It was some time in November. I’d come in to the GP surgery for the second time that week to collect my prescription for my blood pressure medication. It was really busy and I don’t really like being around other people so I was getting quite anxious and I could feel my blood pressure going up while I was waiting, so when I got to the desk I was quite agitated. I’ve always had an anger problem, I’ve lost count of how many times I got thrown out of school or lost a job because of losing it. I basically cope by keeping myself to myself. I’ve got a few friends who know what I’m like and I’m grateful for that. Anyway, when I got to the desk they couldn’t find the prescription – again. I totally lost it, it was so embarrassing, they threatened to call security, but by that time I’d already left. I’d been without my medication for over a week by then, but I wasn’t going back there, no way. It was about 3 weeks later I suddenly couldn’t balance properly, like vertigo, I had to hold onto the walls to keep myself upright. I didn’t know what it was, but I didn’t want to call the doctor so I waited to see if it would get better. If anything it was getting worse and I was getting headaches and feeling sick, so eventually I did. It turned out I had a stroke. Because of my blood pressure.
It had been one the worst days of my life. I’d been getting bullied at work for a while, teasing mostly, but it was getting on top of me. I’d had to get up and leave a meeting 3 times in an hour and a half that afternoon, and they didn’t even try to hide their sighs when I came back. My girlfriend had been on at me to see my GP for about 2 years, but the last time, about 5 years ago had been a disaster. Basically, as soon as my bladder is even half full I need to go to the loo. I can’t wait, I can’t hold it in. Never have, for as long as I can remember. That day after work, I was on the tube on the way home when I suddenly needed to go. It was packed, and we were stuck between stations. I was terrified, sweating, wishing, like Dorothy in the Wizard of Oz that I could just be somewhere else – preferably in the bathroom at home – Instead I felt the dreaded hot, wet patch go down the inside of my right leg. I looked down trying to avoid seeing the other passengers frowning and trying to work out where the smell was coming from. I wanted to make myself invisible, but, instead, to make it worse I started crying. When I got home my girlfriend, gave me an ultimatum, either I go to the GP, or she goes there for me. The last time I went, though, five years ago – they just didn’t take it seriously. I’d used Ketamine a couple of times as a student and they fixated on that and basically said there was nothing they could do. I tried telling them it had always been a problem, but they didn’t want to listen.
Doug was my patient. His blood pressure frightened me a lot more than it appeared to bother him. Typically around 220/130, no amount of medication made the slighted difference. He was always jolly, came to all his appointments and would say he didn’t know why I was so worried. It never occurred to me that he wasn’t taking his medication. Eventually, when he was on 5 different blood pressure pills a day, I called the local hypertension specialist. Immediately she said, “He’s not taking his medication. You need to bring him in and ask him to take it in front of you and then check the blood pressure every couple of hours.” It seemed so obvious, I felt stupid for not having thought of it, so I called Doug and asked him to skip his medication next Tuesday morning, but bring it all in to see me at 8am. Dutifully he came in and laid the boxes out between us. I had a glass of water on the desk ready for him. “OK, I said,” feeling quite pleased with myself. “Now I’d like you to take the meds, just like you do every morning. “What? Are you trying to kill me?!” He asked. “No, I’m just asking you to do what you do every day at home”, I replied. “Er, yeah, right, OK”, he said. And took the tablets. At this point I should have stopped him. I should have said, “wait, it’s OK. I don’t want to kill you. I just want us to figure out how to deal better with your blood pressure. We can talk about the medication if you like, or anything else that’s on your mind. If you’re not taking it like this every day, then let me know and we’ll try to work with that”
But I didn’t. I wanted to humiliate him, and I succeeded. He did come back every couple of hours to get his blood pressure checked. At the last check in the afternoon it was 80/55. He never came back to see me again, and has since left the practice.
I’m haunted by this failure, and include it to show that all of us who work in healthcare are confronted by vulnerable people and are in positions of great power, to pass judgement on the needs of those who come to us for help. The slightest lack of sensitivity can stay with someone for years, stopping them from asking for help when they really need it. It is especially true with problems that are embarrassing and stigmatised, like mental health, continence and obesity. The media rages against people who waste NHS time and resources, but say nothing about those who need our help, but do not come. I hear stories like those above, every week, sometimes every day. Because they are so embarrassing they are very rarely told in public. I’ve changed a lot of details to protect my patients’ identity, and I hope that this might help others tell their story to a doctor or nurse who needs to hear it.
I expect most of us have some horrible consultations that remain like grit in our psyche. Mine was a home visit the week before Christmas to a little old lady. I felt she could have come to the surgery and berated her so, and she just crumpled, like a ball of paper. With hindsight, I think she was just lonely, and it was a terrible thing I did. It has haunted me ever since.
BTB DN is fine, just taking a sabbatical to look at other things…
This is probably your most insightful post yet. In my experience – doctors who don’t seek to shame and humiliate patients are in the (very treasured) minority.
If you read magazines like GP Pulse – it soon becomes clear that a lot of doctors are attached to the idea of themselves as special, clever and better than the general population. Patients are used as a foil in the consultation in order for the doctor to highlight their own “cleverness”, “specialness” or “superiority”.
A profession that valorises the abuse and denigration of patients in its own specialist publications is not a profession that aims to make patients feel comfortable or respected in the process of consultation. Equally when you have a situation where any doctors who dare to suggest that patient experience is important are denigrated as “cardigans” – what does that say about the people operating in these roles? Why do they bother working in a patient facing job if the main point of the patient is to prove to the doctor how superior they are? <— Oh I answered my own question.