Julian Sheather: When patients become the enemy

I was out with a friend recently, a GP. He works in an inner-city practice. By all accounts he is a good GP.  As a mate I know him to be passionate, hard working, and committed. He is bright, with interests that range way beyond medicine. I got to know him when he was a junior doctor. Over the years I’ve seen him go through some professional highs and lows. I’ve seen a great deal of his love for medicine and of his unsentimental regard for his patients. (Anyone working in an inner-city practice gets to see a deal of the good and the ill in the human lot.) At times though I’ve also seen his humour corroded by pressure of work and his love of life wither from fatigue. This time though he was at an all-time low. After a few drinks there were tears in his eyes. The job that he loved was killing him. He recounted to me his average day. How he parcels out his time in ten minute slots. How consultations are computer-led. How no matter the complexity of the case or the scale of the clinical challenge – nor even whether he and the patient share a common language – ten minutes was all they got. Helplessness was his chief complaint. Loss of control. The relentlessness of the demand. The limitations of the medical arsenal in the face of the sheer complexity of human distress. As he talked though other things seeped through his words. He works in a progressive practice in northern England and although instinctively a democrat there were times when the lack of respect hurt. He had no love for deference, but had not expected it to be replaced by contempt. He spoke of patient rage at not getting exactly what they wanted, of insult, complaint and ingratitude. He was also struggling with himself. Doctors, he said, were supposed to be able to cut it. There was an esprit de corps: you held the line, you didn’t show weakness, you didn’t let the side down.  Was it just that he wasn’t up to it? And what did that say about him?

We were drinking in one of those bars that might be an art gallery, or one of those art galleries that might be a bar. At a neighbouring table was a group of media professionals. Similarly paid to my friend, no doubt, similarly successful.  Happier though they looked, happier by far and collectively they radiated that slight air of – how difficult it is to define – call it a slightly smug knowingness that sometimes goes with their territory, a sense of being in the innermost of in-groups. My friend spoke of his troubles and they spoke of theirs. Now every walk of life has its shortcomings, its frustrations – only he who wears the shoe knows where it pinches – but their day had been passed filming a plate of lamb chops – I jest not – while my friend’s had passed very differently. A patient had complained because he had not signed her child off sick from school. A drug addict had admitted to criminality that he should probably report to the police. A lone mother had been on the brink of suicide. And he had worked through this non-stop for five and half hours – thirty-three patients – without as much as a cup of tea.

I have been thinking of him a lot since we met. I see him in his consulting room, the waves of human suffering, small and large, lapping at his door. No doubt there are many reasons why people go into medicine, but one of my friend’s was that old old impulse to help people out. So exhausted had he become though, so drained by the demand, that he had come very nearly to dread the next person coming through the door. It is a terrible thing when good doctors start to see patients not as people to be helped but almost – and it is difficult to find a better word –  as an enemy to their own wellbeing.

Julian Sheather is ethics manager, BMA. The views he expresses in his blog posts are entirely his own.