Opening the floodgate

‘I’d like to be tested to find out my blood group’.

If general practice teaches you anything, it is to expect the unexpected and think on your feet. The only motivation behind such a request that I can think of is some kind of paternity question, and I proceed to probe with due sensitivity as to why my patient wishes to discover this information. After a few minutes I have failed to get beyond ‘I just want to know’, and am forced to leave it at that.

‘Then I advise you to become a blood donor. The donor centre will give you a certificate with your blood group on it.’

I instantly regret this rather impudent response. Have I infuriated my patient with my preachiness and reluctance to help? Thankfully not, but as the discussion proceeds it becomes clear that he has no interest in placing his erythrocytes at the disposal of the accident-prone. For the second time in five minutes I say something that makes me feel distinctly uncomfortable:
‘I’m sorry, but that’s not covered by the National Health Service’. He looks mildly disgruntled but moves on to a second request without any obvious chagrin, and we part amicably enough a few minutes later.

So was I right to stand in his way? It certainly would not have been difficult for me to complete a request form for blood grouping, though I probably would have had to falsify a reason for the test to be done. His curiosity would have been satisfied and the cost to the NHS would be undetectable, a fraction of a raindrop in a veritable ocean of public expense. However, aside from holding stronger than average views on the merits of blood donation, I also believe that there are some things that our publicly funded health system is simply not there to do, and one such thing is the provision to anyone who wants it of information about their body purely for their own interest.

Of course, sometimes information needs to be gathered to provide effective reassurance to the patient of something that his or her doctor is already sure about -i.e. that their current symptom or collection of symptoms does not represent any serious threat to their wellbeing, and I think that this is completely valid. So for example I have no qualms about arranging a thyroid function test for a patient who believes that their tiredness may be down to thyroid deficiency, even if there are none of the other clinical features that one would expect with this condition.  The only foreseeable benefit will be in helping me to convince them that their habit of trying to do too much on too little good-quality sleep is the true culprit.

So far, so clear-cut; to me at least. But there are other patients whose GP will assess them clinically and then say something along the lines of ‘I really don’t know what’s causing this ache but I can safely say that it’s nothing serious and there is every chance that it will have gone within a couple of weeks, please come back if it hasn’t’.

If pressed by such a patient, should the doctor stand by his or her convictions that there is nothing significantly amiss and decline any requests for prompt referral or tests? In theory, perhaps. In practice, hardly ever: someone who feels unwell will usually have a justifiable wish for some sort of diagnosis (however tentative) on which to hang their symptoms, and as a gatekeeper to the resources of the NHS I for one am loath to show them the ‘keep out’ sign.