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Wednesday, March 1, 2017

Making of a Child Psychiatrist: (57) The General Practitioner (2)

One evening, a mother brought a rather small 7 year old boy into the clinic. He had had a recurrent sore throat, and seemed to have difficulty swallowing lumps of food. Mum had wondered whether he might have tonsillitis. I took the rest of a history, and then his temperature. He was a bit wary of me, but eventually I persuaded him to open his mouth wide enough for me to get a good view and he did indeed have lumpy reddened tonsils, very common in the age group (I was told later). He also had a bit of a cough, I noted, so I asked him to lift his shirt up so I could listen to his chest. He looked very uncomfortable, and the mother became very flustered. “Oh, that’s not necessary. We don’t want to take up any more of your time, doctor. Can we just have a prescription for his throat?” I insisted on the grounds it was important to ensure he did not also have bronchitis, and she looked as if she was going to argue. But then she gave in, and looked really deflated (and miserable, I later reflected). The boy himself was not too happy and tried to resist a bit, but I lifted his shirt at the front and pointed out where his heart was and had a listen. Then I turned him around to listen to his back. As I lifted his shirt he began to cry. And no wonder! Across his back were eighteen looped red marks that at first sight looked like the hand end of a dog’s leash. This proved to be the case; this little bloke had suffered a right beating! With both mother and child in floods of tears, the story came out that the boy’s father had been really angry over some small defiance and had taken the dog’s lead to his son ‘to teach him a lesson’. “Please doctor, don’t report him. I am sure we will all get over this.” Gingerly I listened to the boy’s chest, and then prescribed an antibiotic in liquid form. I was flummoxed; whatever should I do now?
I discussed it with my senior partner, and asked him what he would do? “Do you want the truth?” he asked. “Of course” I replied. “Well, I would go up to the house, and confront the bastard. I would threaten him that if he did not stop hitting his son, I would personally beat him up!” “Oh.” “Well” he added, “you won’t get the bastard to just pop down to the surgery for a nice little chat!”
I thought about that afterwards. John was about 5ft 6ins, and the thought of him confronting anyone was somewhat odd. Then I imagined myself banging on someone’s door and grabbing them by the scruff of the neck, while I berated them. “Not likely”, I decided. But I mulled the idea over, and discussed it again with John next morning.
He reaffirmed his idea, and suggested we could get the local police constable (“Noddy” to his friends, apparently) to back me up, if I thought I needed it. And so it unfolded. At the appointed time that afternoon I drove to the estate, duly noting that all 6ft 3ins of Noddy was just down the road on his bicycle. With my heart pounding I banged on the front door, preparing myself for a possible boxing match (me with no skills at all!). A rather meek man opened the door, looking slightly sheepish. “Hello, doc, I rather thought it might be you. The wife thought you might pop in some time. Would you like to come down to the kitchen for a cup of tea?” I signalled to Noddy, and went inside, on alert but already somewhat relieved. We sat across the kitchen table, and he rehashed the story, saying how sorry he was that it had happened. “I just lost my temper, and that was not really about Chris; it was something left over from work. It won’t happen again…” Well” I said, “ I am pleased it will not happen again. I discussed it with Dr. Hayden, and he said that if it did, then he and I would come down here and beat you up. So it might be best if we did not have to!” He looked at me strangely for a long time, and I just looked back. Eventually he nodded. “It won’t happen again.” We parted friends, and from time to time he would come to the surgery for some small reason, and we would chat about his work or his family life. He kept his promise.
I am not too sure what to make of this story, given my early registrar psychiatric training in trying to understand people and gently and respectfully help them to sort out problems. Later I was to have formal training in seven or eight differing approaches to therapeutic intervention, none of which involved threatening the patient or a member of their family with violence (about which I have grave doubts I could have managed anyway). Yet it worked, although in part perhaps because my patient was already feeling remorse. I always wonder whether the story ever got out. Did he ever talk about these strange doctors while he was down at the pub with a couple of friends? I have no way of telling. I never had a third party quietly take me aside and suggest that it was not a good look in a doctor to have a reputation for threatening patients with violence.

And yet Birchington was a tiny place, and there was a gossip machine. And there were dear old ladies who were never frightened to confront the local doctor. My father came to stay from time to time. And on one single occasion on a Friday night, he and I decided to have a drink at a local restaurant and bar. Quite literally we had half a pint of beer; neither of were prone to drink much more than that. The next morning in surgery, I had one of my dear old ladies in as a patient. At the end of the appointment she was putting her prescription in her handbag, and looked up at me with a slight frown. “Doctor, I am sure this is none of my business, but… You were seen to be drinking in the pub last night. We already have one doctor in this practice who is an alcoholic; I would recommend you do not take the same pathway!” And with that she stood, turned for the door, and left… leaving me speechless.

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