Sunday 6 October 2013

Break it to me gently, doctor, how long have I got?

Also published on here:

A notice on the wall of my GP’s surgery reads, “Do not discuss more than one problem per appointment. Remember, you are allotted only 10 minutes.”

It was a message reiterated to my dad during a consultation in early 2011 when he mentioned a second concern: a lump on his head. The primary concern was a larger, as-yet-undiagnosed lump on his shoulder.
“This is a 10-minute appointment,” the GP said firmly. The implication was clear: he didn’t have time to look at the growth on my dad’s head.

Three months later, Dad was dead. The lumps were cancer that had spread from his lungs. 

I’m not blaming the GP for my dad’s death. The cancer had metastasised and there’s little chance it could have been halted by swifter medical intervention. I am not blaming; I am asking: when did GPs run out of time for their patients? What changed? 

You don’t need to know much about biology to realise that the body is a holistic system: the component tissues and organs interact and affect each other. It’s not uncommon for a symptom in one part to be traced to a root cause in another. 

We rely on GPs to be crack detectives of physiology, seeking out as many clues as possible to home in on the underlying malady. Our lives are in their hands, and that shouldn’t be an unsettling thought.

For many of us, it takes guts to book an appointment and tell a stranger about our worries. (Not to mention the added stress of negotiating time off work, etc.) We’re often scared, especially if we fear it might be something serious. We also worry that we’re wasting the doctor’s time, even when we know deep down something is wrong. We’re easily put off by brusque treatment, made to feel feeble and even more apprehensive; next time something hurts, we think twice before seeking advice.

A detective wouldn’t cut short a witness: “Stop blathering about the colour of his clothes and cut to the bit where he pulls the trigger.” So why does a GP in pursuit of diagnostic pointers discourage a patient from describing fully their concerns?  

Yes, I know time is money (a GP’s time, lots of money) and money is limited. I know too that some people waste GPs’ time with untreatable sniffles etc, but that can’t be helped except through patient (in both senses of the word) education. If the system is buckling, let’s at least take notice and fight to save it. Institutional cursoriness isn’t a solution, it’s surrender.


I’m a sniffling time-waster, perhaps: there’s probably nothing seriously wrong with me, but a couple of times lately while running my heart rate has leapt up to 220bpm. My usual ‘maximum’ is 185bpm. It didn’t hurt but I felt a flutter in my chest and running suddenly felt harder. The first time it happened I wrote it off as a one-off glitch and did nothing; the second time, I figured I should get checked.

The GP referred me to the practice nurse for an ECG, which came back as abnormal. The length of time between the electrical signal telling my heart to finish a beat and the beginning of the next one, to start the next beat, is longer than it should be. Having an over-long QT interval is associated with dropping dead while playing sport. 

“I want some advice from a cardiologist on this,” said my GP. “We ought to get an answer quite swiftly, so I’ll have a fax sent today. In the meantime, don’t push too hard.”

That was a fortnight ago. I’ve heard nothing. I phoned the GP’s surgery and the receptionist told me to contact the hospital cardiology department directly. So I rang the hospital, and was told that the relevant paperwork would be impossible to find unless I knew the name of the consultant to whom the fax had been sent.  

“Which consultant was the fax sent to?” I asked the GP’s receptionist.

“We never specify a consultant, we just send it to the department.” 
“But… But please, I don’t know what else to do.” 
“Well, I shouldn’t be doing all this chasing-up. We’ve been told not to. We don’t have time,” she huffed, before reluctantly agreeing to resend the fax. “Try calling us next Monday to see if we’re heard back.” She didn’t sound confident.

I don’t feel entitled to urgent attention; I suspect my heart is OK – I’ve been running for years and I figure that if my ticker were going to fall fatally out of rhythm, it would have done so before now. Even so, what if there were a serious risk? What if I did have a timebomb in my chest? Would the NHS have the time to tell me? Who knows.