Pandora’s Box

I saw Mrs P today. She is her late thirties, and I first met her four years ago not long after joining the surgery when she came for a blood pressure check. She has hypertension and type 2 diabetes, but had lost six stones on WeightWatchers and she had been able to stop all of her medication. It was such a joy to see her confidence and her optimism about the future. We saw each other infrequently after that as she was so well.

Sadly I have had cause to see her rather more frequently recently. Her weight is piling on again, her blood pressure has returned, she says she is depressed and just can’t stop eating. She tells me her marriage is suffering. She says her husband couldn’t cope with the male attention she started getting when she was slim. Her friends told her she looked “gaunt” and ill (even though she was a healthy size 12 at her smallest). She lost confidence. Her husband got aggressive, a push here, a shove there. “He’s got a bit of a temper.” She feels so low she spends all evening in the kitchen, eating whatever she can find. She has a disabled daughter in her teens, who has never spent a night away from her mum. She believes she is a failure in life, she is weak, she is useless. She eats because she’s unhappy; because she eats, she is unhappy.

A few things struck me today. Firstly, that it has taken her four years to disclose to me the domestic violence that (it emerges) has gone on since she married nearly twenty years ago. I wondered why she felt she could open up now. I wondered, if she hadn’t had one doctor whom she saw regularly, and trusted, whether she’d ever have opened up. I know I’ll see her again; I don’t have to leap in and start Doing Things; she’s requested some antidepressants, she’ll see me in a couple of weeks; we’ll talk some more about her eating, her marriage, her husband, her daughter. This is what GPs mean when they talk about continuity of care; this is what we want to keep. Whatever happens to the NHS over the next ten or twenty years, I hope that patients are given the chance to develop this kind of relationship with their GP.

Then I thought about obesity, and how difficult it is to help patients like Mrs P. She doesn’t need education about how to lose weight – she knows what to eat, she knows how to exercise, she knows more than anyone what health problems it can cause. I won’t tell her to lose weight; it’s ridiculous. She thinks about her weight every waking hour of every day and a nagging from her GP won’t help her one iota. She needs support and a listening ear. Unlike her husband, who can walk down the street without abuse even though he beats his wife behind closed doors, every time Mrs P walks down the street she sees wrinkled noses and disgusted glances – everyone can see what her weakness is. But she’s done it before, and she will do it again. To be a GP you must be an optimist. For Mrs P, despite her life full of violence, sadness, shame, toil and illness, has a GP who knows that what Mrs P needs more than anything, is hope.

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8 Comments

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8 responses to “Pandora’s Box

  1. Wow, that’s powerful stuff.

    I too have problems with my eating and have PCOS (possibly as a consequence) and that now makes it harder to shift the pounds.

    I have been referred to a weight management specialist who works for the gynae team and I am seeing them next week. I have to fill out a questionnaire before I go and it has questions like, “could you eat an apple instead of a chocolate bar?”

    I was stunned. How patronising!

    That questions, written by supposed weight management experts, has clearly come from someone with no idea about the emotionally destructive relationship that most overweight people have with food.

    Thank heavens that I have none of the other dreadful difficulties that Mrs P has to endure.

    I hope she makes some progress and she is lucky to have you as her GP.

  2. One of my early posts was about why I considered it so important for me to have continuity of care from a GP and how I felt that Lord Darzi’s review meant that this was going to become the exception rather than the norm.

    When you suffer from mental health problems it is so important that you regularly see the same doctor so that they can get to recognize when you are having good periods and bad periods. In addition, it is so difficult having to explain what the problems are if you see a different doctor each time.

    I will always be for continuity of care over the ability to see a doctor any time that I want to. I would rather try to cope for a few more days in order to see the doctor who knows me best rather than see someone on the day who has no idea what I have been through.

  3. I often wonder when I visit the doctor whether I give her enough information to help me, bless her she has never said anything about losing weight to me (yet I needed too – but am working on it) she is a support and comfort and it means a lot to know she is on my side. Thank you for being someone she can turn too, it is rare enough in this day and age.

  4. psychsarah

    Thank you for recognizing that telling your patient to lose weight is not helpful. Fat people aren’t stupid, but I’ve run into too many GPs who seem to think that’s the case. Props to you for being supportive and caring, rather than judgmental.

  5. That’s a really good post. You are doing everything right.

    I hope this poor woman finds herself, and the strength to be who she deserves to be.

  6. CD

    Thanks a lot for being such as good example, people, doctors should see more than what they are told to do.

  7. Hooch

    What she needs more than anything is a therapist, in my opinion. What are the chances of that?

  8. rosieposy8

    Thanks for this post, made me hopeful.

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