As a doctor, one of the delights of living within a rural area is the strong sense of being part of that community. A large number of the local inhabitants know the doctor, and the doctor usually has a fairly good idea as to who you are, as well as often knowing your parents, children, cousins, aunts and so. A stroll up the High Street becomes punctuated by nods, smiles of acknowledgement, fleeting conversations and other casual greetings. A ‘big fish in a small pond’ perhaps, but in a world where we live in an increasingly large ‘global village’ it can be an enjoyable sense of belonging.
However, there is a downside to the local pseudo-celebrity status afforded the country doctor. If one is not careful, walking to a meeting with the local solicitor at his office becomes an al fresco surgery; a quick trip to the supermarket can turn the aisles into a gauntlet of patients ceasing the moment to quiz the doctor about their latest symptoms or acquaint him with the outcome of their hospital appointments; an evening with one’s wife at a restaurant can even be interrupted by enquiries about blood test results from diners or waiters who also happen to be patients. One memorable day, whilst standing in the queue at a bank, the chap in front started to inform me of the lump he had recently detected in his nether regions. His hands were quite graphic in illustrating the size and whereabouts of the problem; a display which attracted curious and amused attention from others in the bank. His opportunism was brought to an abrupt halt when I politely suggested that he could either drop his trousers and I would take a look there and then, or alternatively he could make an appointment to see me in the surgery.
However, all of this is about to change if the Department of Health gets its latest wish granted. The NHS Future Forum, a sort of health ‘think-tank’ for the government, has made the recommendation that all healthcare professionals should ‘make every contact count’ to promote health. According to the forum, doctors should miss no opportunity to quiz their patients about their lifestyle, advise them on their diets, and counsel them to reduce alcohol consumption, stop smoking, reduce weight and take more exercise; as if we haven’t already been doing that for years.
Nonetheless, according to the government, it should be the role of doctors to ‘make use of contact with patients wherever appropriate’. So, the table may be about to turn folks. If trying to consult your doctor in a public place is acceptable to you, no doubt you will not mind if we wave an admonishing finger as you enter the wines and spirit aisle, have a quick review of the contents of your trolley at the checkout, or make ‘tut tut’ noises when you order a particularly creamy, sugar laden pudding on your evening out for dinner. Perhaps larger medical practices could start local ‘community doctor patrols’, making the round of fish and chip shops and other takeaway outlets at lunchtimes. One can see the scenario now: ‘No, Mrs Smith, with your obesity, uncontrolled diabetes and high cholesterol you really shouldn’t be ordering that large portion of chips. Put it back and let me introduce you to the salad bar down the road.’ Like young boys in danger of being caught scrumping by the village policeman years ago, patients will start placing lookouts at the door of the cake shop, and furtive shouts of ‘Psst! Watch out, the doctor’s about!’ could become commonplace.
Alternatively, we could all agree to act reasonably and live in respectful and tolerant harmony with each other. As a doctor, I will keep my comments regarding your less healthy habits to the confines and privacy of my consulting room if, when we meet in the street, the shops, a restaurant or the bank, you promise to talk to me about anything other than the state of your arthritic knees, the quality of your phlegm and the difficulty with your bowels. Paraphrasing Ecclesiastes (chp.3), there is a time and place for everything, despite what the government says.
(First published in the Scunthorpe Telegraph, Thursday, 26th January 2012)