When the GP goes under the knife

I had known for some time that I needed to see a GP about my perennial rhinitis but had neglected to do so. Why did I delay doing something about my health? Gwen Adshead a noted psychiatrist possibly has the answer – in her work ‘Personality dysfunction of doctors’ she states doctors are:

  • Perfectionists
  • Narcissists
  • Compulsives
  • Denigrators of vulnerability
  • Martyrs

In the same vein, Jonathan Tomlinson brilliantly observes that there is a loss of identity when doctors become patients – he states the following “It is generally acknowledged that doctors make bad patients. Our professional identity enforces, or reinforces, the divide between us, the healthy doctors, and them, our sick patients.”

I proceed to tell my GP about the snoring, noisy breathing, blocked nose & the supposed apnoeic episodes noted by my wife. He goes through his consultation and I could not help but think ‘Nice consultation-style – not the way I would have done it, but clearly effective” He subsequently refers me to an Ear, Nose and Throat (ENT) surgeon for further investigation.

2 months after my initial GP appointment, a consultant examines me and states he cannot pass his nasoendoscope through my nose due to a prominent inferior turbinate and a deviated septum. Suddenly the appointment that I had begrudgingly booked to appease my wife had turned into something serious – I was now being consented for an elective septoplasty operation.

The surgeon was brilliant in explaining what the operation was and what would happen after the appointment. He actually apologised in advance for explaining and consenting the operation – “I know you’re a GP but I’m sorry, I’m going to explain this to you as you don’t know anything”. I told him he need not apologise as I appreciated him explaining every detail. This approach reminded me of the excellent GMC guidance on ‘treating the doctor as a patient’.

2 months after I had seen the consultant, the day of the operation had arrived and I was incredibly nervous. Why was I so nervous? I’ve been a doctor for several years; I had looked after hundreds of elective surgery patients and hadn’t given it a second thought. As the nurse in charge & ENT consultant prepped me for the operation – my mind wandered to my wife and 2 children. Panic hit me like a freight train-I hadn’t written a will – what will happen to them If I don’t wake up? I know it sounds ridiculous to think like this for a supposedly routine day-case procedure but in hindsight, this operation was a huge moment in my life. As a doctor, I often am in charge of people’s health – this was the first time I was on the receiving end of someone else’s care. 

I recently read the brilliant, yet poignant ‘When breath becomes air’-in it the late Paul Kalanithi perfectly describes my mindset at this point:

“I had traversed the line from doctor to patient, from actor to acted upon, from subject to direct object. My life up until my illness could be understood as a linear sum of my choices”

As a doctor, you are rarely alone. You work in a multi-disciplinary team – nurses, receptionists, secretaries, healthcare assistants, junior doctors, GPs, consultants, and others. There on a hospital trolley-bed however, I felt helpless & abandoned. The anesthetist told me what medication she was going to give me and declared ‘Now I am going to give you some Propofol- but not as much as Michael Jackson had’. At that moment I thought – this inappropriate comment may be the last thing I hear before I die….

As I counted to 10, waiting for the anaesthetic to course through my bloodstream, I said a prayer.

I woke up post-operation and it was the best sleep I have had since before the children were born – basically best sleep in 5 years.

My journey as a patient ended and within 2 weeks I started seeing my own patients again.

I now work as a GP with a fresh perspective – elective operations shouldn’t be measured by how routine they are or how long they last in an operating theatre. I now have first-hand experience that they constitute months of thoughts, anguish and reflection.

As a doctor, it is important to always think of how an illness or diagnosis affects an individual. How does it affect one’s family, their daily routines, career, beloved hobbies? I was one of 1.5 million patients in the UK who were admitted to hospital for elective procedures or operations in 2016/17. The operation is not restricted to the operating theatre- it is a journey from first presentation of strange symptoms to being consented for a procedure that will drastically alter your future. Never again will I gloss over my patient’s need for elective surgery.


James Thambyrajah
Salaried GP, Cheam Family Practice, Sutton CC

References:

1. Disruption and disorder: personality dysfunction in doctors.- Dr G Adshead from the original article: http://careers.bmj.com/careers/advice/view-article.html?id=20015402

2. “Lessons from ‘the other side’; Teaching and learning from doctors illness” narratives by Dr Jonathan Tomlinson BMJ CAreers  http://careers.bmj.com/careers/advice/view-article.html?id=20017843

3. When Breath Becomes Air by Paul Kalanithi 

4. GMC guidance ‘Treating the doctor as a patient’ http://www.gmc-uk.org/doctorswhoarepatientsjanuary2010.pdf_62126868.pdf

5. King’s Fund statistics for elective procedures. https://www.kingsfund.org.uk/publications/hospital-activity-funding-changes#elective-care

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