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What Really Goes On Inside Your Doctor's Surgery | The Secret GP | Modern Wisdom Podcast 202

This guest's identity is being kept anonymous. He is a GP working for the NHS in the UK. Trips to the doctor are never fun, but how fun are they for your doctor? What is life like dealing with 70+ patients a week in 10 minute windows? Expect to learn why you should never take a picture of your bumhole to show your GP, why your doctor is always running late, why you can never get a lunchtime appointment, how long a doctor spends fingering patients per month and much more... Exclusive Preview: Get a first look at the Modern Wisdom Academy Notes - https://chriswillx.com/preview/ Sponsor: Check out everything I use from The Protein Works at https://www.theproteinworks.com/modernwisdom/ (35% off everything with the code MODERN35) Extra Stuff: Buy The Secret GP - https://amzn.to/32LEVkW Get my free Ultimate Life Hacks List to 10x your daily productivity → https://chriswillx.com/lifehacks/ To support me on Patreon (thank you): https://www.patreon.com/modernwisdom #nhs #healthcare #medicine - Listen to all episodes online. Search "Modern Wisdom" on any Podcast App or click here: iTunes: https://apple.co/2MNqIgw Spotify: https://spoti.fi/2LSimPn Stitcher: https://www.stitcher.com/podcast/modern-wisdom - Get in touch in the comments below or head to... Instagram: https://www.instagram.com/chriswillx Twitter: https://www.twitter.com/chriswillx Email: modernwisdompodcast@gmail.com

Dr. Max Skittle (The Secret GP)guestChris Williamsonhost
Jul 27, 20201h 2mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 0:52

    Intro

    1. MG

      Being a GP is a bit like being a (censored) hairdresser. Uh, you had to, you had to go in and you had to figure out how to make people's lives better. But the major factor with that statement is that that doesn't mean anything unless the patient is motivated to change. If the patient comes in and you say, "You need to do X, Y, and Z to make this condition better," and they don't, that's on them, and that's the truth. I can do all I can, but if they have the mental capacity to say, "I get that if I don't do these treatments, I might come to serious harm or death," and they decide not to, there is nothing I can do about that.

    2. CW

      This is a first, where I'm actually recording with a guest who I don't know who it is. So what should I call you? Mr. GP? Doc?

    3. MG

      No, I think why don't you st- why don't you call me Max? I think that's, uh, I think that's a f- a good starting point.

    4. CW

      Cool.

  2. 0:52 – 1:53

    Why are you anonymous

    1. CW

      So Max, which is the pseudonym moniker which you've used to write this book. So why are you anonymous?

    2. MG

      Yeah, that's right. So, so the, um, so m- I guess my full anonymized name is, uh, Dr. Max Skittle, uh, and Max to, to, uh, everyone, including my patients. Um, why anonymous? Well, I think there's a couple of reasons. The first is, is to protect my patients. I mean, the whole... When you decide to write something like a, uh, a warts-and-all book, a, a medical biography, um, o- or sort of, um, talking about your, your life and the job, you, um, you need to protect the confidentiality of your patients. And, and that's not just anonymizing them and changing ages and genders and ethnicities, but it's also about, um, I guess protecting yourself. So by me being anonymous, it gives another layer of protection to my patients, and it, it probably stops me from getting fired as well.

    3. CW

      (laughs)

    4. MG

      Um, so, so, uh, it's a kind of a win-win.

    5. CW

      Yeah, I get that. (laughs) I get that. Well,

  3. 1:53 – 3:11

    Why did you write this book

    1. CW

      sadly, we've broken at least one of the potential, um, fibs that you had, which was that you could have been Maxine in real life.

    2. MG

      (laughs)

    3. CW

      Um, so that one's out the window.

    4. MG

      I may just have a very deep voice. You have no idea.

    5. CW

      Oh, imagine. Or if you're using a really fancy voice modulator, that would have been-

    6. MG

      Exactly.

    7. CW

      ... that would have been cool.

    8. MG

      You never know.

    9. CW

      So-

    10. MG

      You never know.

    11. CW

      ... why did you decide to write this book?

    12. MG

      Uh, it's good question. I mean, I think there's probably, uh, the simple answer is that I love talking about health and I love writing, and, uh, and I think that the opportunity came up when I kept coming home and I was like, "Oh, that's just such a good experience," or such a haunting experience or such a hilarious experience, and the emotions that it made me feel on that day, I just thought, "You know what? Let, why can't we put this down on paper and why can't we share it with people and, and let them see what the job's like, let them see, um, you know, life's journey through the eyes of, uh, multiple patients?" And you might find that some of them resonate with you. You might see a journey of a patient that I've written about and gone, "Yeah, that was me." Or it might be that that's you in the future, like, you have no idea. Um, and that's the sort of thing that led me to write the book.

  4. 3:11 – 4:15

    What is the book about

    1. MG

    2. CW

      It's kind of semi-autobiographical da- diaries format, isn't it? Kind of goes through day by day over a, a, a-

    3. MG

      Yeah.

    4. CW

      ... tight period.

    5. MG

      Yeah, that's right. It's a, it's a diary, um, uh, version of a year in my life. And, uh, it sort of takes you through the journey of my day-to-day patients, but also gives you an understanding about, um, what happens behind the scenes. Like, how does a, how does a GP surgery run? What are the highs and lows? What are the hiccups? Um, and then I suppose as a sub-context to that, it's about my life and about my young family and I guess how that blurring of the work/life balance, um, occurs and how it impacted in me. And then, because that's something I guess that we all experience, we're desperate to try and keep our work and our life separate to a degree, but with technology and just the emotions that work pulls out people now, you realize that that's not possible. And, and in the book, um, there are definitely times when, when that comes

  5. 4:15 – 5:23

    Are you a typical GP

    1. MG

      through.

    2. CW

      Would you say that you're a typical representation of a GP? Are you a-

    3. MG

      (laughs)

    4. CW

      ... fairly representative GP? Is your experience going to be sort of, uh, synonymous with, uh, many others?

    5. MG

      Yeah. I mean, I, I don't think that, um, I- I don't think that, um, GP's experience unnecessarily a different caseload. I mean, we all see the same people walking through the doors. Um, it varies a little bit because what happens is people decide who they want to see, and so you start to get a bit of a, a niche. So for example, I knew that I loved seeing, um, children, uh, because it allows you to be a kid for 10 minutes. Uh, but also sort of, um, adolescents and, and teenagers, who I guess prefer someone who, you know, I mean, let's be blunt, I'm not near to their age but nearer to their age than say a 50 or 60-year-old GP.

    6. CW

      Yeah.

    7. MG

      And, um, and is fairly straight talking and, and, uh, you know, that's something that, that I've always tried to do. You know, I don't, I don't beat around the bush. I think you need to be honest with people and, um, and that's never more the case than with your patients in front of you.

    8. CW

      Yeah.

  6. 5:23 – 8:40

    GP normal people

    1. CW

      The topic of work/life balance really interested me. Like, I, I had a question down here that just asked, "Are GPs normal people?" But upon- (laughs)

    2. MG

      (laughs)

    3. CW

      ... reading the, the book, it, it comes across that you are. But there's something weird, and everyone that's listening might feel the same, or this might just be some bizarre quirk of my own mentality. But-

    4. MG

      Yeah.

    5. CW

      ... you kind of see GPs, doctors as these, like, weird, angelic, omnipotent sort of f- fountains of life-giving-ness. You almost don't expect them to have a life outside of that. It sounds bizarre. Like, you know, I expect a bus driver to be gruff to me if he's had a bad day, but I don't expect my GP to do that. Does that make sense?

    6. MG

      It, it does, it does.

    7. CW

      Like, I kind of believe that they're almost above the, the decree, the law of normal, normal behavior.

