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Hello Mrs Heartsink

In his second column, our registrar diarist Geoff Tipper offers advice on how to manage frequent-flier patients

In his second column, our registrar diarist Geoff Tipper offers advice on how to manage frequent-flier patients

Ah, come in Mrs Smith – good to see you again. No, you're right, once a week is simply not enough. What's that? You've been coughing for two days and you want to be checked out to see if it's anything serious? Well, thank goodness you've come to me. I haven't seen a case of the plague this bad in years.

Heartsinks and frequent fliers. How does one deal with them? How do you deal with them? You can get back to me at this address, I'd love to know. In the meantime, here are some of my previous methods and reasons for failure:

1) Oversolicitousness: On bended knee take the patient's hand in yours, maintain steady eye contact, and intone: 'I'm so pleased you've come to see me about this. I've been very concerned about you.' Repercussions: A delighted patient prone to making individual appointments for each of their 47 moles. Christmas card list for life.

2) Brusqueness: State in no uncertain terms: 'You'll live' while writing 'time waster' in large letters on their file. Then return to your coffee/sudoku/doing your nails as appropriate. Repercussions: Tendency of patient to (quite rightly) complain to the GMC.

3) Feign death: Insert previously prepared frothing salts into mouth, clutch the desk, then headbutt the keyboard with a dying gurgle causing the printer to spit out enough repeat prescriptions for 10 years. Repercussions: Patient likely to sneak back in and make another appointment when the emergency services leave.

4) Pull the fire alarm: Self-explanatory. Repercussions: As point 3.

5) Combined therapy: Put yourself in their place and explore their health beliefs. No – don't stop reading. I mean it. I vividly recall going to the GP as a medical student. It was the second consultation of my life. I had laryngitis. I had been the butt of jokes for a week and I was miserable. The GP very pleasantly told me that there was little to be done – get over it. Devastated is probably too strong a word, but I was severely disappointed.

The predominant view in western society is that we are incapable of looking after ourselves and we need doctors to sort us out. Fortunately this keeps us in jobs. Unfortunately it leads to a lot of 'Mrs Smiths'.

I received a pep talk from the senior partner similar to the above prior to telephoning a patient at her request for the second time in as many hours. I tried it out and you know what? It worked.

Geoff Tipper is a GP registrar in Maidenhead, Berkshire

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