Friday, 18 September 2015

Doctor Foster

What is going on here in the first episode? Paranoia and delusion? Or a woman's worst fears confirmed? It's not easy to tell. Doctor Foster on the surface has it all - sexy husband, good job, well-behaved son, nice house. Only then she finds a stray blonde hair on a scarf. Rather than confronting her husband directly about it, this discovery sets in motion seemingly irrational behaviour in Doctor Foster and an obsessive drive to determine the truth. Yes, it does rather look like the sexy husband is, um, sowing his oats elsewhere with a woman possibly half his age. But is he really? You can't quite trust anything you see. And a GP who bribes a drug-seeker to tail her husband with the promise of Temazepan is not the most reliable of witnesses. Although she does have a good sideline in evicting violent boyfriends. "Hell hath no fury like a woman scorned" - it's all very intriguing, with a slight air of Fatal Attraction about it.

But before we start boiling bunnies, it's interesting to see the GP at work. She rolls her eyes at the latest visit from her resident hypochondriac and hastily evicts him when she finds something better to do. She has her mobile phone switched on during consultations and doesn't hesitate to use it for personal texts. She is distracted and dismissive. She also chairs a committee to strike off the only traditional family doctor left on the team, the one who laments the turning of the practice from one that cared about, had time for and knew all its patients into one that is just a systematic factory on an efficiency drive. Admittedly said family doctor also has a drink problem and fails to turn up for surgery, but he does have a point.

I think all of us have seen the rapid decline in GP services in recent times. Practices are closing or merging with others, but after a merger there seems to be no increase in numbers of doctors available, just even more patients than before clamouring for appointments. So much so that it's now often completely impossible to get one. For at least a decade it's been standard practice to ring your surgery on the day at 8am sharp to book yourself in. Not long ago - after a night of watching my delirious daughter hallucinate, struggle to breathe and not even be able to keep a sip of water down - I had to wait on the phone for 45 minutes before my call was answered, by which point the ten appointments available that day had long since been allocated. I knew it was probably a virus, but it's hard to think straight when you have been up all night and she was so ill that I needed reassurance that it wasn't something more serious.

There's that mother's instinct, which a GP has to trust. I find it's more reliable than my instincts about my own health. I don't want to bother a doctor unnecessarily, which means I, like many others, am relying ever more on NHS Choices and online discussion forums for information. NHS Choices is generally very helpful. Some of the other sources are terrifying. Possibly medically uninformed and probably trying to sell something and definitely likely to make you want to see a doctor even more. But what is bad is that Google sometimes offers more facts on a given condition or symptom than your average GP. They seem to be terribly ignorant about a lot of things. Medical students have always had a bit of a reputation for hard drinking and partying at UK universities. It's hardly practising what they will later preach, or a good basis for learning all that they need to know. I remember the medics at Newcastle University complaining about the pass rate for their exams being higher than for other subjects. But the point is, none of us want to see a doctor who only knows 40-50% of what they are supposed to. You want them to know a good 80-90%, or ideally 100. But that ain't ever going to happen. Certainly not now, when you are lucky if a doctor even wants to stay in the profession, or the country, after qualification.

GPs have so many patients to see that they have become masters of the fob-off - they will diagnose you with the first thing that comes into their heads so that they can get you out the door and see their next patient on schedule. They'd probably prefer to just speak to you on the phone and not see you at all. There is no time for them to probe any deeper and no budget for tests or referrals if they can possibly avoid them. Ten minutes is often nowhere near enough to get to the root of a problem. Or you just discuss the most pressing issue and have to leave the three niggling other things for another time that never comes. Most of us don't mind a longer wait if it means that the doctor will also not make us feel rushed when it's finally our turn, but GPs are having to meet targets and quotas and this is sometimes what they are pushed to care about more. I did have an excellent local GP who always gave you the impression she would do anything in her power to help you, but she is a rarity and sadly she has been off sick for the past six months (miraculously not with stress). I hope she isn't relying on her own GP or local NHS services to cure her.

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