Diagnosis: Pathetic

After working everyday at the surgery for the past three months, I met her for the first time today.

I wasn't sure whether to be scared, or to regard it as a challenge; but to be honest, it was with trepidation, tempered with a bit more cynicism and a little less sympathy than I would like, that I called out her name.

The consultation itselt was rather innocous, but it was more a case of putting a face (and body) to the reputation.

JT was notorious in the practice. She had so many problems: some of them real (diabetes, hypertension), some of it questionable (arthritis) and much of it imagined (pseudo-stroke, total body pain). Maybe a better classification for the last two would be psychosomatic (ie in the mind, but manifesting in the body).

During de-briefs, I'd listened as other GPs spoke of their frustrations in trying to look after her - she was never happy, no medication was enough, and despite numerous hospital reviews, no consultant specialist had ever found anything wrong with her. Everything I heard about her reinforced my desire to stay in hospital medicine - we too had our fair share of problem patients/heartsinks/nutters, but not even half as many as there were in GPland.

Being a general practice, I came into contact with members of her family - all adults and all of whom seemed to suffer from the same strange attitude to health and sickness - or in their case, they were all ill (there is no such thing as healthy) and deserving of a zillion repeat medications and a bus pass.* And I'd come to form a picture of what she must look like: a stout 60year old, with wrinkles, possibly looking much the worse for wear, and maybe a variable limp, or even a scruffy bandage on which ever limb she favours.

Imagine my shock when I first saw her. A fresh-faced lady, looking no older than 40odd years old, and would have looked the picture of health, had she not needed her husband and daughter to hoist her up by the arms, and totter if they relaxed their grip for a second. And it only got worse - her coat had to be unbuttoned and removed for her; they practically lifted her onto the couch, and all she did was scowl, moan and complain of pain (in a rather strangulated tone, which became decidedly normal when discussing in Urdu with her daughter which medications she needed). At the end of the consultation, they hoisted her out of the chair and off they struggled.

After dealing with her, and in need of a caffiene boost, I went to the kitchen. Staring absent-mindedly out of the window whilst the kettle boiled, I was surprised to see JT walking home with her daughter and husband - not a limp or helping hand in sight!

And there I was berating myself for being so cynical!

*yes, a bus pass - apparently, its the ultimate proof of ill-health and considered a trophy by a certain subset of our patients. One of the GPs has a brilliant questionnaire for dealing with unreasonable requests: "Are you blind?" "Do you have both your legs" Yes to both? "Well, I'm really sorry I have to disappoint you!" (yes, of course she phrases this better.)