    8. MG

      Yeah. I mean, I, I think, uh, I, I wasn't sure if I could swear on this, Chris. So, I, I, I, I Fire away, man. Fire away. So, I, I, I, okay, right. I mean, to be, to be blunt, I mean, it, it, it's bullshit. I mean, we're, we're all, we're all human and, uh, GPs more so than ever. Um, we, uh, the i- the concept of emotion, um, is a really difficult one with a GP and I think it varies throughout your career because basically you have to learn to, to really, um, suppress it when you're in front of a patient because, uh, you probably read it in the book, you know, there are, there are patients that make me, you know, see red. There are ones that make you want to cry, there are ones that make you want to bang the desk, shout at them, just be like, "What the hell are you doing?" But you have to try and compose that to a degree and then tell them in a steady tone that I think they're crazy.

    9. CW

      (laughs)

    10. MG

      That I think they're mad for making that decision, that I think they're, you know, they're talking shit and that I'm gonna give them the truth and that that's the reality and that we need to find some way of, of marrying the patient agenda with the, with the, with my GP agenda, because my agenda is always to try and do the best for that patient. But the challenge is that they don't always see it that way and that's, that's part of the beauty of the job but there's a veneer to being a GP and what happens, I mean it happened in the book, The Secret GP, that veneer gets scratched away at points because, you know, when you've been slammed by, you know, the fifteenth super complex unhappy patient 10 minutes after 10 minutes, like, you just want to explode and, um, and there are times when, when I, when I feel like that. Actually, I've had a day like that today where, you know, I've literally come home and I, I've just, I want to sit down and have a beer and just decompress because it's been, it's been one of those days and, um, yeah. I mean, you try and mask it as much as you can but actually I think conversely patients want to see you as a person. You know, you're not, as you said, this sort of like, you're not a deity, you're nothing like that. You are a human who has learnt a job and you're trying to help the person in front of you and it's not about being nice to them, it's about being honest and telling them the truth and helping them through processes, um, related to their health and, um, you can have a, you can have a nice shit GP if you want-

    11. CW

      (laughs)

    12. MG

      ... but that's not what I want to be.

    13. CW

      (laughs)

  7. 8:40 – 10:32

    Finger up the bum

    1. CW

      That's a good way to put it, yeah. How much time per month do you think that you spend with your finger inside of bums, total, on average?

    2. MG

      Um, ooh, that's a good question actually. I mean, it, it, you know, I don't hang around when I'm up there, uh, let's be honest.

    3. CW

      Well so, okay, let's work it out. So what do you, what's typical rectal exam length? 20 seconds?

    4. MG

      Yeah 'cause you've got to, you've got to essentially get them on their side-

    5. CW

      Mm-hmm.

    6. MG

      ... laying on their sort of fetal position.

    7. CW

      Yep.

    8. MG

      Knees up. I usually sort of say, "Think of queen and country." Uh, you got a lubed, uh, uh, gelled glove.

    9. CW

      Yep.

    10. MG

      And-

    11. CW

      Into, into gluteal cleft.

    12. MG

      Yeah, absolutely, yeah.

    13. CW

      Weren't expecting-

    14. MG

      A little bit down-

    15. CW

      ... me to know that, were you, Dr Skittle?

    16. MG

      Yeah. Are y- y-

    17. CW

      That's because one of my best friends, my best friend is also a doctor as well, so...

    18. MG

      Okay, fanta- so you know, you know what to ask me now.

    19. CW

      Okay.

    20. MG

      And, um, you extern the out- you examine the outside and then you say, "Okay, a bit of pressure," and in you go and you sweep around feeling for masses and you sweep around feeling the prostate, uh, or the edge of the prostate and then you come out, look at the glove, you're looking for blood, you're looking for, um, mucus, um, and then you go away and give them a tissue. And that, not to wipe their eye, that is. That's to-

    21. CW

      (laughs)

    22. MG

      ... to sort the other end. Or two tissues sometimes later.

    23. CW

      Yeah.

    24. MG

      You know, and that, and that's it but yeah, I mean, I've probably got enough, I've probably had my finger up for long enough to, to see a good ad break in a month.

    25. CW

      Go- okay, cool. Yeah, well, I mean, it's, it's all just-

    26. MG

      Enough.

    27. CW

      ... accumula- it's all just accumulating time, you know. I had, um, I had salmonella a couple of years ago from Africa.

    28. MG

      Nasty.

    29. CW

      Yeah, really would not recommend it.

    30. MG

      Yeah.

  8. 10:32 – 11:05

    salmonella

    1. CW

      I didn't even think of this. I got a call from Environmental Health-

    2. MG

      Yeah.

    3. CW

      ... asking where I'd been eating recently because they knew that I had salmonella before I got a call from my doctor's surgery telling me that the diagnosis was salmonella.

    4. MG

      Yeah, it's pretty, um, pretty swift, isn't it? So Public Health England will have notifiable diseases. If sal- salmonella comes up, they need to find where the source is and track it down and, uh, isolate it if need be. I mean, you know, you know, it's a, a very different game when we think about the coronavirus pandemic but it's that on steroids really, isn't it?

    5. CW

      Got you, yeah. I was

  9. 11:05 – 12:21

    getting fired as a GP

    1. CW

      like, um, oh, I'm gonna guess that's my diagnosis, thank you for telling me, and just obviously some fella, some girl on the other end of the phone trying to track down like a, a, a hotel that had been serving bad chicken or something like that unless-

    2. MG

      Yeah.

    3. CW

      ... unless you fly to Africa.

    4. MG

      Yeah.

    5. CW

      That's, that's not going to happen.

    6. MG

      Pretty tough, yeah.

    7. CW

      Um, how hard is it to get fired as a GP?

    8. MG

      Uh, well, I haven't been fired yet but I'm probably working quite hard to, um, I, I think, I think it's pretty hard. You know, GPs are in demand, you know, we're, we're short thousands of GPs and, and government after government make pledges that they're going to, uh, you know, boost, you know, the GP numbers by 5,000 come 2020, 2021 and it just doesn't quite ma- get there. I think to get, to get struck off, to get fired as a GP, I think you have to have gross misconduct and, um, uh, you know, they're the kind of guys and girls that you're seeing in the Daily Mail, um, after their, their, uh, sort of lawsuits. So you're seeing people that are sort of using sexual exploitation, taking photographs, unnecessary examinations. Um, you don't, you wouldn't get struck off for just being a bad GP, you'd get pulled aside, mentored-... trained up. I mean, the training is good. Um, the reason you get, uh, you'd probably get fired is if you've got a darker side to you that comes out.

  10. 12:21 – 16:22

    the stakes are high

    1. MG

    2. CW

      Ah, yeah, uh, because I was thinking, the, the stakes are obviously quite high. There's a, a story in the book about a lady who comes through and points her finger at you and accuses you of not detecting her husband's soon-to-onset heart attack that kills him-

    3. MG

      Yeah. Yeah.

    4. CW

      And it's like, well, that's... That, i- i- obviously, there's a lot of, uh, emotion and-

    5. MG

      Mm-hmm.

    6. CW

      ... not culpability, but i- there's, there's a, um, a potential for someone to find you, create you, be the, the reason, the behest of this particular problem that's occurred, right?

    7. MG

      Yeah. And, and that, and, and to be honest with you Chris, that, that happens a lot, partly because we're the person sat in front of them. You know, if you're looking for someone to blame for, for, for a loved one's death, um, a GP is, is someone who's there, is accessible, and, and often, I, uh, I think I remember I said about this in the, in the book with that particular, um, lady, you know, it's a grief reaction, and I bear no bare, no bad, um, feelings towards her, because while it was a horrible experience for me, her experience was, was immeasurably worse, and what I was receiving from her was her grief reaction.

