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At the heart of general practice since 1960

Maybe they’re not all cretins

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Having just received an unusually curt and critical outpatient letter from a consultant, I’ve been re-reading my original referral. And I have to admit that the contents are perplexing. Here it is:

‘Dear Doctor.

I wonder?

Yours, Dr C.’

That’s it. It seems that the rest of the letter, comprising crystal-clear background and incisive clinical questioning, has disappeared into some computing black hole. And though I’m mainly horrified, I’m also a little bit thrilled. Horrified because this is clearly useless on the part of NHS IT, but thrilled because maybe I could limit my previously detailed referral letters to brief but deeply existential questions such as ‘Do you think?’ and ‘Could it be?’

Anyway, I’m left feeling slightly humbled. Which is unusual, because we GPs are generally viewed as tending towards arrogance, though I think that’s simply because we’re better than everyone else. After all, we’re the final common pathway for all sorts of dysfunction, which can’t help but make us think that everyone out there – patients, hospital doctors, podiatrists and patients again – is just plain stupid.

Indeed, only this morning, I encountered the following:

• A woman who used up an entire appointment to tell me, incredulously, that, ‘The consultant has sent me your letter!’ Because, in her case, the ‘cc’ part of ‘cc patient’ means ‘complete cretin’ (or ‘completely confused’, if you’re kind, which I’m not).

• A discharge note on an elderly patient with unilateral leg swelling who’d been sent to hospital as a ‘query DVT’, concluding that his – I repeat – unilateral swelling was the result of amlodipine, which his GP should replace with an alternative. A drug with bilateral side-effects, presumably.

• A request from a podiatrist for a heel X-ray on a patient with plantar fasciitis, ‘in case he has a calcaneal spur’. That’s what these people do, isn’t it? They dream up something illogical that won’t alter the management, package up this thought-salad and expect us to swallow it.

• An out-of-hours report on a female patient who had called  with the complaint of ‘ongoing sexual frustration’, which I’m not making up, because how could I? I understand there are numbers you can ring for that type of thing, but not NHS 111.

So anyway, there I am, feeling annoyed and smug about how stupid everyone is. And that’s when I read Curt Consultant letter and realise that, at that very moment, he is shaking his annoyed head in disbelief at stupid GPs.

This means, tragically, that maybe those people who routinely create dysfunction – patients, hospital doctors, podiatrists, patients again – aren’t as stupid as I’ve always supposed. Maybe their apparent imbecility can be explained by an error – a mixed message, a computer slip, something lost in translation. Maybe I should cut them some slack. Maybe they’re even as intelligent and functional as GPs. I wonder?

Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com and follow him on Twitter @DocCopperfield.

Readers' comments (5)

  • LOL

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  • What a lovely referral letter, surely that is the root of our working day, we make educated assumptions about a patients disease process and it's management.

    We wonder.

    Sounds perfect!

    - anonymous salaried!

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  • I had a genuine 'I shall be grateful for your doing the needful' letter today - it omitted anything to include anything useful, like the past medical history (complex) and the current medication (many and varied)

    It did say that 'she is prim' ... not so sure about proper, but maybe he meant it was her first pregnancy.

    It's these little moments that make us smile

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  • Many many years ago, when I was a neurology registrar, I received a similar letter from a GP. It was one of the old blue letter forms and had applied a rubber stamped message 'please see and advise' as the only clinical information.
    I was rather irritated when my reply, ' I have seen and have no advice' elicited a complaint from the GP in question - at least it was short (under a side of A4, unlike most neurology letters) and absolutely to the point.
    I wonder if TC would have approved?

    Semi-retired GP

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  • As a trainee in the Highlands many years ago I attended an ophthalmology lecture - the consultant having the same surname as me. His first slide was an example of a referral letter received from a GP who happened to be my uncle. The letter read 'MacRae, please see this lady who can't. MacRae'

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder