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Every doctor knows the moment. The patient has, with no warning, lost their temper and you are in the way.
It doesn’t happen often and the older and more experienced you become, the less likely you are to get into situations where you sit in your chair listening to a rant. But it happens to the best of us.
Usually it is someone who has difficulty with everybody. Their method of dealing with a situation is a barrage of abuse. They do it to teachers, social welfare officers and family members. Quite often, the GP will have seen them through many a traumatic situation. They have gone out on a limb for them, written letters, listened when nobody else did.
Suddenly, it is a shouting match and there is the threat they will take it further — and if anything goes wrong, it is your fault. They often drag up something you did or said years before, maybe a joke that you barely remember and thought nothing of at the time, but which will be used against you now. You tell yourself it is not really you they are mad at; it is the useless boyfriend or a result of addiction, but it hurts and it is upsetting when the fist is waved in your face and the threats come raining down.
The doctor is like a guard outside Buckingham Palace, keeping their professional cool while somebody goads them, knowing that they are the only one who could lose everything if they retaliate. The patient may be a bit like a stroppy teenager, who maintains a façade all day at school and comes home and lashes into the parents, and many an addict has that kind of immaturity, but it is still scary and often dangerous.
We are sitting ducks, really. We are trained to be intuitive, empathetic and sensitive. We sit listening and then wham! Our defences are totally down and the attack, when it comes, knocks us right in the solar plexus.
I know, I know, doctors can be arrogant, patronising and intimidating, but I find that the world has changed in my professional lifetime and the pendulum may have swung too far the other way.
It is estimated that a general practitioner will have a quarter of a million consultations in their lifetime. If Lionel Messi had to take a quarter of a million penalties, he would miss a few. In fact, although he may be the most all-round gifted soccer player the world has ever seen, he is perhaps not the best penalty-taker ever.
It is the same with doctors; they can be incredibly good at some aspects of their job and only average at others. They are under powerful scrutiny to make sure they are not actually bad at anything.
I miss the days of the ‘good old-fashioned’ dope-smoker with the bad teeth and the wheezy chest. He did no harm to anyone, except those who wished he had realised his potential. An alcohol counsellor I know laments the days of the pint-drinking alcoholic. He would sit in the pub all day drinking porter. They are dying out.
What we now see is the ‘tablet head’. They got addicted to tablets, which they bought, and they think they know your job better than you do. They whine that you did nothing for them, by which they mean you did not promptly prescribe everything they asked for, including the tablets they lost/were stolen/mother threw them in the fire/dog ate.
The response to these problems are poorly resourced, with a dearth of drug councillors, police and mental health facilities. GPs are in the firing line with no back-up.
They threaten you that they will have a convulsion if they don’t get the benzos. They will kill themselves. And if they do, it will be your fault.
The poor GP, sitting in the chair, who did not start them on drugs, whose taxes pay their social welfare, etc, who is trying to practise good medicine, is told that if anything bad happens, it will be deemed their fault and there will be hell to pay.
The worry is that even if they go out, have a row with their girlfriend, buy a load of drugs and take them and get in a fight, it may well be seen as the doctor’s fault.
The families will want vengeance, the tabloids will want blood and ink, and the Medical Council will want to kick-off like an avalanche in the Alps.
I know doctors who have become frightened to relate to their patients, who write everything and say nothing. They are reduced to practising defensive medicine. They are scared. They are burnt-out. Some have taken their own lives. Most doctors are perfectionists and try too hard to do their best, to the detriment of their health.
Many are old and trying to cope with the changing world.
They are on their own. Two-hundred and fifty-thousand penalties.