Bad Medicine: Rest in peace

The Americans call it ‘bullshit’, the Irish ‘blarney’, the English ‘the gab’, the Scots ‘patter’, the RCGP ‘drug Doctor’, but whatever it is it’s a type of magic.

He was 62, dressed in a pin-striped suit, cufflinks, thick grey hair swept in a side parting, his stomach heaved at his shirt buttons; he smoked like a chimney, swore like a trooper, drank like a Glaswegian, knew nothing about and had no interest in knowing — modern medicine.

He prescribed at will, used all the latest and most expensive medications, loved drug reps (it was mutual), and hated the BNF and NICE. Patients waited weeks to be seen by him, spurning Dr MRCGP and his part-time partner Dr MRCP, and hung on his every word. His word was gospel. For people could talk to him. He was a ‘pal’, not a doctor.

He was often heard saying ‘You’ve the heart of an 18-year-old’ to 80-year-olds, ‘What the hell, there is no real evidence that it does any harm’ to smokers, ‘What a beautiful child’ to a Cabbage Patch Doll of a baby, ‘It’s your glands, so it’s not really your fault’ to the obese, ‘That’s nonsense, eat what you like’ to the diabetics, ‘Tense? Well go home and have a drink with some friends’, ‘Those statins are poison, walking is better than medication for cholesterol.’

Unhappy? ‘Get a dog, you don’t need medication’, ‘Exercise?! You will die anyway.’ He smiled easily, displaying his yellowing teeth. He smelt of cigarette smoke and Old Spice aftershave.

He couldn’t be bothered with making referrals, and he referred virtually no one. He reassured patients even when the situation was hopeless and laughter often buffeted his door. No one ever complained. His note-taking merely consisted of one word, even when the practice became computerised. He would pop in to see patients at lunch and sometimes at the weekend. He nodded in agreement at practice meetings but then carried on as before, regardless. He could be found sometimes at night drinking in the local pub. He had always worked full-time and, despite his lifestyle, never took a sick day.

His wife was merely a female reflection of him, and his five children seemed surprisingly well adjusted and successful.

Dr MRCGP was incensed. It was all too much:

‘Medicine is serious. He knows nothing of the guidelines, never uses any of the risk scores, NEVER does any bloods, and when he does it’s only a full blood count! He thinks that revalidation is “bullshit” and the College is full of “work-shy spanners”. I just don’t know why anyone would ever go to see him. He is a disgrace to the profession!’

One day, while having a ‘ciggie’ outside the health centre (while on Health Board property) and chatting to a patient, he clutched his chest, had a massive heart attack, and died. Half the town turned up for the funeral and the pub threw a wild wake. Dr MRCGP even raised a smile. He went the same way as his local hospital friends, ‘007’ the surgeon, ‘Absent’ the local physician, ‘Fruitcake’ the psychiatrist, and ‘those will need to come out’ the ENT surgeon.

Rest in peace.

• © British Journal of General Practice 2019