Posted by: Tony Copperfield29 August 2012
Nails down blackboard. Drill against molar. Polystyrene edges scraped together. Excellent, I’ve got you in the mood.
So, in the ‘teeth on edge’ stakes, here’s what does it for me: the patient walks in, she gives a rueful smile and she says: ‘You’re going to tell me off.’
That pause is because I just had to go and hit a pillow.
The GMC doesn’t have a problem with that, but it does with me smashing the patient in the face with a plank, which is the alternative.
I know – get over it, Copperfield.
I’m now at a stage in my career when those stock opening gambits – ‘I’ve got a list’, ‘I don’t know where to start’, ‘I want a brain scan’ etcetera – should be less red rag to a bull and more gauntlet thrown down in battle. With only one possible winner: me.
And, to be honest, I enjoy these fights – at my age, you have to take your pleasure where and when you can.
But, ‘You’re going to tell me off.’
Yep, that still does my head in.
Why the wind-up? Perhaps because, compared with the other hackneyed
clichés, it’s rare, so I’ve yet to build up an immunity.
Or maybe because it never features in the regular GP-only forum threads discussing ‘opening gambits which make me head-butt a wall’, leaving me wondering whether it’s just me being idiosyncratic or even a bit mad. Or maybe it’s because the phrase is simply overloaded with meaning.
Because it is. Let’s analyse it. ‘You’re going to tell me off,’ says something about the patient and the patient’s perception of the doctor.
a) The patient: she’s painting herself out as a self-sufficient, uncomplaining stoic who has soldiered on with what she’s trying to convince me could be serious pathology that she’s ‘delayed’ presenting.
‘You’re going to tell me off, doctor,’ she’ll say, with a long-suffering sigh.
‘I’ve had this back ache for a whole week. But you know me, I don’t bother you for nothing.’
Yes, I know you, and I know that what you’re doing is using amateur reverse psychology to over-compensate for having the patience and pain tolerance of a two-
b) The patient’s perception of the doctor: she thinks I care. Enough, that is, to reprimand her for a delayed presentation.
I don’t: it would have to be rather more than backache and rather more than a week to have me expressing shock at a delayed presentation.
And even with, say, a neglected tumour, I might raise an eyebrow, but I wouldn’t tell someone off – people have the right to ignore illness without me rubbing salt in the fungating wound by making them feel stupid or guilty.
So: self-justification, self-aggrandisement, feigned self-sacrifice, false assumptions and manipulation. That’s pretty impressive for six words.
Harsh, perhaps, but remember – this is Pavlovian. I’m positively drooling with irritation. Besides, some good may come of the catharsis.
Because any patients reading might realise that it’s best to leave the melodrama at the door.
‘You’re going to tell me off’? Possibly, but not in the way you think.
Where’s that plank?
Dr Tony Copperfield is a GP in Essex. You can email him at firstname.lastname@example.org