Lying in a bed was a frail old lady with her pyjamas ripped open and her torso exposed. She was grey and lifeless and I can remember her ribs protruding out of her chest wall. A couple of nurses were frantically running around looking for oxygen and the patients notes, while another nurse was doing chest compressions. To my relief, a remarkably relaxed-looking medical registrar was standing at the head of the bed and calmly taking charge. A monitor was set up and it was clear even to me that the wiggly lines on the screen meant that the patient needed to be shocked. A few other doctors soon turned up and I was pretty much a spectator as they expertly performed a few rounds of CPR (cardiopulmonary resuscitation) followed by a set of shocks. It was all very dramatic but the woman didnt seem to be making any signs of a revival. Thinking that I had managed to escape my first cardiac arrest as an onlooker only, I began to consider sneaking away, aware of how many mundane jobs were waiting for me to be done on other wards. Unfortunately, the relaxed-looking resident spotted me and called me forward. This ones not coming back; shall we let the house officer have a go with the defibrillator? I had just done my resuscitation training and it was all still clear in my mind. This was my big moment. For some reason, I had it in my head that if it was me who shocked her, she would suddenly come round. What a great story that would be, I thought as I stepped up to the bed. The one thing that the instructors had really emphasised in the resuscitation training was the importance of safety. I had to make sure that all the doctors, nurses and oxygen masks were clear of the bed before shocking the patient. I stepped up and took the paddles. Lifting them out of the machine I carefully placed them on the womans chest. Looking all around me, I started the drill: Oxygen away, head clear, feet clear, charging to 360, shocking at 360.
BANG. My adrenaline had been pumping but I hadnt expected that. I had stayed on my feet but had been thrown backwards with a jolt. That never happened with the dummies. I must have been looking slightly dazed and the registrar glanced over at me with faint amusement. Youve electrocuted yourself, you bozo! Unfortunately, he was right. I had checked closely to make sure that the bed was clear of bystanders before I gave the electric shock, but I hadnt realised that on running to the ward, I had shoved my stethoscope into the pocket of my white coat and as I was leaning over the patient, the nicely conductive metal tubes had been lying on the patients left hand.
As if to rub salt in the wound, my first pathetic effort at resuscitation led the woman to go straight into asystole (flatlining) and the registrar called it a day. The correct thing to have done would have been to report my electrocution as a critical incident and give me a bit of a check-over, but instead the registrar just disappeared off the ward chuckling to himself. I had made his night and he called me Sparky for the rest of my six-month spell at the hospital. I was left to carry on with the boring jobs on the ward and by the following morning everyone had heard of my disastrous first night. Perhaps it was an early indicator that I was better suited to the slightly less dramatic world of family medicine.
Jargon
At my high school I was known as Benny Big Nose. Not the most charming of nicknames, but nevertheless a beautifully simple and succinct summary of my name and most prominent facial feature. I sometimes wish medicine could be as straightforward. Why do we use long-winded medical jargon to describe something rather simple?
Purulent nasal discharge snot; viral upper respiratory tract infection a cold; infective gastroenteritis the shits; strong urinary odour stinks of piss.
One reason for medical jargon is so that we doctors can write something in the notes that if the patient were to read, they wouldnt take offence and complain. There was a time a few years back when patients had no right at all to see their own medical notes. I was recently looking through the old paper notes of one retired farmer and the sole entry for 1973 was Patient smells of pig shit. How beautifully jargon free.
When I first qualified, I loved all the medical jargon. I felt that it made us sound clever and elite and I got off on the fact that I could have a chat with a fellow medic on the train safe in the knowledge that the rest of the carriage would have no idea what we were talking about. However, it only takes an interaction with someone who uses jargon that you dont understand to realise how annoying it can be. Current letters from my manager have just this effect on me. What do phrases like performance-based target strategies and competence managed commissioning mean. They certainly dont seem to bear any relevance to my daily routine of listening to peoples health grumbles and trying to make them feel a bit better.
