Like most Londoners, I don’t have a doctor. I belong to a practice, but take pot luck on whom I see. Last time it was a locum who was mainly interested in global health; he did some general practice to provide some income. Neither he nor I were much interested in the consultation.
So far I’ve averaged a consultation rate of about once every five years. I wouldn’t dream of going to the doctor with a cough, a cold, a fever, or most aches and pains. Something has to persist for a while before I contemplate going, and even then I usually don’t—because I don’t expect much value from the consultation. The doctor usually says: “It might be this, or it might be that. Or it could be something else altogether. We might run some tests.”
Some of the this’s or that’s might be alarming. A close friend of mine went with a persistent cough, and their GP mentioned a condition that terrified this friend when she looked it up on the internet: death seemed close. After many tests she was referred to a consultant, who said that she had a sensitive respiratory tract and to forget it. Lots of cost, but little benefit there.
One good reason for going to the GP is to get referred to a surgeon—because surgeons can add value, at least when they stick to the simple stuff. Twenty years ago I had a left inguinal hernia repaired. Now I need a right one repaired. I don’t want it to reach my knees.
The operation that added more value than any other—because it stopped me populating the world any further—was my vasectomy. But I didn’t bother my GP with that. I paid my £50 to Marie Stopes, climbed up on the operating table, confirmed that I knew my vasectomy was forever (even though I know they can sometimes be successfully reversed), and had the snip.
I also take the polypill to avoid having to go to the doctor. I don’t know my blood pressure or my lipid profile (and am pleased not to), but I know that because of my age I have about a 10% chance of a heart attack or stroke in the next 10 years. That seems like enough risk to me to justify taking a pill each night, which seems for me to have no side effects, comes through the post, and costs me £12 a month. But if I had to go to the doctor every three months to have my blood pressure measured, I’d rather take the risk of the heart attack or stroke. It’s all I can manage to go to the barber’s, and I don’t dislike that as much as I dislike going to the doctor’s.
Then there is the whole feel of a consultation. I know doctors’ lingo, and I was editor of The BMJ for 13 years. Indeed, I have a medical degree. But I still feel like a little boy when I go to the doctor, even though most of those I see are at least 20 years younger than me. Odd, isn’t it?
I suppose that one day with my coming multimorbidity, I may have to troop along to the doctor every week, but I think that I’d rather be dead. Wouldn’t you?
Richard Smith was the editor of The BMJ until 2004. He is now chair of the board of trustees of icddr,b [formerly International Centre for Diarrhoeal Disease Research, Bangladesh], and chair of the board of Patients Know Best. He is also a trustee of C3 Collaborating for Health.