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.