An appointment with disappointment

Mr P lived by himself in a studio flat furnished with a single bed, an armchair with an inflatable pressure cushion, and a television on which he watched the racing on Saturdays. He no longer slept in the bed, as he found it too painful to get in and out (he had bad arthritis in both his hips): he spent the nights in his chair instead, with a duvet over his knees. He had no books or photographs, just a botanical print in a gold-coloured frame with a postcard of Princess Diana tucked into the corner.

One wall of his sitting room was entirely taken up by a mirrored wardrobe. It had a terrific crack running diagonally across it where Mr P had fallen on it, three years earlier. After the accident, he stuck masking tape across the crack to stop the glass from falling out. Now the tape was yellow and stiff. The first time I visited, I made a lame joke about my beauty having cracked the glass. He gave me a look of utter disdain. Nothing I said subsequently made our interview any happier. No, the new pain medicine wasn’t helping; no, he didn’t want to change it to anything else; no, his mood wasn’t good, wasn’t that a bit of a stupid question? Would my mood be good if my only excursion was a weekly trip to Sainsbury’s on a mobility scooter? “He doesn’t like doctors,” one of the partners said, when I got back to the surgery. “Don’t take it personally.”

I saw Mr P every few weeks while I was based at the practice near his house. Each visit was the same. He would open his door, look me up and down, and say: “Oh.” Then we would sit reflected in the giant mirror, the jagged crack running between us like a cheesy stock photo of patient-doctor disjunction, while Mr P ran through a tally of that fortnight’s medical disappointments. His back, his hips, his neck, his heartburn: none of them improving, thanks to our uselessness. Would I mind “seeing myself out”?

General practice is often in the newspapers, mostly in an unfavourable light. In what I soon came to regard as a personal lowlight, Mr P began saving pages from the tabloids – “Cash-crazed doctors dish out millions of useless drugs each year!” and so on – in order to keep me updated.

A GP, he let me know, is a doctor who spends her consultations scrolling feverishly through her computer, asking you if you’ve thought about giving up smoking and whether you’d consider losing some weight. She can’t do any proper medicine – or she’d be in a hospital – and yet she doesn’t seem to know anything about nutritional approaches to irritable bowel syndrome, or homeopathic options for fibromyalgia. She refuses to X-ray your back, citing spurious-sounding “evidence”, and refuses to refer you for an MRI, claiming that it won’t make any difference to your treatment – but how can she know this, if she hasn’t got the information?

Like many patients, Mr P was unhappy; in the context of medicine, he was unhappy with being ill, unhappy with having to take tablets, and most of all, unhappy that I couldn’t make him better. His ability to let me know his disappointment was a good thing (better than the old model of mutely miserable patients being “practised upon”), which didn’t make the experience any more uplifting.

“I don’t know why I bother with you lot,” Mr P said, as I got up to go. “I never get any better.” A week later I came back from treating a patient with pneumonia to find a Post-it note stuck on my computer screen: “MR P REQUESTING HOME VISIT. NECK PAIN.”

Sophie Harrison is a hospital doctor in South Yorkshire

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