    8. CW

      Mm-hmm.

    9. MG

      Um, you know, uh, and, and that, I suppose that's, you get a thick skin as a, as a GP. As a doctor in general, I think, or as a nurse, or any healthcare professional, you get a thick skin because that stuff happens all the time. You get blamed for missing cancers, you get blamed for not diagnosing heart attacks, or, or not seeing the signs of one. You know, we are human and, um, I will miss things in my career. I will miss cancers. I know that because I'm, I'm not, you know, I'm not infallible and I'm human, and it's just, uh, that's the life that we live, and, um, every doctor knows that. If you speak to a doctor who says, "I'm never going to miss a cancer, I'm never going to miss a, an acute serious illness that could lef- lead to a fatality," I think they're killing themselves. I mean, that, you know, we have to have the humility to say, "I'm gonna, I'm really gonna fuck up at some point and I'm gonna have to just shoulder that." Because if you're seeing-

    10. CW

      I'm just going to do the best that I can at all times.

    11. MG

      Yeah, and if you're seeing hundreds of patients a week, you just need to miss one thing, like just one tiny thing, one subtle symptom. That's, uh, you know.

    12. CW

      Stakes are high, Max. The stakes are really, really high.

    13. MG

      Yeah, but that's why I love the job. I mean, I love the, I love the risk that comes with it. People... You know, when I, when I suddenly realized I was coming out of medical school and going into being a GP, I was like, "Oh my God, this is gonna be the most boring experience of my life."

    14. CW

      (laughs)

    15. MG

      But, you know, I've done A&E, I've survived all that, I've enjoyed it, it's great fun, but I want to come home on the weekends. I want to come home to my family in the evenings. Um, let's make that decision. What I found is that every day is just the, a cacophony of, of experiences, of, um, with patients, and I, I love it. Like from the acute illnesses to the utterly weird and wonderful, to the, um, sad and somber. I mean, you know, you can, one day you can be talking about someone's sore knee, and within 10 minutes you're talking to, you know, the guy in the book, Benny, who came, comes in and his question is, "You know, seriously Max, what, what's the meaning of life?"

    16. CW

      (laughs)

    17. MG

      And, and that, that puts him immediately on my top five patient list of all time. Because just to have the, to have the, the guts to come in and ask the question that perhaps we all do wonder from time to time, particularly at sort of 2:00 AM when you can't sleep, to come in and ask me and think that I'm gonna have the answer-

    18. CW

      Yeah, it's a, it's a low-key compliment, man.

    19. MG

      I mean-

    20. CW

      Really, really is. I know who's gonna have the answer to this. Dr Skittle, Dr Skittle knows the answer to this one.

    21. MG

      Ex- exactly. And, uh, and, uh, you know, well, you had to read the book to find out what happens.

    22. CW

      That's right, yeah.

    23. MG

      But, uh, he is, uh, he's one of my all-time favorites. Never forget him.

  11. 16:22 – 17:55

    its like being a hairdresser

    1. MG

      Never forget him.

    2. CW

      It's, it's a little bit like... Being a doctor, being a GP sounds a little bit like being a really hardcore hairdresser. Like everyone that comes in, their hair's shit.

    3. MG

      Yeah.

    4. CW

      Like it's totally shit and the best that you can do is get them to leave with an acceptable hairdo, which might happen in three weeks' time.

    5. MG

      (laughs) Yep, yeah. Well, y- you know what? I've got, having, like you and like all of us, just gone through the lockdown and had a lockdown haircut-

    6. CW

      (laughs)

    7. MG

      ... and tried to cut my wife's hair-

    8. CW

      Oh dear.

    9. MG

      ... um, it is not that easy. And so hat, first of all, let's just give a hats off to the hairdressers because-

    10. CW

      Absolutely, yeah.

    11. MG

      ... it is not easy. Um, but yeah, I mean, being a GP is a bit like being a shit hairdresser. Uh, you do, you have to, you have to go in and you have to figure out how to make people's lives better. But the, but the, the major factor with that statement is that that doesn't mean anything unless the patient is motivated to change. If the patient comes in and you say, "You need to do X, Y and Z to make this condition better," and they don't, that's on them. That's not, that... And that's the truth. Um, I can do all I can to try and encourage them, make them see and understand why they need to do something, but if they have the mental capacity to say, "I get if I don't do these treatments I might come to serious harm or death," and they decide not to, there is nothing I can do about that.

  12. 17:55 – 20:40

    the challenges of being a doctor

    1. MG

    2. CW

      That really surprised me to find that out. You know, a, a doctor tells me to do a thing and I'm, I'm pretty much to the letter, but you had a lady who...... had put off a, uh, breast cancer assessment for-

    3. MG

      Ugh, yes.

    4. CW

      ... four times because of work.

    5. MG

      Yeah.

    6. CW

      You had a, a guy who-

    7. MG

      Yeah.

    8. CW

      ... was like pre-diabetic, high blood cholesterol, smoked every day, drank every day, didn't eat anything, was also like, looked like he might be a low-key 60-year-old porn star. And then he wanted-

    9. MG

      Mr. Tosk- yeah, Mr. Toska, he was one of my faves. He was like-

    10. CW

      (laughs)

    11. MG

      ... just came in smelling of sort of stale cigar and sex.

    12. CW

      (laughs)

    13. MG

      He was, uh, he was, he was a great, he was a great guy and I, I hope he's still with us. Uh, but-

    14. CW

      But e- like all these people-

    15. MG

      Yeah.

    16. CW

      ... and they're not d- and you're saying, "Look, thi- this is, this is where you're at." And there was another lady who had an existential crisis in front of you.

    17. MG

      Yeah.

    18. CW

      And didn't bother to go to her, her, uh, cancer treatment or whatever 'cause she was like-

    19. MG

      Yeah.

    20. CW

      ... "Just give it to someone that deserves it." And I'm thinking like-

    21. MG

      Yeah.

    22. CW

      ... "Ugh, e- th- just seeing people like that, it must be, it must be challenging as a, as a doctor to do the thing, get them to the s- as much as you can do, lead a horse to water, but-"

    23. MG

      Yeah.

    24. CW

      ... then you get stuck.

    25. MG

      It, it, it is a- and some people find that harder than others. So for me, I, I f- I've, I'm very, you know, I'm, I'm blunt. I will say that, you know, if, if you don't do this, this is what could happen and, um, and of course you do... I don't want people to think that's me being incredibly harsh and then going, "That's it. I've wiped my hands with them." So the lady, for example, who you mentioned who I don't think it was a cancer treatment, it was her, her diabetes appointment and, and, um, she'd said, "Oh, li- you know, I- I'm not good enough to have treatment. Give it to someone else who's, who's, who's salvageable." And, um, and, and in the book I think I said, you know, I will follow up with her in a few weeks time and I will say, "Oi, have you changed your mind?"

    26. CW

      (laughs)

    27. MG

      "And here's why you should change your mind again." And you keep doing that. So I guess, I guess what I'm saying is people may listen to me, or they may read the book, which I, I'm getting a feeling is going to be a bit of a Marmite book with people. Um, they might think, "Max is a, a real dick," but actually every single decision I make, everything I say or do is, is in the patient's interests, um, a- because that's why I love the job, because I'm doing something to h- try and help someone else. You just don't need to sugarcoat this stuff because health doesn't n- is sugarcoated enough, you know, you just sort of need to go on sort of Instagram a- and, and you know you can get some shiny enameled tooth, um, doctor who can tell you this stuff. Um, but, but the, the reality is that, you know, you have to be blunt, you have to be harsh, um, because you're trying to do everything in their best interests.

