Tips on how to annoy your doctor

I thought I’d share some things which wind me up or give me that heart sink feeling when I’m consulting. This is partly therapeutic in me ventilating my frustrations but also I have this small hope that word will get out about how to avoid the following and my life might become easier.

DISCLAIMER: There follows some examples of political incorrectness. Please do not take this too seriously (if you’re one of my patients, or have ME, or are on DLA). I am actually a bit more sympathetic and sometimes less grumpy in real life.

1. Talking when the doctor is using his stethoscope. This one always helps me gauge a patient’s intelligence. I’m amazed at how often it happens. I have these big tubes sticking in both my ears, listening carefully to a child’s chest with a look of concentration on my face and the mother keeps talking. Firstly you can barely hear anyone talking when you’ve a stethoscope in your ears, secondly if you’re talking I’m less likely to hear that heart murmur or patch of pneumonia in your child’s chest. Lesson 1: Zip it when there’s a stethoscope about.

2. Regressing to a 3 year old’s ability of undressing when being examined. This is quite a prevalent phenomenon. I say, “Just pop up on the couch…I’d like to listen to your chest”, or “I’d like to examine your tummy.” Grown adults (probably men more than women) just sit or lie there, expecting me to untuck their shirt and unbutton their jeans for them! Of course there are some who are overly helpful – unfortunately they are usually little old ladies, who for some reason think that when a doctor wants to examine their abdomen, they have to get totally naked. Lesson 2: Dress and undress appropriately for your doctor.

3. Only telling the doctor why you’re really there 10 minutes into the consultation. Again you’d be amazed at how often this happens. It’s referred to as a ‘hidden agenda’. The patient comes in complaining of a sore toe. After taking a history, examining the offending toe, explaining the diagnosis and treatment, printing a prescription, the patient comes out with, ‘actually doctor the main reason I came in today was because I think I’m depressed and I think I have fibromyalgia’ (see below). Lesson 3: Don’t beat about the bush and come straight to the point.

4. ‘Hi, I’ve just registered with your practice, I’ve got ME/chronic fatigue and fibromyalgia.’ Ok, so maybe it’s not fair to complain about this sort of patient – their symptoms aren’t (always) their fault. But it’s a huge heartsink for most doctors. This is for a number of reasons. It’s the realisation that there’s no diagnostic test for these conditions, many patients have a completely normal examination with no physical identifiable cause for their symptoms. There is often no effective treatment. This unfortunately often results in dysfunctional consultations with unmet patient expectations and the doctor feeling inadequate and exasperated. Lesson 4: Try not to get ME/chronic fatigue, fibromyalgia. If you do, move abroad.

5. ‘I wouldn’t get addicted to sleeping tablets…. Can you give me some more – I can’t do without them.’ It’s amazing how many people think that becoming addicted to a drug is a conscious decision. They will often say, ‘Oh I know they can be addictive but I’m not like that, I wouldn’t become addicted’. The truth is if you take enough of a drug with psychoaddictive properties you are likely to become addicted. The country is full of wee old ladies who can’t get off their diazepam. Lesson 5: When your doctor tells you something is addictive, he’s not making it up.

6. Producing a list and saying, ‘I don’t come to the doctor very often so I thought I’d collect up a few different problems to talk about’. Now it’s quite understandable why some people do this. Often they are working and find it difficult to get in, or have difficulty getting appointments etc. But whatever the reason, it’s still rather annoying. Appointments are booked every 10 mins and usually run over. So the last thing you want when you’re running 40 minutes behind after seeing 3 people with depression, 2 with fibromyalgia (see above), and 2 Polish people who don’t speak English, is Mr Brown with his list of 6 complaints including chronic fatigue (see above), sore throat, request for diazepam and a vasectomy, a suspicious mole and a DLA application form for you to complete (see below). Lesson 6: Prioritise your complaints and if you have multiple problems to discuss book a double (or triple) appointment.

7. I’ve had a sore throat for 12 hours – I need an emergency appointment and an antibiotic stat’. In our consumerist culture most people seem to think they should be able to get what they want. This seems to be true of antibiotics. People seem to think that there’s some sort of conspiracy theory when they aren’t prescribed. ‘Those evil doctors want to keep those good antibiotics for themselves, they want us to suffer and die from our minor self-limiting infections!’ The truth is unfortunately modern medicine has not yet found a cure for the common cold or viral respiratory infections in general. As most sore throats and ears are viral, antibiotics will do no good, in fact they may do more harm than good. One of the reasons we have superbug infections like MRSA and C. Diff is because of the over-prescribing of antibiotics. Lesson 7: God has given you an amazingly complicated and effective immune system – give it a chance to do its job!

8. ‘I really don’t understand why I’m fat – I eat less than a mouse’. Now I’m not pointing the finger. My wife regularly makes me well aware of the fact I’m overweight. And with good reason -I eat too much and don’t exercise enough -simple as that. But it’s amazing the number of fat people who refuse to take responsibility for their excess adipose tissue. They swear blind that they hardly eat anything and think that exercise means walking to the fridge. Ok, that’s harsh but often when I ask people if they exercise they say, ‘Oh well I’m on my feet all day’ or ‘looking after 2 young children keeps me active enough’. Well, clearly it doesn’t because you’re still 30 stones. Lesson 8: You do not have a rare fattening gene. The simple fact is that: (calories eaten) – (calories burned) = (calories on the hips).

9. Exaggerating your symptoms. Some people just like telling good stories. They don’t want to disappoint with unimpressive sounding complaints, so a cough for a few days has been there for a few weeks, a niggly ache becomes a constant excruciating pain etc. Unfortunately this may result in patients being managed inappropriately. The patient themselves may be put at risk by being given unnecessary investigations and treatment. Thankfully it is usually obvious who the embellishers are. My most memorable examples of this are a 12 year old girl who was adamant she only urinated once or twice per week. She seemed a bit shocked when I told her either she had a 3 gallon bladder or she should be dead. Another mother was adamant that her 4 year old daughter hadn’t eaten or drunk anything in 3 weeks. (Again pretty much incompatible with life). After 10 mins of confirming that nothing really did mean nothing, it transpired that oh, she drank milk and ate bags of sweets! Lesson 9: Your doctor will not be disappointed if your symptoms aren’t all that bad.

10. Thinking that it’s your God-given right to claim Disability Living Allowance (DLA). Last but by no means least. This one REALLY bugs me. The benefits system is a farce in this country. 1 in 10 people of the workforce in Northern Ireland (not including the unemployed) are on Incapacity Benefit. That means 10% of people apparently have a disability so severe that they cannot do any form of work. The problem is that many people believe they deserve these benefits regardless of their medical problems. And why would you want to work when you can get almost as much for doing nothing? There are many entire families who are on DLA and in some cases are entitled to as much as £30,000-40,000 pounds a year as well as housing benefits. DLA must be one of the biggest disincentive to better health. The reality is that virtually no-one on DLA ever gets better. Lesson 10: Get out of your rent-free house with the satellite 40″ widescreen TV (seems to come as standard with DLA) drive down to the Job Centre in your modified, ‘chipped’ motability BMW and make some valuable contribution to society.

Apart from all this, I love getting up for work in the morning…

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