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1、 Confessions of a GP Benjamin Daniels Table of Contents Cover Page Title Page Disclaimer Who am I? Introduction Mrs Peacock Tom Jones Targets First day Jargon Proud to work for the NHS Drug reps Mr Tipton, the paedophile Average day Tara Sex in the surgery The elderly Bums Julia Good doctors Connor
2、Janine Saving lives Kirsty, the trannie Its my boobs, Doc Mr Hogden Small talk Notes Lists Ten minutes Alf Meningitis Uzma Africa Evidence Carolina Lee Hugging Shit life syndrome Mrs Briggs Betty Bales cat Vaccines Darryl The pat dog Rina Dos and donts Home births Michael Alternative medicine Thai b
3、ride Dead people Holistic earwax Obesity register Dr Arbury Body fluids Racism Sleep Magic wand Cannabis Sick notes Drug repsagain MistakesIve made a few Dying Happy pills Top 1 per cent of the population Computers Kieran Peter Granny dumping Aggressive conduct disorder Ed Camouflage man Memories Fi
4、ghting Class Tingling ear syndrome Gary Beach medicine Gifts Politics Passing judgement The examination game Sex Money Angela I dont like some of my patients Boundaries Smoking Angry man Maintaining interest The future? Tariq Babies Acknowledgements About the author Copyright About the Publisher Dis
5、claimer The events described in this book are based on my experiences as a new GP. For obvious reasons of privacy and confidentiality I have made certain changes, altered identifying features and fictionalised some aspects, but it remains an honest reflection of life as a young doctor in Britain tod
6、ay. This is what its like. These things really happen! Who am I? Humans have a universal desire to be listened to and share their stories of pain and suffering. My job as a GP is to listen to those stories. Sometimes I interject with some suggestions or medications, but more often I am simply a pass
7、ive observer of the soap operas that are peoples lives. With regular appointments, I watch the characters develop and the narratives unfold. Although some of my patients have an overinflated view of my significance, I really am just a walk-on part in their lives. Im like the extra in the corner of t
8、he Queen Vic who tries his best to play a small role in one or two of the storylines, but in reality rarely affects the progress of the plot or the big ending. The advantage I do have is that I get to watch the story unfold from a unique and fascinating angle. Being a doctor gives me a privileged in
9、sight into the more private and often bizarre aspects of human life and, with that in mind, let me share some slices of my working life with you. Introduction I love my job and have no regrets about choosing to become a doctor and then a GP. This is quite fortunate really, as my decision to study me
10、dicine was made as I chose my A levels at the tender age of 16 . At this time my only real reservation against becoming a doctor was the knowledge that I would have to endure chemistry A level. I couldnt really think of any other reason why I shouldnt be a doctor. What could be better that swanning
11、around a hospital full of beautiful nurses and “saving lives”? People would think I was great and ultimately this would lead to me finally getting a girlfriend. As an awkward 16-year-old with bad skin and greasy hair, most of my career aspirations were based on what profession would give me the best
12、 opportunity of gaining me some interest from the opposite sex. I had accepted that my carnal ambitions would ideally be achieved by being in a boy band or playing premiership football, but unfortunately my lack of talent in both these departments led to the inevitable choice of medicine. I chose my
13、 A levels in the year that ER first arrived on our screens. A poster of George Clooney in a white coat was on every girls wall. Of course I wanted to be a doctor! On my university application form, I had the good sense to not write that I wanted to be a doctor so I could save lives and hence get lai
14、d. I scribbled down something about my love of working as part of a team and my fascination with human sciences. To be fair, I suppose these statements were also true, but it is so hard to pick a career aged 16. The real world of work is always such a mystery until you enter it. When my mate Tom app
15、lied to teacher-training college, he wrote that he wanted to help young people flourish and fulfill their true potential. After a five-year tour of duty in an inner city comprehensive school, like us medics, he is just trying to get to the weekend without being punched or sued. Although Im now a GP,
16、 my training required me to spend many long years working as a hospital doctor. I completed five years at medical school and then spent several years working in various hospital posts gaining the experience needed to become a GP. I was a junior doctor in surgery, psychiatry, A I masturbate 10 to 15
17、times per day what should I do? I ate four Easter eggs this morning and now I feel sick; My husband cant satisfy me sexually; When I was in church this morning, I was overcome by the power of the Lord; I think my vagina is haunted. Elaine is a classic example of someone that we GPs see fairly regula
