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At the heart of general practice since 1960

Columnist of the Year: Phil Peverley

Now that has got to hurt

My patient stood up and dropped his trousers and, before my very eyes, my registrar's face went grey. It was a seminal moment of cultures clashing. The appalled disbelief in the air was palpable, and a significant amount of it was emanating from me.

My registrar, only a few weeks out from India, was sitting in with me as an observer to see how British GPs deal with our daily workload. She was struggling to come to terms with what we in this country see as primary care. Frankly, a lot of it looks very odd, seen from outside.

My patient had a problem with a piercing. 'I've had this done, doc,' he told me airily, 'and I don't think it's quite right.' He lowered his kecks and showed us his penis. He had had a metal bar inserted though the glans, sideways. It was like a miniature version of those comedy dumbbells that circus strongmen use in cartoons; two spherical metal balls on either end of a metal bar. Pus dripped from both ends of it. His glans was swollen and purple and quite, quite obscene.

I was silent for a few seconds, not from choice, and eventually I was able to ask him 'Why on earth have you done this to yourself?' I'll give him this; he had no shame at all. 'Well you know how it is, doc. The ladies like it.'

To be honest, I don't know how it is. Thinking back to my carefree youth as a junior doctor, I never met the kind of ladies who expressed a preference for the internal insertion of what was essentially a key ring. We used to make do with what nature had given us, in those days.

'Take it out,' I told him. 'Take it out now, or the whole thing might well drop off.' He was highly offended. 'Not a chance! This cost me 35 quid!' He eventually left with a script for flucloxacillin. I turned to my registrar apologetically. I had no idea how to explain it.

Last year, a patient of mine, a student at Sunderland 'University', made an attempt to get into the Guinness Book Of Records by having the most number of bodily piercing done in a single day. A Sunday newspaper sponsored him to have 250 metal bars inserted into his body in a single session. He approached me to have a medical examination and a certificate to show he was fit for the procedure.

I couldn't do it. No one is fit for this type of self-abuse, there can be no justification for self-hatred on this level. I told him to take a walk. Unfortunately, he was able to find another GP in the city who was prepared to certify his mental stability and the pillock subsequently appeared, skewered grotesquely, across several feature pages. If this moron had ended up in hospital with septicaemia, how much of the responsibility would rub off on his accomplices? There is a limit to the problems general practice might be expected to cover. These two gentlemen exceeded it. At what point, if ever, should we be allowed to say to some damned fool: 'Sod off. You're on your own'?

Dr Phil Peverley is a GP in Sunderland ­ he was named Columnist of the Year at the prestigious PPA Awards 2006

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