A Primary Care Christmas Carol: Stave 5

By Dr Pete Aird, written for Resilient GP

Stave Five – in which we are given cause for hope

It was early morning when Scrooge woke. He sat up in bed and looked around the room. Everything appeared as normal and yet, within himself, he felt changed. Perhaps he was being naive but he felt a sense of optimism that he hadn’t known for years, daring to hope that things could get better.

It was then he remembered it was Christmas Day. ‘At least I think it is,’ he said to himself excitedly, ‘assuming that all three Spirits did indeed visit me last night and that I haven’t missed the great day completely’. He ran to the window and looked out. A light layer of snow coated the ground which heightened his excitement still further. And yes, a young lad was trying out a brand new bicycle, no doubt a freshly unwrapped Christmas present. Add to that the fact that one or two folk were making their way towards a church whose bells were ringing joyfully in the distance, it was, with the utmost certainty, Christmas morning.

But there was no time to lose. He had to check on Bob Cratchit. He dressed hurriedly and ran down the stairs and out into the crisp morning sunlight which reflected off the snow-covered ground. Scrooge got into his car and within a few minutes he was outside the house of his trainee. He knocked loudly on the door but there was no answer. He knocked again and, when there was no response, shouted through the letter box. Still there was only silence. Scrooge moved round to the side of the house and looked through the same window he had the previous evening, its curtains still only partly drawn. Cratchit was sat there, just as he had been when Scrooge and the Ghost of Christmas Present had left him earlier. Scrooge hammered on the window until, at last, he saw movement and a wave of relief surged through him. Slowly Cratchit stood up.

‘Open up Bob. Open up this instant. Do you hear?’ Scrooge shouted at him though the glass. ‘Open up. It’s Christmas Day!’

Cratchit, clearly half asleep and still the worse for the half bottle of whisky he’d drunk the night before, gradually stood up and made his way to the front door. Scrooge had never been one for outward displays of affection, but now, as Cratchit opened the door, Scrooge greeted him with a hug that was as welcome as it was unexpected.

‘How are you Bob? Are you alright?’

‘I’ve a bit of a headache if I’m honest. And not one that’s improved any by all your hollering. But why are you here? Has something happened? Have I done something wrong?’

‘On the contrary. If anyone is at fault it’s me, for not appreciating you more. And to show you that I mean it, what do you say to a partnership come August when you’ve completed your training? I’d be proud to call you my partner’

‘You must be desperate!’

‘Desperate? Of course I’m desperate! Have you seen the state of the health service? But that’s not the reason for my offering you a partnership. I would like you to help me change the way we do General Practice. It’s a conditional offer of course – conditional that is on you seeing some change. There’s no way I’d want you to commit to a lifetime of working the way we have of late.’

‘Well I guess I’ll have to think about it. But thank you. I didn’t realise that you thought I was up to the job’.

‘Of courses you’re up to the job. We all worry sometimes that we’re not though, so don’t be surprised if you find yourself questioning the fact – that’s normal! The trouble is that we’re all so anxious imaging that we have to be perfect. We’re not God you know – even though both the government and our patients sometimes expect us to act as though we were.’

‘Well I guess you’re right there’

‘Of course I’m right, I’m your trainer! Now, what’s with the whisky and the packet of antidepressants?’

Cratchit looked down at the ground. ‘I didn’t take any, just thought about it. I guess I was just feeling a little overwhelmed. I was being stupid”

‘It’s not stupid to feel overwhelmed. There’s no shame in being asked to do more than you can cope with. The only foolish thing is to not realise you need to say ‘No’ sometimes – that sometimes you need help and have to ask for it. I’ll try and make that easier for you from now on. Promise me though that you’ll not let your thoughts travel in such a dark direction again without letting me know.’

‘I’ll try not to – I promise.’

‘Excellent. Remember, we’re in this together.

Cratchit couldn’t quite believe what he was hearing and couldn’t stop himself voicing the question that was on his mind.’

‘Dr Scrooge,’ Cratchit began

‘It’s Ebenezer. Call me Ebenezer’.

Cratchit hesitated and then tried again. ‘Ebenezer.’ It seemed strange to hear the name spoken aloud, ‘I hope you don’t mind me saying this, but something seems different about you today. Has something happened?’

‘I rather think it has,’ said Scrooge. ‘As a profession we’re convinced everything’s wrong. A lot is of course, but I see now that if we can see what the problems are, then surely we stand a chance of making changes.’

‘But how?’

‘To be honest, I’m not quite sure. One thing would be our need to challenge the idea that medicine has all the answers. We need to say ‘No’ to the over medicalisation of life and be honest with both ourselves and our patients as to what we can and can’t do. Another thing would be that we have to be allowed to behave as the professionals we were trained to be. Once we were seen as people who could be trusted to make judgments in the best interests of patients. Now it seems we are seen as mere service providers, required to unquestionably follow guidelines regardless of how appropriate or otherwise that might be. It’s as if we’re not considered competent to try to decide what is best for our own individual patients. But one size doesn’t fit all. And so we need to fight to retain the doctor patient relationship that underpins good general practice and not allow it to be lost in the rush to conveyer belt medicine. We have to take back control over our work, make our own decisions as to how to apply medical knowledge to each individual situation and have the courage to resist the inappropriate demand to behave in ways that are imposed on us by government, pharmaceutical companies and society as a whole. That would mean better health for our patients and happier working lives for ourselves. That’s something I can aspire too, and knowing what it is I’m aiming for might just give me a chance of fathoming out how I might go about working towards it. At least, that’s my hope.”