  13. 20:40 – 21:23

    the rubber meets the road

    1. MG

    2. CW

      The rubber really, really does meet the road when you go and sit down with a GP. I don't want the guy on Instagram who, who did a, a level three NVQ in physiotherapy. I don't want him. I want someone that had to go through the fire and brimstone that is five years of med school-

    3. MG

      Yeah.

    4. CW

      ... and two years a locum and blah, blah, blah, blah, blah.

    5. MG

      Yeah. And, and you experience that and, uh, and, uh, in The Secret GP, I, I have a couple of flashbacks to, you know, there's a chapter about when I went through my GP training and what led to me to, to make that decision and there are stories in there about, you know, the experiences that you go through as a junior doctor and how you cut your teeth and, as you say, how the rubber eats the m- meets the road.

  14. 21:23 – 23:11

    what do you want

    1. CW

      Can we play GP bingo? Can you try and-

    2. MG

      Fire away.

    3. CW

      ... come up with some of the cliché phrases that, uh, you either find yourself saying a lot or that you hear your or the doctors saying a lot?

    4. MG

      (laughs)

    5. CW

      So f- for instance, on this show, I'll tend to say something like, "The rubber meets the road," or, "The tip of the spear," or, "You, you, y- wherever, you got to have a pair of bras- brass balls for that."

    6. MG

      Yeah. Yeah.

    7. CW

      What are some of the ones that you find yourself saying a lot?

    8. MG

      S- (laughs) so, I, I think for me, uh, uh, often it's, "What do you want?"

    9. CW

      (laughs)

    10. MG

      Because actually sometimes you just need to cut through all the faff and just say to them, "W- what is it you want?" Um, "What do you think you've got?" Definitely, "What do you think you've got?" Because people come in and they'll listen to you and then they'll say, "Actually, well, I, I, you know, I've played Dr. Google and I think it's this."

    11. CW

      (laughs) That's the, that's the doctor equivalent of, "Do you know why I pulled you over?"

    12. MG

      Ex- exactly.

    13. CW

      (laughs)

    14. MG

      Ex- exactly. Spot on. Um, and then I suppose the other one is, well, (laughs) so this is, this is pr- and I, and I mention this in the e- epilogue as well, this is the, the pre-coronavirus, um, statement, "It's probably just a virus."

    15. CW

      (laughs)

    16. MG

      Okay? And that is the most terrifying thing, isn't it? That for, for, for a GP you come in you're like, "Oh, I need antibiotics," which treat bacterial infections. "I've got, I've got a cough and I've got a sore throat and runny nose. I need antibiotics," and you go, "Look, it's just a virus. It's a cold. Go home, spend time with your family, hug them, take paracetamol, go to work, you'll be fine. You don't need to stay off work for this. It's just a virus." I mean, fast-forward to 2020 and, and it's a totally different world.

    17. CW

      Can you imagine

  15. 23:11 – 24:40

    corona gp

    1. CW

      if you'd written this book from mid-2020 until early 2021?

    2. MG

      (wheel screeching) Uh, yeah. I mean, it would be, you know, never say never. There might be another one in the pipeline at some point. But, um...

    3. CW

      The Corona GP.

    4. MG

      Yeah. (laughs)

    5. CW

      That's (laughs) , that's what I want.

    6. MG

      Yeah. I mean, this is, uh, yeah, I mean, it'd be a different book. I mean, I'd be clad head to toe in, uh, personal protective equipment, I'd be two, two meters away from everyone, um, and I'd be on the phone all the time because, you know, GP has gone from 80% face-to-face, 20% phone call as a split to, you know, what was at one point for many months 100% face-to-face, uh, uh, sorry, 100% telephone call and if you got any symptoms that suggest you might have, um, a coronavirus infection, you go off to a hot hub where you're met by, um, uh, specialist teams. So it's a, just a, it's a totally different, uh, game and, um, but things are changing. You know, we, you know, we have to stay positive and we have to think that things to a degree will return to-... a normal semblance of a, of a NHS and the healthcare service that we, we know and love. Um, but, you'll probably find that GPs might talk to you on the phone more because we've realized how much we can actually manage on the telephone. Um, and that frees up time. It means that we can speak to more patients, um, and address more issues, um, than perhaps historically we could.

  16. 24:40 – 27:41

    the 10 minute window

    1. CW

      You were saying that sometimes a significant portion of the 10-minute window you have to deal with a patient is actually taken up with them getting up from the seat, getting through reception-

    2. MG

      (laughs) Finding-

    3. CW

      ... finding-

    4. MG

      Yeah.

    5. CW

      ... finding the room that you're in. Ge- so the, take us through. You press the button and your 10-minute timer starts when you say, "Uh, Christopher Williamson, please come to unit-"

    6. MG

      Yeah.

    7. CW

      "... five," or whatever.

    8. MG

      Yep. Yep, ab- absolutely. So, so put it in some context. When I was first a doctor and first a GP, um, I would read your notes, Chris, for about 10 minutes, you know? Um, and I'd be like, "Right, I know all about you. I'm going to call you in now." And you, and you press a buzzer because you think that to have that information, you're some, s- in some way sort of forearmed about what's about to happen, which is just, it- it's just total bollocks because what happens is-

    9. CW

      (laughs)

    10. MG

      ... you come in and you throw something out of left field, like, "What's the meaning of life?"

    11. CW

      (laughs)

    12. MG

      Um, and, uh, and so that's, and that's, so that's one of the things. So what we do is we, um, when I press that button, I stand at the door and I go, "Look." I wait for them to come down. "Hi, it's Max. Come in." And, um, and then you just wait for them to start talking because everyone will have a preset, um, idea about what they want to say. So everyone has got a preset sort of, you know, opening few sentences about-

    13. CW

      (laughs)

    14. MG

      ... "Max, this is my problem. This is what I've, um, this is what I've got." And, uh, you need to let them get that out because if you don't, you're basically, um, stopping everything that's been stored up inside for them. And then you listen to it and then you ask some more questions, and then by about minute three, you've got a rough idea, you should have, or certainly I, I try to do, you have a rough idea about what you think they've got and what you need to do. So what's your management plan? So what tests you need to do, what treatment are you going to give, and what follow-up are you going to have? And then the next seven minutes are basically spent making that dream become a reality and getting them out the door-

    15. CW

      (laughs)

    16. MG

      ... at minute 10. Because, you know, if you let it just kind of waffle on and drag on and let them sort of, you know, give you war and peace, what happens is that you don't really get to the meat of the issue. Um, then you find that you can't address all their problems. Um, and then you find that then knocks on to the rest of your clinic. So you have to, um, you have to be quite brutal. I sometimes will just stop people in their tracks and be like, "Just, just what..." Like I said, you know, when we were playing GP Bingo-

    17. CW

      Mm-hmm.

    18. MG

      "... what's the prob- what do you think you've got? What do you want?" Because then you can make things happen. Whereas if you get to 10 minutes and they're still telling you about their first symptom, you know, you can either push them out the door or you can listen, but then you basically make everyone else late for their appointments. So, you know, you got to be a little bit bullish about it.

  17. 27:41 – 30:55

    the worst sorts of patients

    1. MG

    2. CW

      It seems to me, I've got, uh, a number of friends who work in healthcare and are, are the junior doctors or on locum or whatever it might be, and they have said unanimously that the worst sorts of patients that they get are the ones who come in and don't have a defined problem. I don't know whether this is people who are-

    3. MG

      (laughs)

    4. CW

      ... hypochondriacs, whether this is people who are just lonely and want some attention.

    5. MG

      Yeah. Yeah.

    6. CW

      Um, do you often come across those?