18、rly. She was odd and eccentric, but not quite mentally ill. She was slightly obsessive and delusional but not really harming herself or anyone else. Admittedly she didnt work, but she functioned reasonably well from day to day and didnt really have any insight into the fact that other people found h
19、er to be a tad unusual. Instead, Elaine generally saw most of the rest of the world as slightly peculiar and felt it was just her and, of course, her darling Tom Jones who were the only normal ones. Looking through her patient records, I noted that she did once see a psychiatrist a few years back. H
20、e diagnosed her as having some abnormal and obsessive personality traits but no active psychosis. This is psychiatry speak for slightly odd but basically harmless. He does love me, you know, doctor. If he met me, he would know it straight away. Were made for each other. Isnt Tom Jones happily marrie
21、d and living in America? No no no! He loves me, doctor. Elaine would have happily spent all afternoon telling me about her Tom Jones fantasies, but I felt that we needed to move things on. I used the classic GP phrase that we pull out of the bag when we feel that were not getting very far. So Elaine
22、, what are you hoping that Im going to do for you today? Well, doctor, I need you to write Tom a letter. It would sound better coming from you. Hes a doctor as well. Well, not a real doctor, but Im sure hed be a wonderful doctor if he wanted to be. Hes very kind you know and oooh so gorgeous and any
23、way, Im sure if you just explained everything he would see sense, I know he would. Basically, I was being asked to stalk Tom Jones on Elaines behalf. I could imagine the letter. Dear Tom, Please will you leave your wife, family and LA mansion and move into a council bedsit with a slightly odd woman
24、with straggly hair and a duffel coat that she has been wearing since 1983. It will make my life slightly easier as she wont keep coming to the surgery and annoying me with her graphic descriptions of your imaginary sex life. Best wishes, Dr Daniels Stalking is defined as a constellation of behaviour
25、s in which an individual inflicts upon another repeated unwanted intrusions and communications. Elaine probably would have quite liked to have stalked Tom Jones, but I dont think she really had it in her. For Elaine, her problems with relating to everyday folk had resulted in her focusing all her en
26、ergy on an imaginary relationship with a person whom she would never meet. I guess this was a good way to protect herself from the struggles and potential rejections of real-life relationships. Whatever the psychological explanation, Ill never be able to listen to Its Not Unusual in quite the same w
27、ay again. Targets Lucy, the practice manager, popped her head around the door: Ive put you down for a visit to see Mrs Tucker. Shes had a funny turn and fallen over. Perhaps you could diagnose her as having had a stroke? It is January and our Quality and Outcomes Framework (QOF) targets are due in A
28、pril. None of our patients has had a stroke in the last nine months. This should, of course, be a cause for celebration, but Lucy is not happy. If no one has a stroke before April, we will miss out on our stroke target. The government tells us that if a patient has a stroke, we need to refer him/her
29、 to the stroke specialist and then well get five points! But if no one has a stroke, we miss out on the points and the money that comes with them. The more QOF points the practice earns, the more money the partners take home as profit. The practice manager also takes her cut as an Easter bonus if th
30、e surgery gets maximum points. In the world of general practice, points really do mean prizes. Some older GPs hate disease guidelines. They feel that they take away our autonomy as doctors and rob us of our integrity and ability to make our own clinical decisions. I myself dont begrudge guidelines a
31、t all. Strokes have been poorly managed in the community for years and some good research has shown that if someone has a stroke or a mini stroke and we sort out their cholesterol and blood pressure and send them to see a stroke specialist, we can genuinely reduce the chance of them having another s
32、troke. Mrs Tucker is 96 and lives in a nursing home nearby. She is severely demented and doesnt know her own name. In her confusion she wanders around the nursing home and frequently takes a tumble. She had fallen over again today and could well have had a mini stroke. Having said that, she could ju
33、st as easily have simply tripped over a stray Zimmer frame or slipped on a rogue Murray Mint. She was back to her normal self now and common sense told me that this lady would not benefit from a whole load of tests and new medications that in the long run would probably only increase her confusion a
