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.