What's up, Doc?: Wit, wisdom and the medical profession

Leaving home and growing up involves all sorts of tiresome responsibilities, but one of the biggest steps into the adult (ie, post-student) world is acquiring a physician of one's own, and negotiating the health hurdles of the metropolis is no easy process. I remain equivocal on the subject of health reforms. Past experience with the NHS in London has left me with a definite taste for radical bureaucratic surgery, but my recent exposure to matters medical does not entirely reassure me.

However, at least you can change your doctor nowadays without being the subject of a physican's inquisition. I recently made use of the facility. The reason? Well, my former GP functioned from a waiting room which could be likened to the visiting room at Holloway. Bare wooden benches straight out of The Elephant Man, cream-painted walls and a few prophy-lactic posters hanging by a single drawing pin. Here you would report at 10.30am to the nurse, who'd take your name and bid you sit and wait.

And wait. Having exhausted the dog-eared copies of The People's Friend, I'd turn to the diversions of my fellow patients: women with pushchairs and bored infants with perpetually running noses; elderly men with requests for repeat prescriptions; one or two workers looking with increasing impatience at the surgery clock, remorselessly ticking away their time off. The miasma of malady and air of hopelessness was enough to induce clinical depression in the most optimistic of customers.

Eventually our physician would arrive - a minimum of 15 minutes late - blustering into his annex office, trying to avoid eye contact with his patients (an apt appellation if ever there was one). The rumour was that he was also a qualified lawyer, and was moonlighting in that profession. Unlikely as this seemed to me, I none the less decided I'd had enough of it all, and changed doctors.

My new man is entirely satisfactory, I must admit, though not a little eccentric. Worried about the itchy white spot which has appeared on my side, I went for a consultation. The greying, patrician Indian inquired - almost before I got in the door - 'Any serious illnesses?' as if they were on special offer that week.

It was decided that the spot was a recurrence of a minor but obscure skin complaint for which I was operated on ten years ago. The doctor pulled out my notes from Barts, and read the diagnosis: lymphangioma circumscripta. He said it over to himself, rolling the words around in his mouth, savouring the strangeness of the syllables. Meanwhile he wrote out a referral letter for Barts. 'Deliver it by hand, don't post it,' he told me, 'they'll only chuck it in the bin if you do'.

Expressing my surprise at this lack of confidence in his fellow professionals, I asked him why. 'It's because it's closing down. All the doctors are running away. You'd better start making some money out of your books.'

This whimsical attitude seems endemic amongst the profession. Is there something about medical training that induces this propensity for quirkiness, a mixture of nonchalant disregard and dry wit? Sometimes it borders on apparent unconcern, the product of institutional habitude - now held up as a target for Tory reform.

The night before my original operation, I recall, friends came in to celebrate the fact that I was going under the knife. We drank wine out in the corridor, a veritable impromptu party.

Nurses bustled by as if it were the most natural thing in the world that a bunch of punkishly dressed young people should be boozing and smoking in the confines of a medical establishment (they probably thought we were medical students). Our revelry was dampened, however, by the appearance of a woman in a wheelchair coming out for a fag. She was missing one leg, and was about to have the other removed the next day. 'They've told me to stop,' she said, gaily waving her cigarette, 'but what's the point now?' I gave up smoking soon afterwards.

After my op, I lay in bed in some degree of discomfort. I'd been told previously that I would be able to leave that day, but by mid-morning nothing had happened. I asked the nurse when I might be allowed to leave. 'Oh, you can go any time,' she said casually.

Hobbling down to the street, to try to hail a taxi in the middle of Smithfield, I wondered how long I might have been left lying there. I had fantasies of whole hospital wards full of patients who ought to have left years ago, but rather liked it. Of course, nowadays you're turfed out of the sheets practically as soon as the surgeon has scrubbed up.

I will hear nothing said against dear old Barts, however, and much regret the imminent closure of its Accident and Emergency department.

Subsequent visits to the place have included 3am emergency stitches on a friend's blood-spouting forehead (he'd tried to break my door down after I'd locked myself out). We then discovered how convenient the A&E is for dedicated hedonists: the pubs of Smithfield open in the early hours of the morning, thereby enabling us to continue our drinking.

Anyway, my new appointment came along in due course, and I was summoned once again to that ancient hospital. Climbing a wide and richly worn wooden staircase to the skin department, I was seen almost immediately by the consultant. This was a vast improvement on previous visits, entailing great longeurs of Country Life perusal.

Further evidence of Mrs Bottomley's improvements, or merely proof of my GP's remark about the desertion of the sinking ship? I'm not convinced, but my consultant was a terribly nice young man who diagnosed another arcane, but thankfully innocuous condition, lichen sclerosis. 'Should make you feel more at home with your plants,' quipped one of my so-called witty friends.

(Photograph omitted)