Further Confessions of a GP

Mrs Patrick

Mrs Patrick was my nemesis. As already mentioned, she was the very first patient I had seen at this surgery and I can still remember her venomous distrust in me the first time we met. Her misgivings about me had not diminished, but nor had they prevented her from visiting me at least once per week for the past nine months. Such was the frequency of her visits that some days I spent considerably more time with her than I did my own wife.

‘Just a few problems today, Doctor,’ she uttered as she pulled out a lengthy list of her ailments neatly jotted in blue biro on a scrap of paper.

The production of a ‘list’ always causes my heart to sink a little, but when the list belonged to Mrs Patrick, I usually completely lost the will to live. It was a Thursday morning and I had last seen Mrs Patrick on the preceding Monday afternoon. How could she have developed a brand new list of medical ailments in less than 72 hours?

‘Well, first of all I’m getting terrible headaches.’

Mrs Patrick declared this complaint as if it was the first time it had ever been mentioned to a doctor. She had in fact been suffering from headaches since before I was born. It was first documented in her notes in 1974 and I wondered just how many GPs, neurologists and pain specialists had heard about her headaches over the past 40 years. As technology developed so did Mrs Patrick’s headache investigation. When the CT scanner was invented, her doctor referred her for a CT scan. When the MRI scanner was devised, she was diligently sent for an MRI scan. I could just picture her disappointment as each new ground-breaking investigation reported her brain as being completely normal. Over the last four decades numerous new headache medications had come onto the market. A succession of doctors had endeavoured to embrace these latest pharmacological discoveries for her benefit, but without exception each pioneering medication had offered no relief. Continuing this trend, my latest desperate attempt at curing her headaches had fared no better: ‘Those tablets you gave me made my headaches about a million times worse,’ she snarled at me as if I had prescribed them in a deliberate attempt to cause her distress.

On Monday, Mrs Patrick had told me that her headaches were 11 out of 10 on a pain scale, but nonetheless I feebly apologised for somehow causing them to increase by one-million-fold.

Now, I don’t wish to sound unsympathetic. Headaches are horrible. Millions suffer from them, including myself, and they cause untold misery. In fact, a great many of my patients have chronic long-standing health complaints that we muddle through together and I would like to think that I mostly offer empathy and support. My issue with Mrs Patrick is that she seems to actually revel in her ill health. Despite her clear disdain for me and the majority of the medical profession, she seems almost addicted to spending an enormous amount of her free time sitting in front of me and numerous hospital specialists recounting her torment. My computer told me that it was her 31st consultation with me in the nine months since I had arrived at the surgery. During this time, both Mrs Patrick and I would fervently agree that we had made absolutely no advancement whatsoever in resolving her headaches or any other of her ever-increasing catalogue of ailments. Despite my failure to provide her even the smallest morsel of symptom relief, here she was, sat before me, yet again reciting the persistent misery of her symptoms.

This particular morning’s consultation followed the normal routine and once she had offloaded the wretchedness of her headaches, we moved on to the dizzy spells, persistent nausea, sneezing fits and funny turns. Without fail, each effort I made to suggest a possible solution was met with disdain and rejection until I was left slumped in my chair simply waiting for the torture to end. After 30 minutes, I sensed that Mrs Patrick was tiring and the consultation was finally reaching its closing stages. Unfortunately, any relief I might get from her eventual departure was tarnished by the knowledge that it would only be a few days until she would be back in to see me and the whole painful process would be repeated all over again.

‘Mrs Patrick, I’ve got an idea,’ I almost shouted, interrupting her mid-flow in her fifth complaint of the session.

Mrs Patrick looked at me suspiciously.

‘Would you agree that we’ve tried lots and lots of things to try to resolve your headaches, dizzy spells, nausea, sneezing and funny turns?’

‘Well, yes, tried a lot, but they’ve all been bloody useless, haven’t they?’

‘Exactly!’ I declared triumphantly, as if this was in fact something to be pleased about.

‘So, I’ve got a new plan.’ I paused for effect. ‘We’re going to stop all your medications and we’re not going to prescribe any new ones or refer you to any specialists.’

‘Eh?’ Mrs Patrick looked at me as if I had completely lost the plot.

‘Well, we’ve failed, haven’t we? I mean, you’ve seen me 31 times in the last nine months and before me there was Dr Bailey and many other doctors before him.’

‘Well, yes, but you can’t just stop my pills?’

‘Sometimes we just have to accept as doctors that some medical problems are beyond our realm of knowledge. It is important to know when to throw up our hands and admit defeat. You said yourself that not a single one of your tablets makes even the first bit of difference to any of your symptoms, so let’s stop them all.’

‘But not the painkillers?’

‘Yep, all those painkillers that don’t stop your pain. We’re going to stop all of those.’

‘But not the creams and the nasal sprays?’

‘The creams that don’t clear up your invisible rash and the nasal sprays that don’t do a thing for your snuffly nose. We’re going to stop those too.’

‘So, can’t I come and see you any more?’

‘Of course you can, but we’re just going to agree that medical science will never cure you of your symptoms, so instead we’re going to talk about other things that might help.’

‘Er, like what?’ Mrs Patrick asked, looking visibly nervous.

‘Have you ever had a dog?’

‘A dog?’

‘Or joined a choir?’

‘Are you okay, Dr Daniels?’

‘Yes, I really am,’ I said, meaning it.

‘Getting a dog and joining a choir?’

‘Yes, or whatever else inspires you to smile and enjoy yourself ! You can still come and see me and we’ll talk about all the other things you’re going to do in your life rather than take medicines and go to hospital appointments.’

‘But we’re not going to talk about my headaches?’

‘Exactly!’

‘Or my dizzy spells, or sneezing, or nausea, or funny turns?’

‘That’s right.’

‘A dog and a choir?’ Mrs Patrick repeated to herself quietly as she left the room.

This was going to go one of two ways. I was either going to make a massive breakthrough and after 40 years finally free Mrs Patrick and the medical profession from much of her torment. Or I was going to end up being struck off the medical register for suggesting singing and dog walking as a cure for some sort of rare medical syndrome that Mrs Patrick’s next doctor was going to cleverly diagnose.