Patients are always happiest if you skip the jargon and say it how it is. I find that replacing the phrase stage-four renal impairment with knackered kidneys or mitotic growth with cancer is generally appreciated. We all like to have things explained in terms we can understand and I just wish that our managers would write me letters in a language that I could comprehend.
It was Darren Mills who first named me Benny Big Nose. The last I heard, he was spending some well-deserved time in jail. His straightforward and direct manner seemed to get him in trouble from the teachers and later the police. However, Darren, if youre out there, Id like to say thank you for teaching me the valuable lesson of saying it how it is. You usually dont cause as much offence as you think you might and most people will appreciate your honesty.
Proud to work for the National Health Service (NHS)
One weekend I was doing a locum shift in the ER and saw a middle-aged German couple who had been involved in a car accident. They had been on a driving holiday around the UK and had crashed their car into a ditch. Fortunately, they werent severely hurt but an ambulance was with them within ten minutes and the paramedics gave some basic first aid before ferrying them to hospital. They were then seen by me and I organised some X-rays to make sure that the man didnt have any neck injuries and to confirm a suspected dislocation of one of the womans fingers. The mans neck X-ray was fine and I injected some local anaesthetic into the womans finger and popped the dislocated joint back into place. The healthcare assistant got them a cup of tea and a sandwich each and one of the nurses then cleaned and dressed a few of their cuts and scratches. Finally, the receptionist let them use her phone to call their car hire firm and organise a taxi back to their hotel.
As I let them know that they were free to go, the German man got his wallet out and tried to give me his Visa card. I explained that he didnt have to pay me so he then started giving me his address so that he could be billed at home. I literally had to spend ten minutes convincing him that the treatment he had received was free of charge. But everyone has been so good to us, he protested. I wouldnt have got any better treatment back home. Why do you British spend so much time complaining about your health service? It was one of those moments where I simply felt an overwhelming pride to be a part of the NHS. Of course, there are days when I spend a lot of time apologising for the inadequacies of the NHS, but overall I still believe that if you are genuinely unwell or have an accident, there arent many places on the planet where you would get a better service.
Sitting around with a bunch of doctors recently, I was surprised by how many thought that there should be a charge to be seen in the ER or by a family physician like me. The general consensus was that the equivalent of $10 would be just enough to keep out some of the time-wasters and make people think twice before pitching up to see us. I have to say I couldnt disagree more. I appreciate that the NHS isnt free because we pay for it with our taxes, but it is free at the point of delivery and I feel that is something fundamentally vital in maintaining some of the original ideals of the NHS. A charge would keep away some of the more vulnerable people who needed our help most and suddenly change the dynamic and mindset of the patients who would now be paying directly for our services.
Drug reps
Sixteen tablets of a supermarkets own brand ibuprofen cost just 35 cents, while 16 tablets of Neurofen cost $1.99. This is strange to believe considering they really are exactly the same medicine. The drug company that makes Neurofen uses clever advertising and packaging to convince us to pay over five times more money than we need to.
Drug companies are very good at overcharging us for medicine. In the world of prescription drugs, millions of pounds are wasted by the NHS because doctors prescribe expensive ones when they could be prescribing much cheaper versions of exactly the same medicines. How do the pharmaceutical companies hoodwink us into doing that? Again, it is all about marketing. Young and attractive drug reps come and promote their drugs, while buying us lunch or even taking us out for dinner at posh restaurants. They feed us biased information on why we should use their more expensive medicine and give us free pens and mugs sporting their brand. (There are now much stricter rules than there used to be about how much drug reps can spend on us doctors. For example, the free gifts that they give us now have to be under the value of £5 and when drug reps take us all out for a slap-up meal, there has to be an educational component to the evening rather than a completely uninterrupted session of good food and expensive wine. The drug companies all-expenses-paid trips to conferences in the Caribbean have stopped, too.)
I used to attend the lunches and dinners. As I pocketed the free gifts and scoffed down the expensive nosh, I convinced myself that we doctors were too savvy to be influenced by colourful flip charts and pretty smiles. The pharmaceutical industry, of course, knows that this isnt the case. A few hundred quid taking some doctors out for dinner is peanuts compared to the money they can make if one or two of us start prescribing their drug.
