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Gold, incentives and meh

Choose and Book syndrome found

Please find below a description of a new illness I have been seeing with increasing frequency. I have alerted my colleagues in Gloucestershire, some of whom suggested that all GPs should be informed.

'Choose and Book syndrome' is now well documented.The patients affected are usually over 60 and display classical, easily-recognised features.

At first the consultation seems to progress in the normal way with the pithy exchange of mixed fact and fiction. After various posturings, agreement is reached on referral for a specialist opinion. All seems eminently serene.

Then a malevolent force begins to pervade the atmosphere as the Choose and Book emblem glows from the desktop.

The GP, with the first signs that he or she is having an out-of-body experience, invites the patient to choose their desired destination.

Various symbolic phrases are introduced – UBRN numbers, booking centres, reference numbers, passwords, online advice.

It is at this point the characteristic patient feature – an utterly blank stare, akin only to acute late onset severe petit mal – appears.

This is followed by total aphasia lasting several seconds (the 'gobsmacked sign'). Management is now critical.

One wrong word and your reputation is history.

Fortunately there is an evidence-based treatment to resolve the crisis. Look the patient in the eye and state empathetically (but with utter conviction) that the local hospital will send him or her an appointment.

The patient, quickly recovering, thinks his or her mind has simply wandered for a few seconds and is none the wiser. Phew – a close call.

Quickly shred any printout, particularly the NHS-generated password, which, rather unnervingly is given as 'absolute bollocks'.

From Dr Jeremy Halliday, Gloucester

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