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At the heart of general practice since 1960

Is now a good time, doctor?

Presenting too soon? Too late? Copperfield wonders if patients will ever time it just right

Presenting too soon? Too late? Copperfield wonders if patients will ever time it just right

'It's this cough, doctor. I've had it for two days now.' I adopt the expression I deem appropriate, and it's not one that would get me through the MRCGP. She clocks my incredulity and, in a moment of glorious misinterpretation, adopts a look of her own, meant to suggest foolhardy stoicism.

And she ices that cake with: 'I know what you're going to say, doctor - I should have come sooner.'

That is so not what I was going to say. In fact, I wasn't going to say anything. I was just going to continue looking amazed that a sentient adult should believe a two-day cough requires my attention. But now she's adopting the role of respiratory martyr, I think I will say something. And it'll probably involve the words 'pathetic' and 'timewaster'.

She's not alone, though. Countless times I've heard the 'I know I should have come sooner' line, and it's invariably wrong. Presumably, the threat that these consultations could somehow be even more premature is designed to make me feel grateful rather than abused.

Besides, extraordinarily, some really do come sooner. Such as the mum who presents her baby with the complaint of 'vomiting'. Fair enough. 'When did it start?' I ask. Without batting an eyelid, she replies: 'Just a moment ago.'

Because, just a moment ago, she had been booking an appointment for a smear when she had been startled by junior's out-of-the blue, out-of-the-stomach interruption. Hence the request for an instant appointment, instantly granted by a kind-hearted receptionist (note to self - sack her).

So who's to blame for these absurdly early presentations? The punters, obviously, for being feckless, angst-ridden cackheads. The media, too, for fostering the 'you can't be too careful' culture. And also us medics, for the traditional stern finger wag about ignoring symptoms and 'leaving things too late'.

Of course, the truth is that premature presentations potentially cause far more problems than those that are delayed. For example, if every child with one hour's fever was squeezed into our emergency clinics, the impossibility of precise diagnosis would mean either misguided reassurance or unnecessary intervention - except it wouldn't, because the appointment system would implode before we reached that point.

Unusually for me, I actually sympathise with the patients. Because after I'd berated coughing martyr lady for turning up with a symptom that didn't need a diagnosis, a treatment or an appointment, not until it had been going long enough to make some sense or cause some real distress, she made quite a good point. 'You wouldn't be saying that if I turned out to have TB,' she said.

'Then you'd moan that I'd been infecting others and should have come quicker.'

Quite. As a profession, we don't want patients to attend too soon, otherwise diagnosis is impossible. But we don't want them too late, either, because advanced illness is a bit of a bummer. So they're supposed to judge when they're just ill enough, as though they're a symptom soufflé to be removed from the oven at just the right time.

Which is a lot to ask. But that won't stop me moaning in the hope they'll get it - sooner or later.

Dr Tony Copperfield is a GP in Essex

Copperfield

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