As well as constant pressure from drug reps, doctors also face resistance from patients when trying to change medication. Whenever I can, I try to switch my patients from the more expensive medicines to the cheaper ones that do the same thing. Unfortunately, this can be very unpopular with patients. Often they get used to a certain packet and tablet colour and no amount of persuasion will convince them to switch. One elderly lady once stormed into my surgery furious that I had changed her medicine:
You told me that the new medicine was the same as the old one!
Yes thats right, Mrs Goodson same medicine, but different name.
Well, I know thats nonsense because when I try to flush these tablets down the toilet, they dont float like the old ones did.
Drug reps have the cheek to claim that they are helping to educate us by updating us on the latest scientific research. This is, of course, nonsense as their only interest is flogging their drug and earning a commission if prescribing rates of their drug increase on their patch. They give ruthlessly one-sided presentations that show their pill to be wonderful and ignore the parts of the research that dont paint their drug so favourably.
Having finally realised that I will only ever get biased information from the pharmaceutical industry, I now refuse to see any drug reps. They hover around the reception desk like prowling hyenas, only to be batted away by the fierce receptionist. Not having the time or inclination to read all the medical journals myself, I rely on the local pharmacist to keep me up to date with the new medications on the market. She is a fount of knowledge on all the latest scientific research and doesnt work on commission. Like me, she has the best interest of the patient at heart, while also keeping half an eye on the NHS budget. There really is no such thing as a free lunch and so Ill pay for my own, thanks.
Mr Tipton, the paedophile
I had been asked to go on a home visit to see a patient I hadnt met before. Mr Tipton was in his fifties and complaining of having diarrhoea. There was some kind of gastric flu going round at the time, but normally a 50-year-old could manage the squits without needing a doctors visit.
As I skimmed through his notes, there was one item that stood out. In between entries for a slightly high blood pressure reading and a chesty cough was imprisonment for child sex offences. Mr Tipton was a paedophile. There were no gory details of his offences but he had spent six years in prison and had only recently been released.
Mr Tipton lived in Somersby House. Despite the pleasant sounding name, Somersby House is a shithole, a 17-storey 1960s tower block as grey and intimidating on the inside as it is on the outside. As I waited an eternity for the lift to climb the 17 floors, I wondered if the strong smell of stale urine was coming from one of my fellow passengers or the building as a whole. The grey-faced natives eyed me suspiciously; I was looking conspicuously out of place in my shiny shoes and matching shirt and tie. A mental note was made to keep a spare tracksuit and baseball cap in the car to disguise myself on my next visit.
I was annoyed and ashamed by how uncomfortable I felt in Somersby House. When I started medical school I felt distinctly street. While most of my compatriots were privately educated somewhere in the Home Counties, I went to an inner city state school. Why was I feeling so bloody middle class? Medical school had not only desensitised me to death and suffering, it had also turned me into a snob.
I finally got to Mr Tiptons flat. After several minutes of knocking on the door and shouting through the letter box, he finally answered. Walking unsteadily with the aid of a Zimmer frame, he was wearing a filthy grey vest and nothing else. As I followed him into his flat, his bare buttocks were wasted and smeared with dried faeces. The flat was like nothing I had ever seen. There were beer cans and cigarette butts in their hundreds. The floor was brown and sticky and I tried desperately to manoeuvre myself down the corridor without touching anything.
It was the bedroom that was truly shocking. It transpired that Mr Tipton had been pretty much bedridden for the last few days with a bad back and he hadnt been able to make it to the toilet when the diarrhoea struck. There was shit everywhere! His bed consisted of a bare mattress and a coverless duvet. Both were covered in an unfeasible quantity of faeces that looked both old and recent. There were cider bottles filled with his urine and an empty takeaway wrapper covered in vomit. It was truly grim. Amazingly, as we arrived in his room, Mr Tipton calmly laid himself back on the mattress and pulled the shitty duvet over him. I donned some gloves and half-heartedly had a prod of his belly. I made a few token comments about letting viruses take their course and then fled.