    7. MG

      Yeah, we do and, um, the, the undefined problem is sometimes the most unnerving problem because, you know, I've had experiences where patients have come in and they've said, like, "I just don't feel right." And you're absolutely right, there is a, there is a large group of people that are lonely, that are isolated, that, um, uh, that just want to see you to have company and that really does happen. Or there are those people that think that they might have something. They've gone online, they've Googled, or they have a family member who's just been diagnosed with a cancer. They come and see you and they, they don't want to say, "I think I've got cancer, Max." They just say, you know, "I just don't feel right," and you have to explore that. And, and you, you sometimes hear particularly sort of more junior doctors say, "Oh, he or she was a really bad historian. Like, they just didn't tell me what ... they didn't give me any information." That, that's not true. Like, you're just not good at getting it and you need to ... you know, it's your job. You're the detective. Your job is to say, "Okay, well, let's pick apart your life for a second. You know, who's at home with you? What's your daily routine like? What's your appetite like? What are you eating? Bowel's okay? Passing urine? Sweating at night? Any weight loss? Bruising at all?" Like, you just go through and you start in your head to mentally tick off this checklist. But then as you do that, you then come to the, the third category of the "I just don't feel quite right" people, and they're the ones that have got something serious going on, that this is just the first sign of a niggling symptom that then manifests itself. Um, and, and, you know, you do your blood tests or you do your chest X-ray and you reveal something else. And, and that's why it's really important, it's important never to, to, to ignore any patient, um, and always to listen to them. And, and I think the one thing that keeps me going is that I've got diagnostic curiosity. You know, I want to know, I'm curious about people.

    8. CW

      Sherlock Holmes, yeah.

    9. MG

      Yeah, and it, and it's, and, and when you do it that way, you don't miss stuff. Um, if you get blase...... um, that's when you do miss stuff and you make mistakes.

    10. CW

      Hey, we said-

    11. MG

      And then they're the ones that suffer.

    12. CW

      We, we said on the show last year that curiosity is the most important personality trait of the 20th century, and it turns out, not only is that true for entrepreneurs and podcasters, but also maybe for doctors as well, which is pretty cool.

    13. MG

      Yeah, yeah. A- absolutely, and, uh, you get bored in a job like this, you know, you're going to switch off, you're not going to think, and, uh, yeah, then errors come in. Um, I love my job. I wouldn't do anything else. Um, uh, I think it's, I think it's brilliant. You know, you get to see the kind of light and the dark and all the shades of gray in between life.

  18. 30:55 – 36:31

    the spectrum of people

    1. CW

      It must be... The, the, the spectrum of people and experiences that you're exposed to must be a real shock to the system, at least initially.

    2. MG

      It is. So, so when I was, uh, so when I was working in the sort of inner-city surgery that, where the book's, um, set, um, you did, you went... You saw people from, um, extreme affluence to extreme poverty to different socioeconomic backgrounds, different ethnic backgrounds with different cultural beliefs around health to, um, all the way to gang members. Um, so, you know, there are people that would be your friends that you'd think I'd go, you know, I'd go out for dinner with them, they are, to the people that you would cross the road actively-

    3. CW

      (laughs) To avoid.

    4. MG

      ... to avoid.

    5. CW

      (laughs)

    6. MG

      Um, and, and, you know, it's like, you know, I, when I, uh, you know, in the book, I talked about I was out with (sniffs) you know, my wife, um, Alice, and we were, we were walking, and she was like, "I want a lollipop," and I'm like, "Okay, fine. You want a lollipop? All right." And then, of course, there's just a big gang of, of, of kids sort of, um, who are just hovering around the shop door who just look like they want to kill me. And then, um, (sighs) I'm just thinking, "Ugh, bloody hell," like of all the manly things I need to go and get is a lollipop. So I, so I go and, you know, I pick a Magnum because I think that's the most manly, masculine ice cream I could possibly get from the, the shop, and then on the way out, like, one of the, uh, one of the kids goes, you know, "All right, Doctor Max?" A- and it turns out he's one of my patients, and, and, but you just... (Chris laughs) So you just don't know, you know? You... And, and it doesn't matter who they are, you help everyone, and because everyone's got a backstory, no one ended up in that position by choice. No one wants to see their GP. I think that's the other thing to say, Chris, is people don't... Unless you're lonely, people don't want to come and say, "I've got a problem." Like people want to be healthy. It's just inherent with u- in us. Um, there is a very small minority of people who, who do like to be unhealthy and, and, and sort of be medicalized, but I think that's a story for another day. But, (sniffs) you know, the majority of people want to be healthy, so they don't want to see us, um, and I think that's the other thing that we need to bear in mind.

    7. CW

      It's an interesting dynamic, isn't it? For the relationship-

    8. MG

      Yeah.

    9. CW

      ... between... There's, there's very few things that you have to go out of your way, like maybe the, maybe the tax man, you know, or maybe like the people-

    10. MG

      (sighs)

    11. CW

      ... that deal with like environmental health if you've got... y- you don't really want to go and see the guy that cleans your drains out. But even then it's not-

    12. MG

      Yeah.

    13. CW

      You know what I mean?

    14. MG

      Yeah, yeah. I mean, I mean, no. There are, there are lots, you know, there are lots... People don't... You know, we like to think people like seeing us, but actually (laughs) , you know, it's a chore.

    15. CW

      Making the best of a bad situation, mate. That's what you're doing.

    16. MG

      Yeah. Yeah, exactly.

    17. CW

      I mean, I didn't know that doctors had performance targets. How does that work?

    18. MG

      (laughs) So, um, so I think what people might not realize is that GP surgery is a, is a, is essentially a business. I mean, it makes its own profits, um, and what happens is there's, um, there's something called Quality and Outcome Frameworks, which is QOF-

    19. CW

      (laughs)

    20. MG

      ... which I really don't want to bore your listeners with, Chris, because it, it really is for the insomniacs, uh-

    21. CW

      Okay.

    22. MG

      ... to, to hear about this. But in a nutshell, you get, um... If you have, uh, you know, 10,000 people and a thousand of those have high blood pressure, if you can control 95% of those people's blood pressure to within a certain target, you will get extra payment. So basically they're saying, "Well done. You've kept their blood pressure in good control, which means they have reduced risk of cardiovascular disease like heart attack or strokes. Um, therefore, we will reward you, um, with, uh, a financial remuneration." Um, and the, the concept is that, by doing that, we are setting all these health indicators that if we can meet those targets, those targets are linked to research that says if you do this, if you have this in this person, they will be healthier, and therefore they will have less morbidity, i.e. ill health, a- and less mortality, i.e. death. Um, the, the issue I have with it is that it's, uh, it's retrospective. It's going, "This guy has got high blood pressure. Brilliant. Right. Let's, uh, give him a medication. Check his kidney function blood test, um, once a year. Tell him to exercise and reduce his salt content. Get the blood pressure down, and tick, we've met our, our, our QOF indicator, um, our target." What should happen is they should say, "We'll pay you for the amount of people that you can keep off of that high blood pressure register. We'll pay you to," say, think prospectively-

    23. CW

      Mmm.

    24. MG

      ... rather than retrospectively, to think prospectively and say, "You as a practice, do everything you can to keep them within a healthy body weight, having a healthy diet, exercising, and naturally keeping their blood pressure down. We'll reward that." Um, (sighs) yeah, I mean, a- a- and, and it doesn't work like that for every target, but there are lots of, you know, you know, bu- lifestyles, you know, the buzz, s- sort of buzz word of the, the, you know, the, the 20th century. But it, it's rooted in, in fact as well, in science, that-If you can do the basics really well, you don't need drugs and you don't need interventions.

  19. 36:31 – 37:27

    physiotherapists and doctors

    1. MG

    2. CW

      It's interesting thinking about the parallels between, um, physios, physiotherapy-

    3. MG

      Yeah.

