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At the heart of general practice since 1960

Dinah wonders what's happened to our sense of adventure

Tuesday

Practice manager meeting: reviewing various insurance policies. Buildings, contents, public liability. Something in case the autoclave blows up (don't like the sound of that). So what are we paying all this money for, can we get it cheaper, or maybe with travel insurance thrown in free? PM says stop complaining – it's so you don't have to pay even more if they claim. Sign here and shut up. Oh, all right. Anyway, where's my coffee, what about the risk of letting my caffeine levels drop? I am politely ignored.

Go and see patients instead. Listen to a 70-year-old old describe her latest operation. She has seen six orthopods (four privately); five have refused to do surgery as it's not indicated (they say). She disagrees, and has finally found one willing to 'take a risk'; apparently her insurance company is paying. He just needs a referral letter from me. Seems strange to bother with such formalities at this stage. Is my opinion going to change anything (no); is knowledge of her past history going to add anything (unlikely); is a discussion of risk and benefit going to contribute? No. I nevertheless pen a detailed account of her ills and recommend leaving well alone: it was the best I could do for her.

Wednesday

PCT meeting but leave early – 30-mile dash to tertiary centre to see neurosurgeon. Good news, I say – neck is improving and shoulder pain is probably just minor OA. Oh, he says, would you like me to refer you to an orthopod? After recovering from a moment of stunned silence I laugh hysterically, assuming it's a joke, but he means it and smiles so helpfully. My GP would never forgive me – just think of the bill! Take the physio instead and leave as quickly as possible before he thinks of anyone else to refer me to. Did he notice my bald patch? Even now he could be dictating a letter to the dermatologists.

What about my water bottle? Obviously thirsty – query diabetes. And I did leave a little breathlessly – I can just hear the appointment cards falling through the letterbox: respiratory function, echo, exercise test. Home to a big G&T (thank goodness he doesn't know).

Friday

Quiet afternoon sorting out business cases for PBC. They all need risk assessments – detailed documents about 'assurance', 'controls on assurance'... how can anyone do anything new in this world of bureaucracy and anxiety? What happened to Murphy's law? Never mind innovation, the entrepreneurial spirit, free enterprise?

Go on, live a little. I dare you.

Dinah Roy is a GP in Spennymoor, chair of Sedgefield PBC group and co-PEC chair of County Durham PCT

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