34、nd make her more likely to fall over. Im allowed to be puritanical because Im not a partner and so dont make any money from the QOF points. But would I have been tempted to diagnose Mrs Tucker as having had a stroke if I knew it meant that I would pocket some extra cash in April? Amazingly, in the v
35、ast majority of practices that I have worked in, the doctors are incredibly honest about achieving their targets truthfully. However, shouldnt we remove the temptation altogether? Surely, doctors should be able to make sensible decisions about what is in the best interest of our patients without nee
36、ding targets and cash incentives? First day I can still remember my first day as a doctor very clearly. It is something that I had been looking forward to since I first chose my A level subjects eight years earlier. Now the actual day had finally come I was absolutely shitting myself and wondering i
37、f I wanted to be there at all. We spent most of the first day having induction-type talks. These consisted of a fire safety talk and an introduction from a medical lawyer on how best not to get sued. Not particularly confidence boosting. As the induction day drew to a close, most of the other new do
38、ctors went to the pub. Not me though. I was doing my first on call on my first-ever night as a doctor. This may have been the short straw for some but, although frightened, I was excited and keen to get my first on call over with. This night would be the making of me, I thought to myself. By this ti
39、me tomorrow, I would be feeling like an old pro and be regaling heroic stories of my life-saving antics to my admiring colleagues in the pub. It was going to be like losing my virginity all over again. My brand-new shirt was ironed and although a couple of sizes too big, my white coat was starched a
40、nd gleaming. I had a sensible haircut and a stethoscope round my neck. I looked at myself in the mirror astounded that I really was a doctor! I picked up my pager at five that evening and sat there looking at it timidly. This small black box would come to be hated by me during my future years as a h
41、ospital doctor. This box would wake me from sleep and interrupt my meals. When completely overloaded with work and feeling like I couldnt cope, this small inconspicuous little box would bleep and tell me that I had another five urgent things to deal with. Of course I was unaware of all of this on th
42、at first innocent evening. Instead, I had a nave excitement that I was finally considered important enough to have my own pager and that it might actually go off. I had been practising how I should best answer it: Hello, its Dr Daniels, vascular surgical house officer. Thats right, my first job was
43、as the junior in the vascular surgery team. I didnt really know what vascular surgery was, but I liked the sound of it. Perhaps I could drop the house officer bit and just answer by saying: Hi. Dr Daniels, vascular surgeon. Hmm that would sound much more impressive. I could just picture the attracti
44、ve nurse swooning on the other end of the line. To my surprise, at about ten minutes past five my pager did go off. I took a deep breath and answered the call: Hi. Dr Daniels, vascular surgeon. There was a sigh from the other end of the telephone. It was my consultant and new boss. You are not a vas
45、cular surgeon, you are my most junior and least useful helper monkey. Some poor bastard has popped his aorta and Im going to be in theatre with the registrar all evening trying to fix him. I need you to order us a chicken chow mein, a sweet and sour pork and two egg fried rice. Have them delivered t
46、o theatre reception. The phone went dead. That was it. All those years of study and my first job as a doctor was to order a Chinese takeaway. Consultant surgeons have a wonderful way of ensuring that their junior doctors dont get above themselves. Over the next hour my pager started going off increa
47、singly frequently until it built up to what felt like a constant chorus of bleeps. Jobs that would take a few minutes for me to do now, took an hour back then because I was so new and inexperienced. I decided that the cocky doctor role didnt suit me so I went for the pathetic vulnerable new doctor a
48、pproach. It worked and the nurses soon began to feel sorry for me. They offered to make me tea, showed me the secret biscuit cupboard and helped me find my feet. Just as I was beginning to gain a little confidence, my pager made a frightening sound. Instead of the normal slow, steady bleep there was
49、 a stream of quick staccato bleeps followed by the words Cardiac arrest Willow ward Cardiac arrest Willow ward. To my horror, that was the ward that my consultant covered. That meant that I should really be there. I started running. The adrenaline was pumping, my white coat was sailing behind me as I zipped passed people in the corridor. I was important. It felt great! Suddenly, as I got closer to Willow ward, a terrifying thought dawned on me, Oh my God. What if Im the first doctor there! Ive
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