Trust a GP’s intuition . . . it’s a real life-saver

How did I know something was wrong? Looking back, I still can’t explain it but the moment I spotted her in clinic, an alarm bell rang.

to anyone else Mary might have seemed fine, more than fine — all smiles and thank-yous as she chatted to nurses. But it made me uneasy.

one of the things I treasure about my job in mental health is the opportunity it gives to really get to know my patients over a long period and develop a relationship with them.

I’m luckier in that respect than colleagues in other specialities where continuity of care is less of a factor, or the teams of GPs in the super- sized practices that are becoming the norm.

Patients grow to trust me, and some of them have confided things that no one else knows about them. It’s an incredible privilege being invited into someone’s life like that.

I’d known Mary (not her real name) for about six years, and saw her every month or so to help her deal with the legacy of years of sexual abuse.

when she sat down, I asked her if she was okay. She brushed my question aside. I asked again, several times. She was dismissive, yet bright and breezy.

I persisted, speaking softly and trying to get her to engage. eventually, I snapped: ‘I’m not letting you leave until you tell me what’s wrong, Mary,’ then I crossed my arms and stared her down.

You have to know a patient pretty well to act this way: plenty wouldn’t stand for it.

Mary understood then that there was no messing with me. She also knew that I cared about her. In an instant, everything changed as she seemed to physically crumple into the chair and burst into tears.

She told me she’d spent the weekend writing her will and putting her affairs in order — because she’d decided to kill herself. She’d planned it in detail and even written a note for her door, warning people not to enter but to call the police.

It may sound extraordinary but it’s not uncommon for someone who has reached the decision to end it all to experience a temporary sense of relief and euphoria. often, like Mary, they can appear happier than they’ve been for years.

If I had not known Mary so well, and felt able to challenge her, I dread to think what would have happened next.

I was reminded of that recent experience by a British study of 1.4 million patients in 22 countries, which found strong evidence that those who see the same doctor at each appointment are far less likely to die than those who don’t.

In America, nearly a fifth of diabetes patients who saw different GPs died within three years. this compared with just eight per cent of those who saw the same doctor every time.

Researchers concluded that patients are more open about symptoms and more inclined to take advice and medication if they know their doctor. I’m sure that is true. But what the study does not address is the role played by a doctor’s intuition about a patient that he or she knows well — picking up on the subtlest changes in demeanour or conversation, and perhaps what they’re not telling you as much as what they are.

when family doctors truly were ‘family’ doctors — with long-term knowledge of patients and in some cases caring for them from the cradle to the grave — this kind of relationship was a given.

Sadly, that’s no longer the case. Last month, Leicester University reported that just half of patients had a preferred GP — and only half of them were able to see that doctor for most of their consultations.

PAtIeNtS

are often dealt with as though they are on a conveyor belt, with appointments (when you can get one) allocated according to whichever doctor happens to be free. It’s just not good enough. Some years ago, when working in A&e, I took a referral from a GP about a little girl he’d seen. the symptoms were vague.

‘I’ve known this family for years,’ he told me on the phone. ‘they’re not the sort to make a fuss. they’ve brought their daughter to the surgery three times in the past three days. there’s something not right, I can sense it.’

And he was correct. It turned out the child had an unusual and particularly dangerous form of meningitis. She would certainly have died if it hadn’t been for that GP’s sixth sense in sending her to hospital.

It’s not easy to quantify the value of this kind of relationship with a doctor, but there’s no doubt in my mind it can be a life-saver.