    4. CW

      ... and doc- and doctors because there's a perverse incentive, bizarrely, with a physio in that when they get a person better, they no longer (laughs) get paid off that person.

    5. MG

      (laughs)

    6. CW

      And it's kind of this QOF thing is kind of somehow, uh, working, deriving its metrics of success from that in a weird way.

    7. MG

      Yeah, they are. Uh, uh, but I think the one thing I would say is that even with, with any healthcare professional, whether it be physiotherapists, occupational therapists, uh, speech and language or nursing staff, doctors, um, there are always patients. Always, always. You know, the world keeps turning, people keep getting older, people get muscular skeletal problems that need physiotherapy. Uh, you know, it is, uh, it will never be short of, um, supply.

  20. 37:27 – 41:53

    how to be the perfect patient

    1. CW

      How ... If you were to coach everyone who's listening, the thousands of people that are listening, if you could coach them through how to be the perfect patient, what would you tell them to do? What can we all do to make your lives easier and to also get better outcomes ourselves as patients?

    2. MG

      Mm. Okay. All right, this is a good one. So, um, let's go with top three. So top three, number one, turn up on time.

    3. CW

      (laughs)

    4. MG

      Okay? (laughs) But I appreciate there's probably gonna be a lot of people shouting at me and get, being like, "Yeah, but Max, you're never on time anyway." Um, so, eh, I can see where, that, that sort of there lies the rub.

    5. CW

      It becomes circular, yeah.

    6. MG

      Um, two is if you're coming with something like a rash on your thigh ... Uh, two is dress appropriately. So if you're coming to me with a sore knee, don't come wearing knee-high boots and skinny jeans, because it takes about 10 minutes for you to get that stuff off so I can actually look at your knee.

    7. CW

      Yep.

    8. MG

      Um, and, and thirdly, I would say don't save up your problems. I think that's a really important one. So, uh, I have a lot of people that come to me and think that they're doing me this enormous, uh, service by going, "Max, I've, uh, I've saved up, um, my seven problems because I just thought, you know, you want to see other people around the, you know, in the, in the previous week, so I just didn't want take up ... So anyway, here's my seven problems," and I'm dividing seven by, uh, 10 minutes or 600 seconds, which, um, you know, well, uh, you know, which I can't even do the math.

    9. CW

      Not long.

    10. MG

      Um, not long basically. And, um, and you can't do it. So I would say two, three at a real push. But I also, I suppose, Chris, I'd, I'd, um, uh, uh, sort of put a little, um, alert on that as well saying that I guess it, because people will sometimes say, "Oh, by the way, I've just got this little thing," and they think it's a little thing, but I in fact think it's a really big thing.

    11. CW

      Mm.

    12. MG

      And, and you then have to, um, go through a whole process. So really interestingly, and I get, the one I get a lot is, um, women might say, I spoke to them a coup- talked to them about a couple of different issues and then they'll say, "Oh, by the way," just as they're going out the door, "I've just got this one thing, like, I've just got, I have this little, uh, sort of lump sort of just near my breast." And immediately, you know, you think, "Okay, well, I can't, I can't unhear that."

    13. CW

      (laughs)

    14. MG

      Um, and-

    15. CW

      You're halfway out the door. Close the, close the door.

    16. MG

      Yeah. And, and it may, it could be for many reasons. It might be they're anxious about bringing it up and, you know, it's like, you know, so, you know, like a 15-year-old going and trying to buy an, a, buy a porn mag in a, in a newsagents and they, like, buy about seven different things before they kind of point at the Playboy and say, "And can I have that as well?"

    17. CW

      Mm-hmm.

    18. MG

      You know, it, it, it's, it's really difficult and, and they, but in any case, I've heard it, and at that point you have to go, "Well, I have to examine you," or, "I would like to examine you," if, if they gi- if they give you permission, and, um, you need a chaperone, so I need to go, um, downstairs to the reception and get a, a trained chaperone, um, from reception to stand and, and make sure that everything is above board, and, um, if there, anything ever did come to light or be an issue, we had a third independent party. Um, and then you examine them and then you, then you make a decision. That is, that, you can't do that in, in a minute. Um, so I often will navigate that third tip by going, okay, um, w- if they say, "I've got four things," I'll say, "Just, just, I don't want you to go into detail, but just give me the, give me the highlights. Give me the top four bullet points."

    19. CW

      The headlines.

    20. MG

      And they'll go, "Knee pain, lump in the breast, um, uh, um, constipation, and I've got a sore right," and I'll go, "Okay, tell me about the breast lump first."

    21. CW

      (laughs) You organize them in-

    22. MG

      Yeah. Yeah.

    23. CW

      ... order of priority.

    24. MG

      Yeah. Yeah. You triage them. You triage them, because they might not ... Why should they know that one is more important than the other? You know, that's my job. Uh, and so, you know, sometimes you have to blunter with others, uh, th- um, than some, but, you know, that's, you know, you try and, again, it's all about trying to get as much maximizing the time and what you can give to that patient, um, and not getting annoyed at the same time.

  21. 41:53 – 42:30

    lemon ball

    1. MG

      (laughs)

    2. CW

      I think, um, I think not saving it up is, is a really, really good point. We were talking on this podcast on the pilot episode, like, three years ago-

    3. MG

      Mm.

    4. CW

      ... uh, about one of the, uh, regular co-hosts, Yusuf, who, uh, had a, um ... I'm gonna forget what it's called. He called it lemon ball, but it's actually got a very specific name. It's where one of the ducts, testicular ducts, gets blocked.

    5. MG

      Nice. Uh, so he had a varicocele?

    6. CW

      Yes, I think it's-

    7. MG

      Or a hydrocele.

    8. CW

      ... hydrocele.

    9. MG

      A hydrocele is fluid.

    10. CW

      Hydrocele.

    11. MG

      A hydrocele is, uh, fluid around the, around the testes.

    12. CW

      Yes.

    13. MG

      So, your scrotum or y- your sack on one side, uh, looks like you've stuffed a party balloon in it.

    14. CW

      Yeah. So he had-

  22. 42:30 – 44:43

    inbuilt denial

    1. CW

    2. MG

      Yeah.

    3. CW

      ... he had hydrocele. But even him, as a person I think at the time who was third-year med school-

    4. MG

      Yeah.

    5. CW

      ... maybe fourth-year med school. Even him, hi- the- the, um, in-built denial of medical problems run so deep that even he was like, "No. No, no, it's always been that si- that side. It's always- one's always been a bit bigger than the other. It's fine."

    6. MG

      Yeah.

    7. CW

      And it just, like, gone around. And this is how people, like you say, can almost accumulate this little collection of things.

    8. MG

      Yeah.

    9. CW

      It's like, "Ah, well, one of them has got to the point where I need to see you about that. And by the way, here's all of the other shit that I didn't want to-"

    10. MG

      Yeah.

    11. CW

      "... bring up in the interim."

    12. MG

      Yeah. Yeah, absolutely. And, and that's the, um, sort of in the introduction I talk a bit about windows and, uh, and the idea that, um, as a GP, you know, I hold up this, this windowpane and stare into your life. You know, I see your house. I see your... You know, I'm looking at your life and, and there are different types of patients. So you get the patients who come in and say, you know, hold up the window and they point to their knee and say, "Max, um, you know, I've got knee pain. Can I, can you, um, can you look at it?" And you get those who sort of hold up a window go- and go, "Max, I'm- I'm- I'm worried about my cholesterol." But then I say, "You're worried about your cholesterol, but I've just spied your, your blood sugar result and I'm worried about you developing diabetes." So different agenda. And then finally, you get people who hold up the window to someone else and they go, "I'm worried about my loved one." And, and they say, you know, "I'm worried..." Often it's, "I'm worried about my aging parent. I think they're getting a bit more confused. I'm worried they've got dementia." So it's not that they are... It's not about them, it's about another person. And, and they're the challenging cases because you are kind of... You haven't... You can't talk, necessarily talk to that person who's come to see you about somebody else. You can't talk to them about... You can listen to them. You can listen to everything they had to say, but you can't necessarily say, "Here's what I'm going to do." You can say, "Okay, I'm going to book to have them come in and see them myself." Um, but you can't, you can't discuss someone else's case, um, if, you know, with a relative if they haven't given permission. So yeah, it's all about windows and journeys.

