LITMIR.BIZ

       Introduction

      I can still fondly recall the first diagnosis I ever made. As with many others that followed, it was spectacularly incorrect, but it still holds a special place in my heart. In my defence, I was just a mere boy at the time, wet behind the ears and only a few weeks into my first term at medical school. I was sitting in the local Kentucky Fried Chicken and spotted a man slumped unconscious in his plastic seat. A wave of excitement flooded over me. This was what it was all about! This was my vocation! With the limitless enthusiasm of youth and inexperience, I bounded over to undoubtedly save his life with my new-found wealth of medical knowledge.

      It didn’t take me long to conclude that this gent had suffered from a spontaneous pneumothorax. This was not based on clinical signs and symptoms but more that this was the condition that we had learnt about that morning in a tutorial and so was the first and only diagnosis that sprung to mind. With an air of self-importance, I explained to the KFC manager my diagnosis and instructed him to call urgently for an ambulance. Looking thoroughly unimpressed, he wandered out from behind the counter and roughly manhandled the unconscious man from his seat and threw him out of his restaurant. My first-ever patient spectacularly regained consciousness, uttered a few obscenities addressed to no one in particular and staggered off down the street. The KFC manager in his far superior wisdom had, in fact, made the correct diagnosis of ‘drunk and asleep’ and prescribed him a swift exit from his premises.

      I can see why the professor chose to teach us innocent medical students about a spontaneous pneumothorax that morning. It is, in fact, a wonderful feel-good condition for doctors. An otherwise healthy person collapses with a deflated lung and then the clever doctor diagnoses it with his stethoscope and sticks a needle between their ribs. With a triumphant hissing sound, the lung inflates and the patient feels much better. The professor was trying to help explain the normal functioning of the lung and what could go wrong. He was also trying to encourage us to embrace the wonderful healing abilities we could have as doctors. Back during those early days of medical school I believed that most of medicine would be that straightforward. Someone would be unwell, I would do something fabulous and then they would get better.

      Funnily enough, despite a spontaneous pneumothorax being the first medical condition I ever learnt about at medical school, I have, in fact, never actually seen one since. Looking back, I wonder if actually a far more useful and accurate introduction to being a front line NHS doctor would have been a tutorial on how to remove a semiconscious drunk bloke from a waiting room:

      ‘Would everyone please welcome our guest speaker today. He has a long and celebrated career working in numerous late-night fast food outlets and will be giving you his annual demonstration on how to prepare yourselves for spending your futures working in the NHS. Do take notes on how he skilfully removes the inebriated gentleman while remaining entirely unsoiled by any body fluids and simultaneously evading drunken punches. You will be tested on this in your end-of-year exams, so do pay attention.’

      When I think back to that KFC, I can still recall my shock at what I perceived to be the terrible ill treatment of this poor man. The callous, heartless actions of the restaurant manager only increased the feeling that my true vocation was to become an amazing doctor in order to cure just such vulnerable people who needed my help …

      Ten years later, after a long day of inner city general practice, my brain was heavy with the multitude of sufferings that I had encountered. Chronic pains, domestic violence, addiction, depression, self-harming and a fairly big helping of broad-spectrum misery were the principal orders of the day. After many hours of putting my heart and soul into my patients’ problems, I knew that my competency that day would be judged not on my diagnostic skills or my bedside manner, but by how many targets I had reached from the latest pointless government directive. While finishing the day reading the latest newspaper headline about how GPs were lazy money-grabbers, it was almost a relief to receive an emergency call from reception to tell me that a man had collapsed in the waiting room.

      Rather than springing up into life-saving action, I heaved myself out of my blissfully comfortable chair and ambled down to the waiting room. Over the last ten years that limitless enthusiasm had been gradually broken down and replaced with a defeated resignation. I took no satisfaction in this time getting my diagnosis spot on. Still waiting for that spontaneous pneumothorax to heroically cure, I was greeted instead by one of our local street drinkers in a drunken stupor in the children’s play area of the waiting room. Using the expertise I perfected during endless Friday and Saturday night shifts in A&E, I skilfully escorted the intoxicated man from the surgery back on to the street.

      In a wave of sad nostalgia I wondered what that naïve 18-year-old me would think about what he had become. Would I have even bothered to have gone on to study medicine if I could have foreseen how so much of that initial hope and optimism would drain away? Not even out of my twenties yet, I began to wonder if being a doctor was anything close to the career I thought it was going to be. As I returned the drunk homeless man on to the street, I offered him an appointment to come back and see me the following morning when he was sober, explaining about organising an alcohol detox. ‘I’ll be there, Doc,’ he told me as he shoved the appointment card into his pocket. We both knew that he’d miss that appointment, but at least we were mutually left with a faint glimmer of hope for something better.

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