Further Confessions of a GP

Nathan

‘I reckon I’ve got AIDS, Doctor.’

‘Right, okay, erm… what makes you think that?’

‘Well, I think that I might have caught it the other night.’

‘Did you sleep with someone you think might be at risk?’

‘Well, up until last week I’d never had sex before, but I think something might have happened on Friday night.’

‘Right, so what happened?’

‘Well, I got really drunk. I remember being in a club and then my friends say they lost me for about half an hour until they found me asleep in the kebab shop with sick down me and took me home.’

‘And are you worried you caught HIV that night?’

‘Well, I don’t remember you see, so I could have done. Anything could have happened in that half an hour.’

‘Well, yes, in theory, I guess, but do you really think you might have slept with someone when you were in that state?’

‘Might have done.’

I looked up at Nathan and wondered how I might put this without sounding mean.

‘I guess what I’m trying to say, Nathan, is that isn’t it a bit unlikely that you had sex in the half an hour between vomiting over yourself in a nightclub and then being found asleep in the kebab shop next door?’

Nathan looked at me blankly, as if this didn’t seem very unlikely at all. I would never claim to understand the inner workings of the female mind, but I can’t believe that any girl would consider a drunken, barely conscious Nathan covered in vomit to be sexually irresistible. I was really going to have to spell this out.

‘I guess what I’m just trying to say is that isn’t it a little bit improbable that you were able to meet a girl, chat her up, take her somewhere quiet and persuade her to have unprotected sex with you, while then managing to get back into the town centre and falling asleep in the kebab shop where your friends found you just 30 minutes later. All this while being so drunk that you could barely walk and were covered in vomit.’

Nathan did look a bit crushed. Perhaps I had overdone it a bit, although I did refrain from mentioning that in that sort of drunken stupor he was unlikely to have been able to get an erection. I really had pulled his story apart like a top lawyer laying into the defendant. Surely faced with such damning evidence, Nathan would crumble and accept that he probably didn’t catch HIV that night.

‘I still think I should have a test just to be sure. It would make me feel better.’

Under normal circumstances regular HIV tests are to be commended, but in Nathan’s case I was worried that by giving him a test I was colluding with his health anxieties. Nathan’s irrational fears about his health weren’t new. A few months earlier he’d been convinced that his very benign looking mole was skin cancer and wouldn’t be reassured until I sent him to see a dermatologist. He had also recently convinced himself he had a heart problem because he was sometimes aware of his heartbeat and so kept coming to see the nurse and demanding an ECG. In fact looking through the notes, Nathan was in the surgery almost every week.

We all worry about our health sometimes, but most of us have a sensible threshold as to when we need to seek medical help for our ailments. We are able to look rationally at our symptoms and decide how potentially serious they might be, and can usually reassure ourselves when they are obviously benign. Nathan doesn’t seem to possess this ability. He could be called a hypochondriac, although this seems a slightly crude, old-fashioned description. I would say he has health phobias. He has an irrational fixed fear about his health that often takes over his life and is very debilitating. When Nathan presents with yet another ailment, my gut reaction is to attempt to reassure him. He knows that he worries excessively, but his overwhelming health fears trigger a niggling doubt in me. Like the boy who cried wolf, perhaps at one point Nathan will genuinely have something wrong that needs treating and I’ll be the one that misses it.

Nathan and I became trapped in a folie à deux, in which he came to see me for reassurance and I encouraged his behaviour by offering him a test that gave him a brief respite from his fears when the result come back as normal. Round and round we went, but I decided it was going to stop today.

‘Nathan, you don’t need an HIV test because you don’t have HIV. You’re a healthy 17-year-old lad and you need to stop worrying about your health.’

‘I reckon I’d just stop worrying if you gave me an HIV test.’

‘I’m going to refer you to a therapist. To address your excessive health concerns. You need help to find ways to stop worrying about your health so much.’

Nathan looked at me blankly and then quietly left my room. He didn’t ever go to see the therapist I referred him to, but instead went and got an HIV test from the walk-in sexual health clinic. I guess that I ultimately failed in my plan to break the cycle, but on a more positive note Nathan does seem to be coming in to see me less frequently. Perhaps he’s better at dealing with his health phobias. Or perhaps he’s just given up on me and is sitting at home terrified that he is about to die from the latest of his perceived ailments.