Doctor’s Orders

So when people find out what I do, they inevitably want to hear my most gruesome stories of injury, disease or misfortune.

Here’s one. This guy comes into my surgery a few months back, he is so obese he can’t see or take care of his feet anymore, and his belly hangs in a floppy apron over his belt, wallowing in a mass of bloated, mottled skin.

He has that smell people have when they just can’t wash themselves all over.  I imagine him struggling to get out of a bath and finally resorting to sitting in front of the sink with a wet flannel hopelessly unable to reach the places he really needed to wash.

Anyway he struggles to squeeze into the seat in my room and settles on the edge of the chair, leaning forwards, his swollen ankles spilling over the rim of his surprisingly clean white trainers. “When my father died I had to step in to run the family business, but I couldn’t cope with the strain and fell out with my brother, so you see I started drinking…”

Looking back in the notes it’s clear that he has admitted this many times before and been advised more often than not to self refer to the local alcohol services – as a test of intent and motivation.

“They just come over and tell me to stop drinking, which doesn’t help much, and I keep getting told to go to the doctor and ask for help.”

I’m internally aware of reflecting at this moment, my mind racing forward picking up all the sensory cues of the scenario as I listen to his story of woe, already jumping ahead to the obvious question he wants answered “can you help?”  As a Christian and a clinician I wrestle internally with my own question – “What can we offer this man with sad eyes?”

As he comes to a halt, I’m brought back to the present, he has used 30 seconds of his prescribed 120 seconds of free speech. Research proves that most patients will tell the key information in their case within the first 2 minutes of a medical consultation if left to speak freely after introductory pleasantries.

When this research study was conducted the average time it took the doctor to interrupt the patients’ verbal flow was ten seconds, cutting down the chance of a good history by drastic odds and ironically prolonging the consultation in an attempt to speed it up by taking control.

As he stops speaking I breathe, reassured that as I met and escorted him from the waiting room my initial assessment of his ability to stop talking within 120 seconds was correct. A few patients are still blissfully unaware of the NHS 10 minute allowance enshrined in the unwritten GP rules and will drone on undeterred by their own statement of, “I really hope I am not wasting your time doctor as I know you’re so busy … but …”

The man with sad eyes is not one of the latter group we learned about in training. Relief! These are the notoriously hard to please “entitled demanders”. As a new trainee GP I soon became hardened by the realisation that we are not trained in order to please all the people all the time.

Some patients will play little games with you to gain your sympathy or win you over to their demands. I remember the lonely old lady who would visit me on a weekly basis for a fix; as a trainee I was the most accessible of all the doctors in the practice.

I naively accepted her compliments, “haven’t you got such nice teeth!” All the while she was undermining my lovely teeth with decay in the form of chocolate bribes to justify a few extra minutes of what would be recorded as “had a chat” in the notes. How much should I conspire with such behaviour and what would Jesus have done in my shoes?

But to return to my sad alcoholic – I was still wracking my brains as to what support we could offer on the NHS? Like I said he had already unsurprisingly ‘disengaged’ from the usual courses of action, I found myself wondering, “could he be another dreaded type of problem patient – the ‘manipulative help rejector’?”

The manipulative help rejector delights in the extra attention afforded by a caring and willing practitioner trying out all possible avenues of referral and therapy, but sabotages every attempt by refusing to accept that solution or help for what are soon discovered to be insoluble problems. When we are sick we get stuck in a rut; sometimes the ill-gotten gains of being unwell are too much to lose as we become comfortable lying in our hole.

So he hit the bottle when his father died – a salutary tale. I quickly perform a mental check on my weekly intake of units and drinking behaviour to make sure I am still on the right side of the line. Men are more likely to become alcoholic than women as they get a greater neurotransmitter response in the brain hitting the pleasure center after alcohol, this pleasure surge reduces over repeated excess so it takes more of the drug to get the same “high” next time.

I want to help him. I became a doctor because I believe Jesus cares so I should care. I believed it would give me the chance to help all kinds of people and be an interesting and fulfilling life – this answer would have resulted in a rejection on an application form for med school.

So did I share the love of Jesus with him and pray a prayer of salvation then and there side by side on our knees on the floor in my GP room? No, it didn’t work out quite like that. In the past I had been ashamed that this sort of salvation only happened once in my life so far and not more often to those under my care. So what would Jesus do?

I looked him in the eye, listened and talked to him, tried to show I cared and found out what his ideas, concerns and expectations were.

I dared to suggest we treated him for depression after he scored for moderate depression on the PHQ9 mood questionnaire. He was interested in treatment as there had been no suggestion of a mental health cause in his case for what looks like a purely social problem.

I advised him to occupy himself with worthwhile activity, offered some antidepressant medication and suggested he reduce alcohol so the medication could work. He managed to do this until the medicine had taken effect a few weeks later at which point I suggested he re-engage with the alcohol team, while awaiting counselling for family issues from his past.

He reported feeling “like a new person” and continued to see me for 3 months until I left the practice. Towards the end of my time he had resolved to lose weight through weight watchers and started a little business dog walking for cash and exercise! He also engaged in voluntary work in a charity shop using his accountancy skills. I have never seen him since, as I moved on to another practise to complete my training. I still think and pray for him and often wonder how he is now.

It takes a lifetime of falling over and getting up again to break some habits, especially those with roots deeply embedded in our past hurts, which may ultimately end up defining us. These issues need a complex concoction of our willing engagement in social, medical and psycho-spiritual intervention – more perceived than prescribed. I hope that through trying to care I can help people into a position where they have a better chance of meeting Jesus through the links he leaves in their path.

I notice like myself some of my Christian GP colleagues attract more than their fair share of alcoholics, druggies, the desperate, the needy, those who society would rather forget and has long since washed its’ hands of – Jesus people!

I long to be a part of a local church I feel confident in inviting them to, but haven’t ever stepped out in this way. I tell patients I will pray for them (with a mostly positive response on their part). I am part of a young community church plant in a poor area and I hope to have the guts to invite my next hopeless patient to the place where they cannot fail to meet the love of Jesus, and get plugged into a caring community of people following the narrow path towards a beautiful heavenly home.

Ben Sinclair is a Men’s Health Specialist. Find out more about Ben and his work on The Optimise Clinic.