Samir Dawlatly: What if En Aitchess was my patient?

“Enfield Aitchess?” I called to the waiting room.

A 65 year old man shuffled towards me and shook my hand. He seemed slightly out of breath.

“My name is Dr Dawlatly, please come in and take a seat, Mr Aitchess,” I said as we entered my room.

As he sat down he mumbled, “Most people just call me ‘En,’ actually, doctor.”

“Okay, En, what brings you here today?” I asked.

“It’s these darn winters doctor. I just don’t seem to be able to cope with them,” he started. I looked at him, encouraging him silently to continue.

“I seem to have some sort of functional deficit once the weather turns cold. Nothing seems to work properly, and I was wondering if you had some sort of diagnosis or treatment doctor?” he asked, looking at me hopefully.

“I see. Tell me more about your symptoms?” I probed.

“Well, you may have read about me in the papers. I always seem to be in the news. My ribs have been very sore from the kicking I have been getting from politicians of all shades. That makes breathing and functioning properly difficult enough.” He paused.

“Go on . . . ” I said.

“Well, in the winter it seems as though my systems are just completely clogged up with plugs of human species that I just can’t seem to cough up and get rid of, and when I do, I don’t have anywhere to spit them out to as my hands are tied by budget constraints, so I swallow them back down into my systems.” He seemed relieved to get this off his chest, even if he wasn’t able to clear his chest in real life.

“Any other symptoms?” I asked.

“I just feel tired all the time; I can’t do what I used to be able to. I’m not sure I would be able to cope with a real crisis if it came along. Oh, and when I breathe and talk I find that I am whining with every breath.” He stopped for breath. I could hear a faint wheeze.

“Whining? Don’t you mean wheezing?” I clarified.

“My passages are constricted and my body is not happy. Whining, wheezing, what’s the difference, doctor?” He looked at me with his deep blue eyes. “What’s wrong with me?”

“I don’t think this is as simple as being one diagnosis, Mr Aitchess. Sorry, En. Do you mind if I take a quick glance over your record?” He nodded as I turned to my computer.

I scrolled through his summary:
Conceived in 1945, born 1948, adopted by the country . . .
Chronic circulatory insufficiency
Anaemia owing to loss of red blooded workers
Multiple ECT—Election controlled treatments
CABG—Commonsense achievement bypass grafting

I turned back towards the patient. “As I thought, there are multiple factors contributing to your symptoms, En. There is, I think, one thing that we might be missing. I think you have COPD. You have, after all, been looking after smokers all your life.”

“COPD? What does that stand for?” asked Mr Aitchess.

“It stands for ‘Chronic Obstructive Patient Demand.’”

“How can you be sure? And how much of my symptoms can be put down to it?” he asked.

“That’s difficult. There are no definitive tests; all that is published is a series of case studies. To make matters worse, there is no agreement on what might be the best treatment. I think it is definitely contributing to your problems, but with everything else going on it is difficult to say exactly how much,” I answered.

“So, is there no hope then?”

“Well, we can always try a trial of treatment; En equals one, you might say. Perhaps a transfusion of fresh blood, a breath of fresh air, or a more radical amputation or transplant of your major operating organs, but there is no saying what might happen. I imagine you will end up with a few more kicks and all of the procedures have possible complications.” I paused again.

“Well, that doesn’t sound good. Perhaps best to not rock the boat, eh? I suppose I shall just struggle on for the next few years and see what happens. Before I go, can I have some soothing platitudes to numb the pain from these bruised ribs?”

Samir Dawlatly is a GP partner at Jiggins Lane Surgery in Birmingham. He combines clinical practice with being a part time house husband and an interest in social media, as well as publishing poems, essays, and blogs. He can be found on Twitter as @sdawlatly.

I have read and understood BMJ policy on declaration of interests and declare the following interests: I am a member of the RCGP online working group on overdiagnosis.