Scrooge, in his excitement, had been pacing around the room. Now, pausing for breath, he sat down.

‘But that’s enough of all that for now. We can get together tomorrow and plan then just how exactly we’re going to do things differently. We’ll call it a practice away day. Just think of all the CPD hours we can claim! So, what are your plans for today?’

‘Well I had planned on a spot of revising for the CSA.’

‘Revising for the CSA. What nonsense – you’d pass that tomorrow with your eyes closed. Like it or not, you’re spending the day with me! We’ll have dinner at my house. I ordered a lorry load of food from Waitrose last week and there’s no way I can manage it all on my own. In fact there’s more than enough for two. Quick, go and get yourself sorted out. I’ve got an idea – one that might, for the first time in my career, satisfy my appraiser that my reflections have altered my practice!”

It wasn’t long before Cratchit was sat in the passenger seat of Scrooge’s car wondering where Scrooge might be taking him. A few minutes later they pulled up outside a block of flats and Scrooge led the way up the steps to the second floor. He knocked on a door.

“Who lives here?” asked Cratchit.

“Mrs Gray. She’s lived here alone since her husband, Timothy, died a few years ago. He was a short man. He had some kind of growth hormone deficiency I believe.’

Eventually, the door opened, and Mrs Gray stood there, evidently astonished to see her GP.

‘Good morning Mrs Gray. And a very merry Christmas to you.’

‘Well a very merry Christmas to you too Dr Scrooge. But what brings you here? Is it about the chocolates?’

‘Certainly not. We, that’s Dr Cratchit and I, have come to pick you up and take you off to my house for Christmas Day. What do you say? Will you come?’ Mrs Gray hesitated, uncertain if she should.
‘Please come, Mrs Gray. It would mean a lot to me’

‘But I’ve nothing to bring’.

Scrooge looked over her shoulder and saw the box of chocolates on the kitchen table. ‘What about those?’ Scrooge asked, ‘You don’t have to bring anything, but if you’d like to make a contribution…’

‘But I’m pre diabetic Dr Scrooge, I need to be careful what I eat’

‘Who told you that?’ said Scrooge, a broad grin forming on his face. ‘Not a doctor I hope. Believe me Mrs Gray, you shouldn’t believe everything we doctors tell you!’

With that, Mrs Gray tottered to the kitchen, picked up the chocolates and made her way back to the front door. Then, together with Scrooge and Cratchit, she made her way slowly down the stairs. Half way down, Scrooge stopped.

‘You go on Bob, I’ll catch you up in a moment. It’s just that I have a feeling that, as a GP, I am, for once, ideally positioned to reduce hospital admissions’

He ran back up the stairs and knocked on the door of the flat opposite that of Mrs Gray. A man opened the door.

‘I don’t want to appear interfering,’ Scrooge began, ‘but your son will develop a rash later this morning. When he does, try wiping it off with a damp cloth. Trust me, I’m a doctor!’

With that Scrooge turned and headed off back down the stairs leaving the man speechless behind him.

…………………………………

A couple of hours later, the two doctors and their elderly patient sat around a dining table enjoying Waitrose’s finest. As the meal drew to a close, Cratchit turned to Scrooge

‘I think I’ve made my decision’ he said.

‘What decision is that?’

‘I’d like to accept your offer of a partnership, if I pass the CSA that is’

‘That’s wonderful Bob, simply wonderful!’ Scrooge stood up and shook Crachit warmly by the hand and then, for the second time in the day, embraced him warmly. ‘This is excellent news – for me and for the practice. We should organise a party!’

Scrooge dashed out of the room and returned with a sheet of paper on which were listed all the practice staff, their names and telephone numbers.

‘And a party we shall have,’ declared Scrooge handing the list to Cratchit. ‘Start ringing round and invite anyone who’s free to join us here this evening. Perhaps someone will bring some of those Prosecco and pink peppercorn Pringles – are they really a thing? Only don’t let me drink too much. The last time I did that there was an incident at a local supermarket, the details of which you don’t want to know!’

‘Can I say something Dr Scrooge?’ Scrooge turned around and saw that Mrs Gray had got to her feet. With one hand she steadied herself by holding onto the table and with the other she was holding a glass of wine. ‘I’ve had a lovely time today and I want to thank you for all your kindness. I’d like to propose a toast, to both of you, the practice, and the NHS as a whole. It’s something my late husband used to say.’ She raised her glass higher. ‘God bless us, every one’, she said.

‘God bless us, every one’, repeated Scrooge and Cratchit, smiling as they raised and carefully tapped their glasses together.

…………………………………

In time, Cratchit passed his CSA and joined Scrooge in partnership and when Scrooge came to retirement he did so reluctantly. He considered himself to have been a fortunate man to have had the career he did. Cratchit continued on, the practice grew and new partners were appointed. Though their processes and procedures didn’t always meet with the full approval of the CQC, the partners always enjoyed strong support from their practice population. Scrooge’s experiences that night may not have changed the state of the NHS as a whole, but they did change how the NHS was manifested in one small corner of that great organisation. Scrooge never had any further encounters with spirits – he had no need of them. Afterwards it was always said of him that he was a doctor who cared for his patients more than he cared how he was thought of by people in power and that he knew how to support others and how he needed the support of others himself. May that be truly said of us all.

And so, as Mr Gray observed, ‘God bless us, Every One!’

Published by

Dr Kate

I am a GP in Benbecula, with interests in patient safety, human factors, and data.

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