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be too careful

      Tracey’s entrance was never quiet. Buggy, shopping and three boisterous children piled into my room in a swirl of chaos.

      ‘’Allo again, Doc,’ Tracey chirped cheerily. ‘You must be sick of the sight of us, eh?’

      ‘Not at all,’ I fibbed back. ‘So what brings you in today?’

      ‘Well, it’s all of us really,’ and with that Tracey listed various transient minor ailments that seemed to be causing her and her brood great concern.

      ‘This one’s the worst,’ she said, pointing at her son Bradley who was jumping most energetically off my couch. ‘He’s really poorly. Not himself at all. He’s right off colour, he is. We was up the ’ospital all Saturday with him. ’Ad to call an ambulance and everything, but after nearly four hours waiting around in A&E they just said he had a virus and sent us home with paracetamol.’

      Tracey spends a lot of time requesting medical attention. It seems that however many times either I or the other doctors offer reassurance, she needs more and will seek out medical help at the drop of a hat. I don’t begrudge Tracey her frequent attendances. Well, if I’m honest, at the time I often do, but in the cold light of day I can accept that she is trying to be the best mum she can be. She worries about her children like all parents do, and she doesn’t have the means to alleviate this anxiety without a trip to the doctor. For the last few years, I haven’t really paid much heed to Tracey’s frequent visits, but her name had now cropped up on our list of patients who attend A&E too frequently.

      As we all know, the NHS has no spare money and one of the directives for saving funds is to persuade our patients to stop going to the hospital so often. For each attendance at the emergency department around £70 is charged to the NHS, and that cost doesn’t change much whether the treatment is simply some gentle reassurance, as in the case of Tracey, or if 10 doctors wrestle to save your life after getting knocked down by a bus. Our GP surgery gets paid £65 a year to look after Tracey however many times she comes in. The simple logic is, therefore, that for minor ailments it is much cheaper for Tracey to see us at the GP surgery than for her to go to A&E. It also frees up time for the emergency doctors to see patients needing genuine emergency care! That is why my bosses were telling me to make an ‘action plan’ with Tracey in an attempt to prevent her from visiting the hospital so often.

      After painstakingly reassuring Tracey that she and her children were going to survive the morning, I decided there was no time like the present and I was going to make the ‘action plan’ with her this very visit. We discussed all sorts of options to reduce her hospital attendances. I started by suggesting that she phoned the surgery rather than dial 999.

      ‘But sometimes I ain’t got no credit on my phone,’ she replied.

      ‘You could also take a taxi to the surgery rather than keep calling ambulances to go to A&E.’

      ‘Taxi! How can I afford a bloody taxi?’

      Finally, I proposed waiting for minor ailments to get better on their own, rather than instantly rushing to find a doctor.

      ‘Thing is, Doctor, you can’t be too careful,’ she replied.

      I printed out a copy of our ‘action plan’ and handed it to Tracey, but if I’m honest I didn’t think it was going to make a great deal of difference to Tracey’s attendance rate. It’s easy to view frequent attendees like Tracey as time-wasters and malingerers, but the truth is that from this side of the fence it is very easy to label which emergency hospital attendances are appropriate and which aren’t. GPs like me have the benefit of many years of medical training behind us to back up our decisions as to whether a patient needs to be seen in hospital – and we still often get it wrong! Tracey has no real support network and so she falls back on the medical profession. She is simply trying her hardest to keep herself and her family safe and for that I have to respect her.

      I know that I’ll get more letters from up above telling me that Tracey and her family attend A&E too often, but I think we just have to accept that some of the more vulnerable people in our society seek out our services to compensate for the lack of local support around them. However frustrating this can be for medical staff and the accountants trying to balance the books, I can’t see any real alternative. If an attempt is made to try to ration Tracey’s medical visits, my big fear is that she would stay at home for that one genuine emergency that really needed our help.

       Crackhead Kenny II

      I didn’t initially recognise Kenny when he came to see me. It had been a few months since he’d been a patient I’d seen high as a kite and handcuffed to a prison officer in A&E. We were now in the very different context of my GP surgery on a drizzly Monday afternoon. Kenny seemed very different too. His face looked greyer and older in the daylight, and although he tried to manage a smile, without the aid of his narcotic buzz he had lost his infectious grin.

      ‘I wanted to come and see you ’cos you was nice to me that time when we met in the casualty department.’

      ‘Oh, how did you know I worked here?’

      ‘Well, since I’ve been out, I’ve been back to A&E a few times. I was asking after you and that big Scottish male nurse told me you worked here as a GP, so here I am.’

      I tried to muster a smile, but I could tell that having Kenny as a regular patient was going to be hard work. I could just imagine Barry the charge nurse thinking it hilarious to direct Kenny to me.

      ‘How long have you been out of prison?’

      ‘Nearly a month now. I’m staying at a friend’s, but I’m going to get myself sorted out this time. No more smack for me, Dr Ben. I’m going clean for good this time.’

      ‘Great, so are you involved with the drug and alcohol team? Are they doing a rehab programme with you?’

      ‘No, Doctor. They’re all useless there. I won’t ’ave nothing to do with them. You’re the only doctor I trust. That’s why I’m here. I want you to help me.’

      I like being told that I’m a good doctor and even though I knew that Kenny was after something, I couldn’t help but feel flattered by his compliments however loaded they might have been. I’m sure one of the reasons that I wanted to be a doctor was some sort of unhealthy need to be liked. Many medics are, like me, constantly searching to be appreciated, and some patients can’t help but try to manipulate that flaw at times. When I first started as a GP, my trainer told me that wanting to be loved by everyone is an admirable trait in a Labrador or a prostitute, but it doesn’t make for a good doctor. I had a feeling that Kenny was going to prove this to be true.

      ‘I really want to make it work this time, Dr Ben. If I can just get off the crack I can get myself a place to live and a job and most importantly back in touch with my little girl. She needs her dad.’

      Kenny looked up at a scribbled picture on my wall that my eldest had drawn for me.

      ‘If you’ve got kids, Dr Ben, you’ll understand how important it is that I stay off the crack right now.’

      ‘Absolutely,’ I said, still waiting for the but …

      ‘But I just need something to get me off the crack. Just to settle me down a bit and stop me losing it. Not much … Just a few Diazzies and some Temazzies and Zoppies. In prison they gave me Pregabbies, so I could do with a few of those.’

      Patients who take meds for their weak bladder or high blood pressure tend not to have pet names for their tablets. When someone affectionately shortens the names of their medications, it always worries me. Diazzies are diazepam, temazzies are temazepam and zoppies are zopiclone. The meds that Kenny were asking for are all addictive and can cause a sort of spaced-out stupor when abused. Pregabbies are pregabalin, which are a type of painkiller, but they can be crushed up and injected to cause a high.

      ‘Kenny,

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