  23. 44:43 – 50:31

    tripwires

    1. MG

    2. CW

      It's interesting that, uh, uh, the process of someone who isn't the patient coming in on behalf of the patient.

    3. MG

      Yeah.

    4. CW

      I imagine that must be the- there's a whole host of different trip wires for both parties to fall over there.

    5. MG

      Yeah. Uh, uh, absolutely. And, and it gets, you know, it gets a bit muddy when you kind of look at teenagers. You know, when you start, you know, you phone up. You see you've got a 15-year-old patient. She's phoned up and she wants the oral contraceptive pill. And you look at her phone details and it's got a home phone number and then a mobile number and you've got no idea if that's Mum's mobile number, Dad's mobile number-

    6. CW

      (laughs)

    7. MG

      ... the guardian's mobile number, the nanny's-

    8. CW

      (laughs)

    9. MG

      ... or the patient's. And then you phone and you're like, "Hello, it's Dr. Skittle. Can I, can I speak to so-and-so?" And then immediately, like the next day, you might get a phone call from the mother saying, "What did you talk to my daughter about?" And you have to say, "Well, look, I'm, I'm really sorry but it's, it's confidential." And yes, she is under 16 but she has something called Gillick competence which basically says, uh, which is specific around, um, uh, sort of, uh, sort of contraception. So young girls who want to have oral contraceptives. Um-

    10. CW

      It's called, it's called Gillick competence?

    11. MG

      Gillick, G-I-L-L-I-C-K.

    12. CW

      Gillick competence.

    13. MG

      And there's also Fraser confidence as well, competence as well, which is sort of bigger picture. Um, and, uh, but it's basically saying if someone is in a sexual relationship under the age of 16 and, uh, it is with someone of a similar age, there's no signs of abuse or, um, grooming and they are going to have sex anyway, you know, you don't want to be the doctor that says, "Well, fine. I'm not going to give you, um, contraception because, um, you're under 16." What you say is, "Well, look, if, if you are not going to stop having sex, I want to be help you be as safe as you can be and against unwanted pregnancies." Um, and of course, talk, counseling about safe sex and condoms and STIs is a whole different issue. Um, but, but if that patient, if that young woman has a, young girl, has a, the, the capacity to retain, understand and communicate the decision that they would like to make, you have to respect that and you have to respect their confidentiality. And the only time you would break it is if you suddenly found that there were, um, you know, signs of abuse or grooming or anything that made you feel that this was, um, a safeguarding issue. But if the mother calls, you have very, very difficult conversations because you're, you essentially are, you know, your duty is to the patient. Um, and all you can do is encourage the, the, uh, the patient to speak to her mother. Um, a- a- and, and of course you do that. You know, you don't just go, "Oh, let's keep this secret between you and I."

    14. CW

      (laughs)

    15. MG

      You say, "Sh- she, do you want to talk about this with your mother? Because it's a big issue and I think that, you know, uh, it'd be really helpful if she's supportive." And we get that. You know, I get, um, uh, teenagers coming with their mum and, and, and saying, "I'd like to get on the contraceptive pill." And they might not be for safe sex, uh, uh, for sort of protecting against, um, uh, unwanted pregnancies. They might be because they're having really difficult, um, problems with their menstrual cycle, um, which, you know, as a GP, as a male GP, is something I never thought I'd be so comfortable talking about.

    16. CW

      (laughs)

    17. MG

      But, you know, after all these years, like it's not... It, it's... We see it every day. We talk about it every day.

    18. CW

      Just a bit of menstruation, everyone. Just a bit of menstruation.

    19. MG

      Yeah, yeah, yeah, exactly. I mean, that, and it... Because that is normal. I mean, though, the, um-The worst, most frustrating case I had, just to talk about menstruation for a second, Chris -

    20. CW

      Finally, that's what we're here for.

    21. MG

      ... was, uh, was I had a, a, a teenager come in with her mum, really embarrassed, and the school had actually asked for her to get a letter from the GP to explain why she was able to be excused from her classes, um, because of her heavy and painful menstrual cycle, which infuriated me because, you know, this is a natural, normal, healthy physiological process for women, um, and, and it was 100% stigmatized by that school in that moment, and, and embarrassed that, that child, uh, she was a child, you know, she was sort of 14 years old, and, um, embarrassed her for the fact that she has to hand a letter to her teachers. Um, so then I basically said, "Well, uh, fine, here's a letter, but I'm going to, um, extend my scope of, of that letter and say that, hmm, teachers are not to be asking her what she's leaving the classroom for." So for all I know, she thinks she can, she can go out whenever she wants now, um, but the point is-

    22. CW

      (laughs) She's got the free hall pass, yeah, exactly.

    23. MG

      Yeah, because, but the point is, and, and, and also the school can pick up the phone and speak to me if they want to talk about anything else because just a, a, a child, a 14-year-old should not be made to feel like that. And, um, and, and just, there are things that I feel just really strongly about. Like you have to fight these people's corner because people will say, "Oh no, that's normal, you need to say..." And actually, no it's not. You shouldn't be stigmatizing something that is a healthy process, um, a normal physiological process in, in women, and making this young girl feel uncomfortable, um, uh, and make her feel potentially more uncomfortable about talking about it with-

    24. CW

      Fucking hell, yeah. Don't make it-

    25. MG

      ... other professionals in the future.

    26. CW

      ... any harder. Well, this is, um, we, we spoke recently on this show to do with the peak-end rule. Have you heard about this?

    27. MG

      No.

    28. CW

      Okay.

    29. MG

      Just, just educate me.

    30. CW

      This might be interesting,

  24. 50:31 – 54:29

    pecan rule

    1. CW

      this might be interesting for you as someone who has to deal with a high volume of patients and-

    2. MG

      Yeah.

    3. CW

      ... you, you don't want to cause problems. The peak-end rule is a psychological bias that suggests our memory applies a higher weight to the most intense and the end of any experience. So let's say-

    4. MG

      Mm-hmm.

    5. CW

      ... that you're going on a roller coaster, you will remember the most scary bit, and the last bit. And the original study was conducted during endoscopies, and what they found was that they could actually extend the length of time that someone was, uh, undergoing the surgery and bring their level of discomfort down at the end, and the rate of perceived discomfort retrospectively ended up being significantly lower, even though by every objective measure, that actually left it in for longer than it needed to be.

    6. MG

      Yeah.

    7. CW

      Um, and I wonder, wh- when I was thinking about that, there, there was this quote where they said, "One of the most, uh, compassionate things that you can do for a young child, your young child, that's going to a doctor's or a dentist's or whatever, if they're going to have something that's going to make them feel uncomfortable, is to do that, is to almost extend it, uh, and, and dampen down the discomfort toward the end."

    8. MG

      Yeah.

    9. CW

      "Because over time, that compounding effect," that, that girl now, you could, you hit the nail on the head, could be terrified of talking to anybody in authority about anything to do with-

    10. MG

      Mm-hmm.

    11. CW

      ... her body for the rest of life, or, you know, the, uh, a three-year-old that needs to have a complicated, uh, dentist operation-

    12. MG

      Yeah.

