Confessions of a GP

Fighting

Tommy has a proper West country ‘ooarr’ accent that never fails to entertain me. He’s not particularly blessed in the brains department and has a very high TTT score. TTT stands for tattoo to teeth. The rule is that if a patient comes in with more tattoos than teeth, they are probably going to have a fighting-related problem. This may seem like another unfair prejudice made by snobby middle-class doctors, but it is in fact a frighteningly accurate clinical sign.

‘’Allo, Doctor. I’ve come about my nose. It’s sniffing, see. I can’t sniffs on this side. And I can’t sniffs on the other side, neither.’ Tommy demonstrates with a long and unsuccessful attempt to breathe in through both nostrils in turn.

‘See, Doctor – I can’t sniffs nothing. I snores like a bear and I can’t even smells my own farts.’

You didn’t have to have a medical degree to spot the problem with Tommy’s nose. It was clearly big to start with, but had unmistakably been broken on several occasions and now pointed in several directions at the same time. Judging from his multiple tattoos and missing teeth, I imagine that Tommy’s nose has probably been punched out of shape, but it seems unfair to jump to conclusions.

‘So, Tommy, it looks like you’ve broken your nose. Was that a sporting injury, perhaps?’

Tommy gives me a big toothless smile.

‘No, Doctor. I broked it fighting. I broked it this way fighting in the pub and then my wife broked it the other way when we was rowing at home. Just the other day I think I might ’ave broked it again when I fell over pissed.’

I send Tommy off to the facial surgeons but warn him that they have quite a job on their hands.

I myself am pleased to say that I have never been hit. Although my nose is big, I am relieved that I have at least managed to keep it straight and I’m rather keen it remains that way. A recent report suggested that up to one-third of NHS staff have been physically assaulted at work. One of the reasons I have avoided violence during my years as a doctor is my natural tendency to exhibit cowardice at every possible opportunity. This was most clearly demonstrated when a fight broke out between two drunk patients one Friday night in the A&E department. When looking back at the CCTV footage with the police, several small nurses could be spotted bravely moving towards the action and attempting to break things up. Meanwhile, I could clearly be seen running away in the opposite direction towards the door.

I have been threatened on several occasions and it is easy to feel quite vulnerable when you are alone with an angry patient in a confined space such as an A&E cubicle or a GP surgery consultation room. People can get angry and aggressive when they are in pain or scared about their own health or the health of their loved one. Sometimes their aggression is part of an illness such as schizophrenia or dementia. Sometimes they are just drunken arseholes looking for a scrap. I have a simple rule. If someone is unnecessarily aggressive and abusive towards me, I won’t see them. On one occasion in A&E a man was needlessly abusive and threatening towards one of the nurses. He was a little drunk but that was no excuse. He was shouting and swearing in front of young children and elderly people in the waiting room and, towards the end of a long and tiring shift, I decided that I was not going to put up with that sort of behaviour and I refused to see him. This made him more angry and he ended up kicking off big time and getting arrested. I could have probably resolved the situation peacefully by placating him verbally, making him a cup of tea and letting him jump the queue to be seen. But why should I?

When I made the decision not to see that man, I was in a busy A&E department with plenty of porters and a couple of burly security guys on hand to help protect me from getting a beating. Had I been less well protected, my cowardly instinct would have kicked in and I’d have happily treated him immediately as long I knew that it was going to prevent me ending up with a nose like Tommy’s.