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Patient stories

Coalface tales

James Booth

Tuesday, 12 November 2019

AdobeStock_120197839_stories_blog.jpgHere’s something that always makes me smile when I think of it: one of my patients has her name on he surface of Mars. 

She works at a large electronic engineering factory in town, and signed off a piece of equipment that formed part of the Beagle 2 lander that, whilst it never got signaling, did end up on the Martian soil and remains there now. Her name is written on that bit of kit, and will sit there, on another world, for quite possibly millennia. 

I mentioned in a previous blog that I think the institutional memory our practices hold about our patients is pretty much the most valuable thing in primary care, and something utterly under recognised, and held to be cheap and disposable when reforms come round. That clinical knowledge is vital, but the thing that I possibly like the most about being a GP is the window it opens on people’s lives, and the things we can learn from what I tell our medical students is a detailed social history, but is in fact often just a bit of a chat (and some friendly nosiness).

Alongside our vicarious Martian explorer, we have a host of patients with a fascinating story to tell. One regular gave me a signed photo he’d got from his best mate a while ago; it’s framed on my wall as it was signed by Darth Vader himself, Dave Prowse. Also, of course, the Green Cross Code Man, for those of us born in the seventies. I used to look after the aunt and uncle of a Turner Prize winner, who’d happily show visitors the original work of his they kept in their bungalow. Our nursing home used to care for an utterly fascinating man, who’d flown for both the Luftwaffe and USAAF, having defected from Nazi Germany during the war.

Looking at framed photos on home visits is something that I also like to indulge in. My training practice has an elderly lady registered who proudly sports the photo of her teaching the Queen to drive when she was in the army. Another has her son in the arms of Marlene Dietrich, who was visiting the school for the blind where he was a pupil. 

I could fill this whole blog with this sort of thing, as more keep occurring to me as I write it, but there is a point to be made here, too. I generally hesitate to romanticise the past, but I do think it is true that our GP forebears had a deeper relationship with their patients. My Dad has been retired for two years now; but still every day, without fail, at least one or two people ask after him during an appointment. Most of the things I know about my patients I learnt from him, and so often a request for clinical information had something like, “Interesting man, fought in Korea,” added. What these things reflect is a deep knowledge and understanding of the people under his care, and that was borne out of continuity, and interest in his patients as people. It makes for better care, better relationships, and the kind of trust that also meant that patients were much willing to share darker, more troubling truths about their lives. Our practice has been a place where people have been able to safely disclose, finally, the dreadful abuse that blighted their childhood, or to seek help when worried about the violence emerging in their marriage. 

So much of GP reform seems now to be interested in speed of access, of target-led care, and it’s easy to see primary care becoming more like a conveyor belt, a place where we accept that it’s ok to speak to a patient via a screen, to run through a template and a few tickboxes instead of conversing, to reduce clinical histories to scores and a social history to some QOF targets. And yet, when we open our ears to our patients, to give them the space to talk, to listen, we can hear things that really demonstrate just how privileged we are to have a window into peoples’ lives. 

I’m going to finish with something I learnt from a patient who has since died; in fact, everyone involved in this story has, so whilst it will of course be anonymous I feel I can share it. My patient was an elderly man, long retired, who I mainly came to know through caring for his wife. He was faced, at a rather late stage of his life, with having to deal with the aftermath of an accident in which he lost his nephew, the only son of his brother. He told me that his nephew had been something of a recluse, as had his parents been, and he was living in the home he’d shared with his parents then continued to live in after they died. Despite their living there for decades, my patient had never visited them there; they came to him on the occasions they saw them. He entered their home for the first time after the accident, when he was the only person left to execute the will. There, in a locked back room, he found all of his brother’s wedding presents, completely untouched for over a century, unopened. 

“He’d had a very difficult war, you know, never really got over it, never spoke of it.”

There’s nothing clinical in this, really, and they weren’t even my patients, but this particular conversation and the thought of this house, full of quietly endured sadness for so long, will never leave me. I feel privileged that a patient felt able to share it with me, glad that I had the time and the relationship that we had to enable him to do so, and sad that it represents a side of our work that is so very important, and so very undervalued.

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James Booth

James qualified from UCL in 2002 and has been a GP partner in Chelmsford since 2006. He is also the named GP for Safeguarding Children locally. All views expressed are his own.
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