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At the heart of general practice since 1960

A behavioural sign I can call my own

Copperfield has always yearned to be eponymous, and he wants to put his name to the phenomenon of patients reporting side-effects before you've even prescribed the drug

Copperfield has always yearned to be eponymous, and he wants to put his name to the phenomenon of patients reporting side-effects before you've even prescribed the drug



Let's get this straight. Yes, I do think that most published primary care research smells like something you might want to scrape off the bottom of your shoe – possibly because it's performed by bearded worthies seeking refuge from the day job, and printed in journals as enjoyable and invigorating as a general anaesthetic.

But I don't deny general practice is fertile territory for pushing the boundaries of scientific knowledge. It's the remote Amazonian jungle of medical research: dark, threatening and full of unexplored areas, but with fewer snakes now that we don't see drug reps anymore.

A hack through the undergrowth would reveal all sorts of fascinating, hitherto unrecorded facts. My personal expedition aims to discover a physical sign or psychological truth that I could claim as my own, because I've always fancied being eponymous.

That way, I won't just be remembered as a stroppy GP from Essex who swore a lot. Instead, future generations of doctors would gravely declare to patients complaining of, say, a shooting pain in the rectum: ‘You've got Copperfield's arse'. Except that Dr P Fugax has beaten me to it.

Anyway, the point is that I have a feeling my mission has already been successful. Because I really have made a discovery.

I kicked aside a rock and there it was.

A consistent, meaningful observation.

This is it. Whenever I prescribe patients some medication and start explaining the side-effects, they say: ‘Oh, I already get that.'

Don't believe me? Okay, listen. ‘Well, Mrs So-Stressed-You-Can't-Hack-It-Any-More, I'm going to prescribe you something for your tension headache. It's called amitriptyline and it may cause dizziness, a dry mouth and blurred vision.'

‘Oh, I get that already, doctor.'

See? With tricyclics, I assumed the punters were reflecting back the symptoms of their depression/anxiety: dizziness (hyperventilation), dry mouth (sympathetic overdrive) and blurred vision (beer goggles caused by self-medicating with Special Brew). But then I noticed the same with other drugs. ‘This amlodipine may give you ankle swelling, flushing and headache.'

‘I get that already, doctor.'

Ditto cough with an ACE inhibitor. Muscle aches with statins. Erectile dysfunction with ß-blockers. And so on.

Spouting garbage

I've even tested this hypothesis.

Thus: ‘Mr You've-Driven-Me-Bonkers-You-Fat-Polysymptomatic-Git, I'm going to prescribe you some pills for being such an arse-ache. These can have the side-effects of colouring your urine green, turning your scrotum inside out and giving you an irresistible urge to stick darts in your eyes.'

‘Oh, I get that already, doctor.'

If only.

So, patients reporting the side-effects of drugs before you've prescribed them: that's Copperfield's sign. And it's simply an indication that patients spout garbage.

It's not to be confused with another sign, which is the one I reflexly used behind the back of the man who refused to take my urine-colouring, scrotum-everting, eye-lancinating pills on the basis that nothing I prescribe ever does any good anyway.

It involved two fingers, but I've no idea what it means. More research required, obviously.

Oh, I get that already doctor

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