Liam Farrell: There are many reasons why GPs prescribe

Bribes I can handle, flattery is always welcome (I need the validation). But threats? I'm a lover, not a fighter, and physical intimidation makes me queasy.

Hunters have a saying: 'Never get between a she-bear and her cubs.' We general practitioners also have a saying: 'Never get between an old woman and her tablets.'

I remember, as a junior doctor, admitting an elderly woman with drowsiness and confusion. She was on multiple medications, and the junior resident was scathing about lazy and incompetent GPs prescribing willy-nilly; it’s always comforting to have your prejudices confirmed.

There is a most expressive German word: 'verschlimmbessern', which means 'to make something worse by trying to improve it'. So with youthful innocence we stopped all her medications, and to our initial satisfaction she began to perk up.

Unfortunately, as she perked up and became coherent, we encountered the usual medical Catch-22 (there’s always one); with her coherence came also the realisation that we had stopped all her medications.

Being drug-free was not one of her goals in life, and over the next few weeks she remorselessly wore us down, day by day, tablet by tablet; firstly the hypnotic, then the anxiolytic, then an antidepressant, vitamins, calcium, aspirin, antihypertensive, etc etc.

By the time of discharge we were putty in her hands and had capitulated completely. She was back on all her original medications with a few more thrown just for show (and to make it look like we’d actually done something), and she staggered out of the ward confused again, but also content.

And plus ça change, plus c'est la même chose; I was trying to rationalise Maggie's particular cocktail, unaltered for millennia. 'You won't need these anymore,' I said, metaphorically reaching for the bottles on her overloaded shelf.

My wrist was caught in a vice-like grip. The great Terry Pratchett observed that whole economies have been built on the ability of elderly women to carry massive loads on their backs; they may look frail, but they're wiry. With my free hand (my other was going numb) I surreptitiously pressed the alarm button, then realised we hadn’t yet gotten round to having it connected up properly.

A prescription has many fathers, and physical intimidation is yet another one.

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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