. I’m not sleeping, not eating, except when she is around, to try and get her to eat with me but it doesn’t work. She takes one or two bites and pushes the rest around the plate, says she is ‘full’, has ‘eaten earlier’, ‘feels sick’. On the rare occasion that she does eat a meal, I hear her in the bathroom shortly afterwards, and even though I tell myself that she is not throwing up, I know she is. I am too afraid to ask her if this is true as I know I won’t be able to help if it is. My sister says it’s a phase, she will grow out of it, and I should give her some space. But I cannot do nothing while my daughter starves herself and withdraws from the family. I just can’t ignore that.”
This was not solvable with a prescription or a referral. I quietened the voice in my head that criticised the scarcity of mental health services for eating disorders and thought instead of what this mother needed to help her daughter. She needed to know that she had come to the right place. She needed help with her fear and her guilt. If I could manage to do that much today, I would be satisfied.
“I am glad you came,” I said. “Your daughter is ill and will need your help to get better. But she can get better. You are not to blame,” I said, looking directly at her. “This is an illness, like diabetes or depression. There is no one cause. It does not mean that your child suffered any trauma.”
The fear began to dissolve, replaced by understanding and hope. She dried her tears and her body relaxed a little. I explained that I would need to see her daughter in order to do a medical assessment. We would decide the next step after that. “Right now, your daughter needs you like a young sapling needs a supporting stake. Let her know it is not her fault. That is all you can do for now.”
She left, saying she would see me again soon.
So, what did I do today that made a difference? I offered to be “a companion and guide through the dark wood of illness and the even darker wood of the health service”1. I weaved the facts of medical science with this mother’s story and changed a narrative of despair and helplessness to one of hope and empowerment.
There is no guarantee of success. However, for anyone travelling through “the kingdom of the ill”2, a hopeful narrative can be the light that makes that journey bearable.
*This column was based on a composite of consultations.
Toon, P. ‘A flourishing practice?’ Royal College of General Practitioners; 2014, Sep 30.
Heath, I. ‘The mystery of general practice.’ Nuffield Provincial Hospitals Trust; 1995, Nov 1.