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You’re breaking up…

I was in the surgery with a patient when the call came through. It was my brother. He informed me that my dad had passed away. As doctors do, I took this on the chin and continued the consultation to its end. I then went outside to more fully consider what I had heard. To let it sink in. I would have to organise time off from work as a GP trainee in Scotland and get home to Ireland.

I went into the receptionist area and began telling the sympathetic receptionist staff about my news. The teaching principal doctor of the practice interrupted that conversation to tell me that the 200 tongue depressors I had ordered were an unnecessary expense. I will be generous and presume he had not heard that I now had bigger concerns.

Telephone calls. We have all had them. We are on-call for them both professionally and socially and we have no idea what they will bring. There are certain rings tones that we can learn to hate because they come from the on-call phone. We might want to smother the phone in a pillow and kill the sound. The Medical Council might have us up for aggressive behaviour to a phone. Don’t we know that the phone is part of the team and only doing its job? Alerting us to people and their problems. We should not blame the phone. My nightmares tell me that many doctors have been struck-off for drowning their on-call phone in a toilet or allowing it to slide under the wheel of a car.

There is a reason I tend not to answer calls on my mobile that do not show the number of the caller. I prefer texting. It gives me more time to prioritise the call and its content. I don’t need sales calls. Not on my mobile.

We know control is important in our lives and even more so in our working lives. Not freakish control; just some room to move. I have sometimes taken control over the possible unknowns of an incoming ringing mobile call where I let the three rings of the mobile give me time to consider the worst case scenario. Some family member might have died. I am being fired. Bad language and bad breath on the phone. Waiting to answer gives me a few seconds to prepare for whatever this call will bring me and take a calming breath. I am not a victim of the call. I am buckled-up and ready for the ride.

I still remember that call in Sydney. I remember it because it was a turning point for me. A cold call from a telephone company, to my mobile phone, while I was driving. Disgusted on three fronts. I was ready to give the caller a right ‘how is your mother?’ on the phone. I was ready with my swords of righteousness and anger. But then I thought, this is just a young guy only doing his job. Why waste my anger? I knew I would pay the cost of Irish guilt afterwards if I gave him the usual abuse.

So as soon as I understood that it was an uninvited sales call rather than something important, I put the phone away from my ear and left it gently on the passenger seat. I did not respond and I did not turn off the phone. I did not get angry. I could hear the faint sound of a voice for five minutes. Five minutes of talking AT me. He finished off after asking: “Are you there? Anyone there?” Did he think I had a heart attack? Did it take him five minutes to even consider that no-one was listening to him? I hope he rang 999. Doubt it.

I was SO happy with my new invention. My new no-agro approach gave me serenity and a sense of control again. He was not insulted. I was not forced into anger, frustration or even a car accident. Am I a bad person?

This new technique must have built upon an earlier discovery, not learnt in medical school, of moving the phone earpiece away from my ear when an aggressive or loud caller begins to invade my ear space. This took me years to discover. A small step, but a giant step for this man to remain kind.

So maybe, years later, when I took a call from a senior registrar about a lady I had referred urgently with concerns about bleeding PR, maybe I was ready. He did not ask if I could speak privately. He did not ask if I was with a patient. I was. He spoke loudly about his view that I should have referred this patient earlier. The patient had cancer. At least, he said, to my credit, I had done a rectal exam. Or so the patient said. It must have been important to him that he pre-judge my actions as he guessed they were. He must have been trying to explain away, while she listened, why his system did not see her urgently, like the GP’s letter requested. I was ready and I listened. And I did not take any bait. But I have not forgotten how hospital culture sometimes treats GPs. For that, they have not gained my respect.

And so the system wants us GPs to correctly refer urgent, suspicious pigmented spots to experienced dermatology centres, without guaranteeing both us and patients that they will be seen urgently. So the GP does not take a skin biopsy on a mole and the system does not give an appointment. A patient WILL lose out. And when the patient loses, we all lose.

I do not want that phone call.

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