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Demands with menaces

If a sick note is what it takes to get this belligerent patient out of Copperfield's surgery, then a sick note she shall have

If a sick note is what it takes to get this belligerent patient out of Copperfield's surgery, then a sick note she shall have

I know I shouldn't stereotype. But there was something about her tattooed arms, her 40-fags-a-day face and her 'cure me if you can' expression that screamed Entitled Demander (ED). And I wasn't disappointed.

Even without those visual cues, I'd have got the drift pretty quickly. Because EDs - whatever their smoking habit, tattoo count or level of belligerence - always give the game away. It's their language. Not the effing and blinding, though that goes with the territory. No, it's those stock, hackneyed phrases they always use that drive me nuts.

'I saw Dr X last month and she didn't do nothing.' Here we go. 'She's bloody useless - she should be struck off.' There, immediately, are two characteristic traits of ED syntax. First, the double negative - when I rule the medical world, patients who use double negatives will no longer be entitled to NHS care. And second, the character assassination. Never mind Dr X's 30 years of exemplary service - get on the wrong side of an ED and a letter from the GMC is just a matter of time.

I patiently explain - though God knows why I bother - that it's wrong to say that Dr X didn't do nothing, and not just grammatically. In fact, Dr X had patiently explained that intractable social problems are not amenable to medical treatment, even if, to quote the patient, they are 'doing my head in'. I'm about to point out that first, she has no right to moan about Dr X, and second, she'll have every right to complain about me calling her a hatchet-faced old boot, which I'm just about to do.

But before I get a chance, she's on to Dr Y. 'I saw him last week. And he fobbed me off. He just wanted to pump me full of drugs.' There we go again. 'He fobbed me off' - pathognomonic of the ED. As is the phrase 'pump me full of drugs'. That said, I do share her reservations about her management plan. If she's going to be pumped full of anything, it should be lead.

I glance at the screen. Presumably in desperation, Dr Y had prescribed an SSRI.

I point out: 'Those are heavy-duty antidepressants - so Dr Y actually took your symptoms very seriously. On that basis, if you were treated for a life-threatening acute coronary syndrome, you'd complain that you'd been fobbed off with a bypass graft.' Her 'come and have a go if you're hard enough' expression hasn't shifted - she's terrorised one doctor who wouldn't prescribe and another who would, and she's dissatisfied with both.

But that's why she's here with me, Dr Z. What she wants - she explains in the tone of someone quite prepared to use deeply unpleasant violence in the face of a refusal - is a sick note. She doesn't actually have a job, of course, but it's all to do with benefits, yada yada yada. Of course - the patient's agenda. How remiss of Drs X, Y and Z.

It can be no coincidence that Entitled Demanders share their abbreviation with the one for erectile dysfunction. Because these patients, with their stroppy wars of attrition, end up making us feel impotent. Which is probably why I hand over the sick note. That, and the fact I just want her to fob off.


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