This site is intended for health professionals only

At the heart of general practice since 1960

Come on in, the gate’s open

No wonder the referral rate is going up, when opticians want a specialist opinion at the first sign of an ingrowing eyelash, says Copperfield

No wonder the referral rate is going up, when opticians want a specialist opinion at the first sign of an ingrowing eyelash, says Copperfield



Although I do bang on about general practice being a steaming pile of poo, there are bits I quite enjoy, providing, of course, the voltage is turned up high enough and the electrodes are making adequate contact with my genitals. And one of those enjoyable bits involves protecting patients from hospital – dangerous places, hospitals – and protecting hospitals from patients – dangerous people, patients.

In other words, I'm the gatekeeper, and that's fab. It brings out my inner Gandalf, making me feel all wizardy, wise and wonderful.

And it evokes images of me singlehandedly fending off hordes of orcs hell-bent on busting through my precious gate to the promised land of secondary care. All I have to defend myself is my clinical knowledge, plus maybe a club and some swear words, which is exactly what general practice is like.

Hang on. Did I just say, I am the gatekeeper? Sorry, that's a typo. What I meant was, I used to be the gatekeeper. I'm not any more. Nor are you. Not when we receive discharge letters stating: ‘Admitted with cardiac failure, also found to have renal impairment, hearing loss and cacky-bird-legs – please refer to nephrology, ENT and falls clinic.'

Or self-important notes from jumped-up physios with phrases like ‘facet-joint syndrome', ‘short-wave interferential' and, most irritatingly of all, ‘this man needs an MRI of his lumbar spine – please arrange'.

Or an A&E note reporting: ‘Twenty-eight-year-old with unilateral numbness of arm and lip followed by a headache, needs urgent referral to TIA clinic, please oblige.' Which obviously begs the response: ‘Fuckwit case officer with acute knowledge deficiency, requires urgent attendance at lecture on migraine with aura – please oblige or start stacking shelves.'

But this one really took the HobNob, and I promise I'm not making it up – a letter from an optician stating: ‘Patient has ingrowing eyelash causing irritation, please refer to ophthalmology (routine).'

Once I had stopped laughing, I started swearing. And then I picked up the phone.

I shouted a few choice words, the gist of which were that the irritation the cornea felt was nothing compared to the irritation my brain was feeling because of her letter. And then, of course, she was so sweet and apologetic that I felt almost guilty to the point that I'm not sure she got the intended message, which was that she was a moron.

Anyway. Enough. Please stop, now, all of you. This relentless wave of inappropriate requests and dysfunctional demands really does wear us down. Quite apart from being a parade of pointlessness and inanity, it sends a powerful message – specifically, that the GP role is viewed with utter contempt.

Gatekeeper? Penpusher, more like. And we're not even pushing pens on behalf of ourselves but at the whim of all-comers. We're like some passive bimbo secretary perched on the knee of a boss-monster who makes all the demands but takes none of the responsibility.

In other words, the gate is wide open. No wonder the referral rate is going up. Through you go, everyone – you'll get what you deserve. As for me, I'll shift those electrodes to my cranium and turn the dial up to max.

'Sick Notes' by Dr Tony Copperfield is out now, available from Monday Books.

Click here for more from Copperfield Copperfield

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say