The Daily Mail Journalist Liz Jones caused quite a stir by writing a vitriolic article criticising GPs (and by extension the NHS) after a surgery she was not registered with refused to see her as an emergency to give her travel vaccinations before going to Somalia.
The response from bloggers including a GP The jobbing doctor and nurse Brian Kellett and the public was predictable ire, leading one commentator after Brian’s post to suspect that her intention was to provoke such a reaction.
I’d like to propose a different perspective. I look after a lot of people whose attitude is like Liz Jones. In fact all GPs (and receptionists, nurses, medical secretaries and so on) face this every day in working in the NHS. An excellent post by blogger LisaSaysThis (who runs a mental health trust) covers some of the same points when responding to Oliver Letwin’s ill-considered comments about public service workers needing more fear and intimidation to make them work harder. The fact that we all look after people who behave unreasonably is one reason why there has been such a strong and immediate reaction from medical professionals.
If we are to take Liz Jones at her word and assume that her account is honest, then we know that she has a private GP, hasn’t used the NHS in 20 years and has two therapists, and she suffered with anorexia as a child and had cosmetic surgery as an adult and is still struggling psychologically …
… then we also know that she is a lady in need of care and compassion. People like this are sometimes labelled with ‘narcissistic personality traits’ or a ‘narcissistic’, ‘histrionic’ or even ‘borderline’ personality disorder. More often they evade diagnostic labelling. Many end up using drugs or alcohol to cope with their distress. Many fail to secure employment or sustain relationships. Most are not given a diagnosis and continue as adults to suffer without us realising why. What may in childhood have been expressed as anorexia (a very serious psychiatric disorder with the highest mortality of any psychiatric disorder) almost always continues to cause considerable difficulties as an adult.
People like Liz are the daily bread and butter of NHS business long after they have gained weight and the anorexia, as a public expression of personal turmoil has passed. Perhaps because of wealth and status, or perhaps for other reasons Liz Jones has managed to avoid the NHS for 20years, but that is simply not possible for the majority of people who struggle with such difficulties.
The surgery I described last week and the patient I described who had the gastric bypass demonstrate some of the challenging behaviour that presents to GPs every day. If we fail to realise what lies beneath this behaviour, which lets face it, is extraordinary by normal social standards, and respond with care and compassion, then we are, as she provocatively suggests, failing to live up to our reputation as a ‘caring profession’.
It is essential for us to recognise that patients like Liz, whose real needs are hidden, present repeatedly to health professionals with seemingly unreasonable demands, but only considerable patience and continuity of care (which the government’s NHS reforms denigrate on their high altar of choice) will allow a therapeutic relationship to develop in which real care is possible.
A Better NHS 
Thank you for the kind comment, but more than that for this compassionate piece. Totally agree. Such people are in a heightened state of turmoil and distress for much of their lives unless they are very brave and seek help. There is hope. I have met people who have successfully completed our specialist evidence based psychogical programme which gives them control over these unruly emotions. Not easy but it does change lives.
She may well be in a heightened state of turmoil and distress. But she wasn’t seeking help for this.
By her own account she behaved in a rude and self-centred way (yes, narcissistic covers it well). Worse, she used her abused sense of undue entitlement to criticise (and invite further criticism of) hard-working healthcare workers.
In my experience (10 years inner-city general practice and inner city acute hospital care including psychiatry) patients who have suffered childhood trauma present considerable challenges to health services as adults for a number of reasons including substance abuse and self-harm as well as abuse of medical staff, chaotic behaviour and unreasonable/ innapropriate demands etc. They rarely ever present with a request for help with the underlying problems, indeed they might very well (and not unreasonably) be unwilling to acknowledge them because of they way they were treated in the past. Where I work we have particular difficulties because of the high incidence of childhood sexual abuse. My opinion, shared by my more experienced colleagues is that a long-term therapeutic relationship is vital.
Secondly, not covered in my article, there is a serious problem in joining up child and adolescent psychiatry with adult psychiatry. Far too often there is very poor continuity and a lack of coherence in care.
I don’t know the person you have written about and I don’t read the Daily Mail. However, I wonder if, on mature reflection, you still think this is an appropriate post to have made?
I see little evidence of the care and compassion that you say she needs. Quite the opposite. Instead, you’ve made what feels to me like a public diagnosis of a chronic and troubling mental health problem and I’d be surprised if you knew her well enough to do so. I wonder how she might feel reading this, and whether doing so might do her any harm.
This probably isn’t the first time that someone has criticised GPs for not dealing with things in the way that they want. I expect the bloke you kept waiting for 60 minutes last week at the end of your surgery had something to say about it when he got home too.
If you read the links you will realise that she (not I) revealed her history of anorexia. She is exceptionally candid in her journalism. I have noted that patients with a similar history present in similar ways and freqently attract diagnostic (and other) labels, though I have not attached any to her. My post is not about Liz Jones so much as the attitude of medical professionals to patients who behave unreasonably, a reflection on my own practice and suggestion that our care and compassion in the face of challenging behaviour may be lacking.
A thoughtful post and with detail that I didn’t know about. I think the problem is that Liz Jones can cause a great deal of damage to the medical profession through one ill considered column and shouldn’t have been allowed to print it. On this occasion, she simply made herself look foolish and the editor let it pass because -hey! It sells. Perhaps the real villain of the piece is the editor, who let her make a fool of herself for entertainment value.
But surely The Daily Mail is just as guilty in allowing this poor woman to harp on & on. It reminds me of the Victorians & Bedlam, using a woman’s mental issues to gain publicity & for entertainment purposes.