I lied to a patient today. I didn't feel good about it, but I didn't know what else to say. It was a man I was visiting at home, let's call him Stan. An elderly patient who is normally in excellent health and rarely comes to the surgery. He was down for a home visit to check his chest after being unwell for a few days. Before I went out I looked at his notes, and saw we hadn't seen him for a good six months. Quite uncommon for a lot of older patients. He isn't a smoker, isn't on much in the way of medicine, and had rung the surgery last week.
The notes were from my colleague. They were brief.
"Cough for five days. Productive. Advised paracetamol as required and fluids."
The patient hadn't been seen, just spoken to on the phone. I remembered the day my colleague was on-call last week. It had been hellishly busy. Permanently one doctor short at the moment, the day had been frantic from start to finish for all of us. This was one of many patients who had rung throughout the day. I knew the doctor on-call hadn't left till gone 8pm that night. Days like this are now common-place.
So on my way to Stan's house, I wondered what I might need to do. I assumed his cough hadn't settled. Or that he was still feeling rough from a cold; perhaps he was anxious or his family were worried.
When I got to the house he was sat in bed, looking pale and tired. A neighbour hovered, looking worried. "He's not eating much doctor. He's been in bed since last week. Coughing something dreadful."
I spent about 20 minutes with Stan. Chatting to him, finding out about the cold that turned into a cough. The cough that hadn't settled. The temperature, loss of appetite, feeling short of breath. When I examined him he had a nasty chest infection and clearly had been struggling for a few days. He was grateful and nodded as I explained my plan to treat him. All good. A happy customer.
It was when I turned to say my goodbyes that he got me.
"Can I ask you, when I rang last week, the doctor I spoke to said I wouldn't be able to have a home visit. There weren't enough of you to do them. He suggested I just sit it out. You are still doing visits then?"
"It's just, I don't want to trouble you. There are lots of poorly people a lot worse than me. I just wondered if maybe I'd have been better a bit sooner if I'd been able to see someone then. He said there was no way he could come out, and I'm sorry, I just don't feel well enough to come into the surgery".
I stood there, totally torn. Half of me wanted to defend my colleague - to explain how busy his day had been, the pressure he was under. That we are all under. I had overheard him on the phone that day, talking to patients and trying to keep the workload under control. I had been pleased not to have more work to do as I overhead him saying we can only visit dying and genuinely housebound patients.
But the other half of me felt dreadful. The voice at the end of the phone was this man, and others like him. This man who was not abusing the system. Who rarely saw us. Who rang his doctors because he was sick, and who really had needed to be seen and assessed by a doctor that day. This wasn't good enough. He had sat, getting worse, because we were too busy to see him. Now he was asking me if I could explain it to him.
Could I defend my colleague? Ultimately their decision was wrong. This man had needed a home visit. He wasn't dying but he was genuinely too poorly to get to the surgery. He didn't need to go to hospital. He needed his GP. But if I admitted that, would this man complain? He would be right too.
Could I make this man understand how busy things were at work? Probably. I felt sure he would feel sympathy for the doctor who was too busy to come out and see him. But should he have to? Surely if a patient needs medical care then we are there to provide it. To the person in front of me at that moment, the rest of the demands on my time can't matter; otherwise how will I ever find the energy to treat them?
In the awkward moment that stretched out, I wrestled with my conscience. Do I criticise my colleague, and say he probably wouldn't have been this sick if we had seen him last week? That he was the victim of our collective burnout; the work none of us had the energy to do?
In the end I couldn't. I swallowed my integrity and made some vague reference to how hard it was to diagnose things sometimes, conditions rapidly worsening and so on - I threw in some medical jargon as I swept up my bag and headed out of the door. I heard a "thank you doctor" as I left the house.
In that drive back to the surgery, I lost a bit of self-respect. In lying to him, I was condoning not just what my colleague had done, which was entirely understandable; I was condoning the system that was making him do it. That doctor isn't alone. We are all trying not to get buried in work. Each phone call, each appointment becomes a challenge to be bounced away. We have been doing it so much in the last few years, it has become second nature. We have hardened ourselves to the fact each of those is a patient, like Stan. Frightened, poorly, needing our help. To us, they are just demand. Endless demand that we don't have the time, resources or emotional strength to meet.
This used to make me angry. Angry at the politicians who aren't listening to how general practice is collapsing; angry at the group of GPs who are selling the rest of us out by nodding in time to a misguided agenda for the NHS to get the scarce extra funding on offer. Now it makes me sad. I lied to Stan. And it worries me that maybe I'm starting to believe that lie. That this really is the best we can do. It doesn't feel like the best. For anyone.