View from the ground, by Dr Joe McGilligan

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One of the great strengths of being a GP is the cradle to grave responsibility we have for our patients. I like to rephrase it as ‘sperm to worm’ as we are there for our patients from preconception right through to after someone dies. The long-term relationship and trust that builds up across generations with their family doctor cannot be underestimated. One challenge, however, is where hindsight comes just a little too late for some patients.

Several years ago I counselled a 6’ 6” overweight policeman that he was in a pre-diabetic phase, but by slimming down, doing some exercise, and eating properly he could avoid developing type 2 diabetes. Two years later he stormed into my room and banged on my table, telling me (with several expletives) that he hated me!! Rather taken aback I gently asked him why. His response was: ‘Because you were right! I ignored your advice and now the police surgeon has confirmed that I have diabetes!’ Fortunately, it was not too late and we worked through a plan that enabled him to lose 7 stone and turn his health around.

I also have a patient with progressive multiple sclerosis. Her consultant offered her the latest treatment to try and arrest the disease process and reduce her chances of lifelong disability, but she turned down the offer because she had heard that there may be side-effects. I spent many hours researching all the evidence and pros and cons of her options. I thought I might have been able to convince her to rethink her decision as the ‘do nothing’ option would only lead her down the progressive disease route and certain worsening of her symptoms, but she continued to refuse treatment. Starting a new treatment is a big decision that has no guarantee of success; however, I have to accept she has made an informed choice, and hope it is one that she doesn’t come to regret in the future.

The worst situations are where patients are advised about their harmful habits and the advice goes unheeded: smokers who end up with cancer, lung disease, or heart disease; drinkers who end up with cirrhosis. Fifteen years ago, one of my patients came to see me with a knee injury that was making it difficult for him to work, but at every consultation he smelt strongly of alcohol. I broached the subject and he told me that he drank as much as his friends, and didn’t think he had a problem. His liver function tests showed that his alcohol consumption was causing significant damage to his liver (I told him that the Irish have a saying: ‘Denial is not just a river in Africa!’). For many years he was in denial about his drinking, but he came back to see me and we tried very hard to get him abstinent with counselling and medication. He was dry for many months and felt great but his drinking problem had done damage to more than just his liver, as his marriage broke down. He returned to see me a few years later having gone back to drinking very heavily. Despite repeated attempts to help him to stop he continued to drink, leading to a deterioration in his health and social situation—he became unemployed because of his drinking habits. One day he presented with profound anaemia secondary to chronic blood loss from oesophageal varices and was admitted for transfusion and injection of the varices. It was then found that he had established alcoholic cirrhosis and that he would die if he drank again. He made an instant decision to give up alcohol and after 2 years of abstinence he underwent a life-saving transplant, and has since made a full recovery. His only words to me were: ‘I wish I had listened to you all those years ago!’ 

The poet William Blake hit the nail on the head: ‘Hindsight is a wonderful thing but foresight is better, especially when it comes to saving life, or some pain!’