Richard Smith: I hate going to the doctor

richard_smith_2014I hate going to the doctor. Don’t you? My statement is unsurprising as I’m a man and a doctor (of sorts), two groups who are known to dislike going to the doctor.

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.

  • David Taylor

    Very true, the thought of bloods twice a year and been on 20 different tablets sounds fairly depressing, I’ve already decided that once my co-morbidities mean I have more than 2 QOF targets I’ll stop everything and start smoking and drinking to speed the process up and enjoy it while it lasts.

  • LJ

    Oh British humo(u)r. How I do miss thee in America.

  • Jonathon Tomlinson

    I look after many patients who have long-term conditions and many more with mental health problems, but the greatest number are probably those who suffer chronic health anxiety driven by perpetual economic insecurity, poor literacy, inadequate housing, substance abuse, domestic violence – in short, poverty. Of course, many of these are also ill because of the strong links between poverty and multimorbidity.

    Many consultations start with patients looking embarrassed or ashamed and faltering apologies for wasting my time. It takes great efforts to reassure them. We have a service with continuity of care at its heart that allows long-term therapeutic relationships to develop.

    I’ve followed Richard’s writing with a mixture of interest and dismay for over 20 years. His contempt for doctors in general and GPs in particular seems increase with age, and articles like this seem to suggest it’s not simply because he is a disciple of Illich (with whom I have many sympathies) but because he doesn’t understand what we do.

  • Dr.K.SParthasarathy

    Dr Smith’s irreverent style makes him eminently readable. That is all. Perhaps if we follow his advice too seriously we may pay dearly.He reminds me of another senior physician. He always asserts that 40 % of diseases do not require any treatment. They cure themselves. I am not sure whether Dr Smith set up a practice ever.