    13. CW

      ... and it goes a bit, it's kind of a bit painful and whatever, and that's it, rest of your life, te- terrified of the dentist. Big implications here.

    14. MG

      A- absolutely, and, and because of that, I think that, you know, you strip the medicine out of it, you know, being a GP or being in healthcare in general, you have a huge responsibility because every, every patient contact you have, particularly with children, you are setting the tone. You're, you're, you're, y- y- you know, you're setting a, a bar at which their experience is of seeing a doctor or a healthcare professional. Uh, which is why when I see kids, it is as fun for me as it hopefully is for them. There are stickers, we talk about their favorite, um, toys or what sports they like, um, and, and often, they don't really even realize that they're being examined or that we've done a consultation. Um, and, and in the same measure, whenever someone comes with a parent, you talk to the, you talk to the child first. Like it's, you don't talk to the parent, and I, and that's really, really important because they need to realize that you are my focus, um, it's about you. So I'll be like, "Mum and Dad, just sit tight for a second, I want to hear from, I want to hear-

    15. CW

      Little Susie or whatever.

    16. MG

      ... from, from little Susie." Um, and then I'll chat to her, and then at the end I'll go, "Susie, do you mind if I ask your mum and dad some questions as well?" And, you know, more often than not they'll say, "Yeah, fine." Because it has to be about them, and then, and then they enjoy it, and one of the, you know, most rewarding thing about, about my experiences working in a, in an inner-city GP is that, um, I'll get kids come back and want to see me. Or even it's a sister of a little boy that I saw, but the little boy wanted to come with the sister because they were coming back to see me-

    17. CW

      (laughs)

    18. MG

      ... and they wanted to have another sticker.

    19. CW

      Such a trip-

    20. MG

      Which is great.

    21. CW

      ... such a trip to go and see Dr. Skittle. Yeah, that's cool, man.

    22. MG

      Yeah. Which is, which is really nice. And actually, you know, whatever all the shit that happens, it, it's stuff like that which is really heartwarming and it just makes me love, love the job. And I spoke to a patient the other day who was having a real change of life direction, had got through some, uh, quite difficult mental health issues, and he was like, "Just to say thanks, like, you totally changed my life." And it's not about changing people's lives, and it's, it's, uh, uh, it's 9:00 to do that, but my God, it was really nice to hear that actually you'd had that kind of an impact......

  25. 54:29 – 1:02:17

    love your favourite content creators

    1. MG

      on someone.

    2. CW

      That's really lo- that's really lovely to hear. I, I tweeted something similar the other day that said, um, "If you love your favorite content creators, tell them that you enjoy their content, because a message means an awful lot more-"

    3. MG

      Yeah.

    4. CW

      "... than a play count." And it's the same for you. Like, just getting someone better, that is s- more than sufficient. That's why you say it over and over again in the book. You do it-

    5. MG

      Yeah.

    6. CW

      ... for that reason as a caregiver. But someone coming back to do that must really sort of drive that nail home.

    7. MG

      It does. It, it really does. And, um, uh, and that's, yeah, I mean, I love it. I'm mean, that's, it's... You don't go looking for it and you don't sort of go to w- I certainly don't go to work e- every day exp- expecting to see it, um, or hear it. But when, when it comes along, it's, it's lovely.

    8. CW

      Pretty special.

    9. MG

      Yeah, yeah.

    10. CW

      What do you wish that Dr. Skittle from five years ago knew that you know now with regards to work? Or if you've got some, some junior doctors perhaps, ones that are just about to graduate or ones that are on locum and about to go into... What are the, what are some of the things, uh, that they should know or that you wish you'd known?

    11. MG

      Well, that's a tough question. Um, let me just think about that for a second. What would I, what would I want to tell somebody?

    12. CW

      Just what are your-

    13. MG

      Um-

    14. CW

      Yeah, if, if you were pre-

    15. MG

      That, that it, that it, that it gets, that it gets easier in many respects, that the, the, the sort of, um, the conscious processes that you go through as a doctor get more automated. And, uh, when I see a patient now I don't think, "Right, what is their presenting complaint? Right, what's their past medical history? Right, what's their drug history? Right, what's their social history?" It just comes out in a conversation, and I think that's what I would say from a professional perspective. From a personal perspective, I would say always look after your own wellbeing as well, because you can burn out very easily as a doctor if you... or, or a nurse, or any healthcare professional, if you, um, if you just don't eat, don't drink, don't sleep-

    16. CW

      (laughs)

    17. MG

      ... don't look after yourself in some w- in some way. Um, um, uh, don't look after yourself in some way, because if you do that, you're then no good to the patient. You need, you need a healt- t- you know, be blunt, being really blunt, you need a healthy GP. If you get, you pick a per- a burnt out, exhausted, just emotionally shattered shell of a, a man or a woman-

    18. CW

      (laughs)

    19. MG

      ... they are not gonna wanna help you at 6:30 on a Friday if you're the umpteenth patient they've seen and that is their, that's their capacity. You need someone who, um, is, is just ready to keep going, feels fresh, and that's, that's why it's so, that's why it's so important. And also, partly, and I really feel like I should explain this, why we don't work five days a week in clinics. You know, I don't, I don't work Monday to Friday, um, seeing patients every single day. I, there's one day where I do something differently. Um, and that's because emotionally, you can't handle that burden, um, and you would really burn out quite quickly.

    20. CW

      I found that so interesting. The, the sort of parting insight that I'd love to get from you is how doctors deal with the emotional distress and the trauma associated with the job, because you get taught all of the things that you need to do, but from, again, speaking to a ton of buddies that have been through, uh, med school, it doesn't seem like there's a massive amount of explanation on how to deal with being unable to save a patient's life that you really cared about, or hearing a sad story about a family member who doesn't want to come in, or any of that stuff. What are some of the ways that you f- found are, are effective for, for getting through that?

    21. MG

      So, so, I mean, for me, I've, I've always found that I've been able to manage, um, those things quite well. Um, but I think what really helps is, um, uh, the things that help all of us. You know, it's exercising, it's trying to, uh, eat well, and talking to your friends about these things, or talking to your loved ones, um, uh, and just decompressing. Writing a book. I don't know. You know, y- yeah-

    22. CW

      (laughs)

    23. MG

      ... you, you've just got to find ways to get through it. And, but people will deal with it very differently. You know, a- and general practice is an interesting one, because you get, you get characters, uh, in your GPS who are incredibly soft and softly spoken, to very brash and brutish, um, and, and everything in between. And I think that, uh, uh, there's no big lessons. It's just about this knowing-doing gap. You know, we, I think we're all intelligent. We all know what we should be doing. We all know what helps someone de-stress and, and process, um, work stresses. It doesn't have to be just be in general practice or healthcare. You know, um, and it's about recognizing what you know you should be doing and actually doing it. Um, I think sometimes that's the gap. So for example, for me at the moment, I know I haven't exercised for about four weeks-

    24. CW

      (laughs)

    25. MG

      ... and I absolutely know that I should be doing it. But my God, Chris, I cannot drag myself out for that first run. Um-

    26. CW

      Gyms are open soon. Don't worry, Max. Gyms are open in a couple of weeks' time.

    27. MG

      Yeah, that's true. That's true.

    28. CW

      We don't k- we don't know how long for.

    29. MG

      (laughs)

    30. CW

      Uh, so we've got, there's some really cool takeaways here. I love the idea of turning up on time, dressing appropriately and, and not, not letting everything build up hopefully will have helped a bunch of doctors and potential med students as well. You know, I didn't get round to this, but another tip would be don't come in and show me a photo of your asshole.

Episode duration: 1:02:18

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