Your Average Irish GP

alterkocker

‘Ask your doctor why’, ‘Discuss it with your doctor’, ‘Successful medical treatment is a result of the coalition between doctor and patient’, ‘Tell him about any side effects you are having’, ‘Get him to fully explain the various options before agreeing to the operation’.

How many times have you seen or heard this kind of admonition? And where have you heard or seen it..? You might have seen it on the internet, in a woman’s magazine or even on the radio. One place you haven’t seen it is on the notice-board of your GP’s waiting room, that’s for sure.
It wasn't so long ago that this kind of dialoguing with our doctor was urged upon us for everything from social to sexual problems. Today it would be too hilarious to even think about. If the doctor you are consulting is a hospital consultant, notwithstanding the platitudes that have always celebrated his arrogance, the likelihood of his allowing you sufficient time, or manifesting sufficient care, to listen to you, is greater than is the case with your GP, especially if you are a ‘medical-card patient’, i.e., not paying directly for the consultation.

The GP’s style is usually brusque and indifferent to pain and discomfort, hence the term ‘bedside manner’ has become obsolete because (a) it is a place he never visits, except to sign a death certificate, and (b) empathy and sympathy well outside of his brief. (Oh, how different things might be were he to experience some of the many excruciating discomforts his patients have to deal with, sometimes even a cluster of them. It would rapidly bring out his selfishness and wimpiness and might make him think again about the old Hippocratic Oath.

If you have a medical card, the consultation is presently about the only thing you will not have to pay for. For example, although at present you do not have to pay the hospital for laboratory tests carried out on behalf of the GP, which require much time, skill and experience, you will pay an exorbitant amount to have the small blood sample taken. The whole process of a medical consultation, starting with the other-than-warm greeting from the snotty receptionist, is redolent of a business, a place, like a travel agent’s for instance, where the making of money is the prime objective and every wall is plastered with rules, regulations and rates.

Because today’s GP is reluctant to get off his easy-on-the-piles cushion and make physical contact with us, the time is surely not far off when we will be referred to the cardiovascular unit at the local hospital to have our blood pressure read or pulse taken. Until then, if he needs the exercise and we have a high reading, we will continue to be assured that it is probably due to the ‘white coat effect’ - fear engendered by the close proximity of a personage of power and importance. Many patients will never have seen a white coat – except in adverts or in an old movie - so never understand why medical staff used to wear them.

Regarding the constant bleating about how hard medical doctors work, there is no evidence that they work harder than anybody else, just that they moan more. GPs in particular work limited and convenient hours, none of which fall outside normal business hours. They no longer make house calls and the time they so grudgingly spend on each patient is so brief that they will soon be starting the consultation while you are undressing, and prescribing while you are getting dressed again. When I was a child, our family doctor, a man in his seventies who literally worked all hours, died on the stairs he was climbing late one night to visit a sick child in an upper bedroom. Can you imagine that today..? It could not happen unless someone had told him there was a treasure chest in an upstairs room, and then shot him in the back as he was running up the stairs.

Because he will not have undergone a realistic personality assessment before and after his medical school training, your GP’s lack of empathy and similar capacity for sympathy will not have been detected, and because of his healthy and wealthy upbringing he will have no idea what real pain is like and why, therefore, effective opioid medication was developed. Like many a ‘liberal’, he thinks such medication is for criminal fun-lovers, not for people who commit suicide because they can no longer endure their agony – and pain is by no means the only awful neuropathic symptom. He does not even understand that the vast majority of his ‘miserables’ only take the stuff because their lives, for one reason or many, are wretched. Nor does he understand that in this case it is the consumer who abuses the medicine, not the other way around. He is so afraid because of his ignorance about the proper use of opioids as analgesics - for which he knows of no alternative because there currently isn’t one – that he is a menace to anyone suffering intolerable pain.
But, of course, pain is not the only ordeal that the average GP does not understand, he does not understand poverty either, although it also is intimately associated with ill health.

This year Ireland celebrates Florence Nightingale, the icon of nursing the world over, who demonstrated her gifts in this respect during the Crimean War and was praised for practising what was called ‘Irish Nursing’ which was introduced to her by Mary Moore and the Irish Sisters of Charity. The tenets of Irish Nursing were first and foremost the essential need to respect the patient, and secondly to adhere to the highest ethics; these things being considered to be just as important as the practice of medicine itself. At that time practitioners of medicine were little removed in time and skill from barbers and quacks. Compare that today with the utter depreciation of ward nurses and their matronly authority, and the concomitant rise in authority (arrogance) of the medical men.

If a student of average gifts goes to university and successfully studies engineering, rocket science, languages or law, chemistry or physics, history or literature, or any of a number of other topics, he or she is awarded a degree, and that is that. If, however, the same student were to study medicine, not only does he or she get a degree, but in addition is given a courtesy title and the right to feel and act as superior to the other students and towards everybody else. Only the Catholic priest is similarly privileged and look what he has done with it.

As far as competence – possibly the most important of all the qualities to which the GP should be heir - is concerned, even his professional education is not all it should be. Nowadays his method is to decide from no more than three symptoms briefly presented, which category an affliction is likely to belong to, and then make an appointment with a hospital specialist so that he can hazard a guess at a diagnosis. This is one of the reasons for the GP so rarely laying hands on his you. Not only does he wince at the thought of carrying out a forefinger examination via your anus, nowadays he does not want to touch anything – especially if it is or was biologically attached to a male. Nor does he want to have to get up off his own point of entry/exit to examine you, he merely wants to sit at his desk with his pen, computer and printer, and, not unlike an air-traffic controller, do everything from there.

Because it is a joke – and not a very funny one – that a doctor (or dentist) chooses his career out of love for humanity and to relieve suffering, etc., etc., and not for the boodle or the power, the majority of Irish medical graduates diddle off forever to lands of milk and honey, leaving their places to be filled by immigrant second-classers (i.e. not Cuban medics) who are quite content to come and work for good money, privileges and pleasant conditions.

Perhaps when Sony get around to manufacturing medrobots, these unarrogant devices will provide the most satisfactory alternative to HSE medicine. We would then have doctors devoid of the inclination to whine about their lot instead of concentrating on ours, who weren’t so bloody greedy, were programmed to address us eloquently and courteously, had computer-like brains that could diagnose anything and indicate the ideal treatment, and wouldn’t be so parky about shoving their NASA-plastic digits up our bums.

But do not make the mistake of thinking lady doctors are any better. They have striven to be the equal of men for a very long time and at least in this they are successful.