Dave, aged 58, has not worked for about 15 years — ever since the canning factory shut down. Somewhere along the line he has acquired sickness benefits or possibly disability living allowance — he is not sure.
In any case, he has not been in to surgery for at least five years, and our records are scanty at best. In these straitened times he has now been summoned to the Job Centre and has been sent a form to complete.
We don’t get off to that smooth a start.
‘I’m appealing against it,’ he says, anxiously, at least three times in the first couple of minutes, producing a card from a statutory advice agency. It takes a while to sort out what exactly he is appealing against. A decision that he is fit to work? A summons to an examination? A change in his benefit?
Finally, it appears that he might have been told by someone that he should be working, and that he is absolutely sure he cannot do so. He looks miserable.
‘It’s the pain.’
He has neck and some shoulder pain, and would find it very hard to do his former heavy work. I’m about to catechise him a bit about this, because you can be sure that the advice agency will be writing to me within the month, and I must have some clinical detail to give them.
But then he mentions abdominal pain and vomiting every single morning. And he is tremulous and red-eyed and florid, though thin, and has a blood pressure of 195/100.
Fortunately, at this point, I stop being a low-level benefits agency doctor focused solely on the question of whether he is fit to work, and start being a general practitioner. We discuss his very considerable alcohol intake, his poor diet since his wife walked out, and his smoking. I examine him, note early osteoarthritis in his hands and nicotine staining in his nails, and tip his liver.
I suggest that he might want to think about making some changes in his lifestyle but he asks me: ‘Why would I want to do that, doctor?’
‘For you,’ I say, ‘for your own health and your enjoyment of life.’
Dave is visibly nonplussed. It seems to be years since anyone has implied that he is worth bothering about or cherishing. He agrees to bloods this week and a review next week to assess his joints for the agency and — equally importantly — his general health and his mood.
I think the benefits squeeze is generally a bad thing. But just occasionally, as in Dave’s case, it can bring people who might be helped to the doctor.
Flora Tristan is an inner-city GP