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Gold, incentives and meh

Mr Angry has infected all my patients

Dinah's waiting room is a breeding ground for discontent

Dinah's waiting room is a breeding ground for discontent


Late for surgery: twisted neck over weekend strapping bikes onto car. Limp sadly, wanting sympathy, but hear shouting in waiting room so hide in kitchen. Practice Manager finds me, sends for bacon sandwich and efficiently warms wheat bag in microwave. Eventually settle before computer with heat pack and paracetamol.

An ‘extra' with anger management issues is booked who can't come any other time, hence the shouting – but which patient is it? Never mind, crack on. First patient excited about waiting room row, can discuss nothing else but at least it's improved his depression.

Next man accosted whilst waiting by rape victim with OCD (‘there's a mad woman out there who washes with bleach, that's disgusting!'). Surgery wears on, an apparently endless stream of disgruntled patients each complaining about the others waiting outside plus me running later and later.

Mental note: need shorter consultations with good gaps in between to avoid them all meeting up like this. With supreme diplomacy I maintain peace and also, miraculously, confidentiality.

Eventually Mrs E, 74-years with knee and back pain, complains bitterly about the next man. ‘What's wrong with him? He says everyone over 70 should get the needle! I hit him with my stick'. Oh dear, suggest anger management but she gets crosser and says no, it's pain management she needs. Feeling intimidated, dictate pain clinic referral.

Then it's Mr Angry himself who's been smoking cannabis (for back pain) since his teens (correction – he stopped once for half an hour). I don't think he's ready for Community Addictions but try some motivational interviewing which takes him by surprise and he decides to come back for more next week. We'll see.

Lie on couch for a rest, wake up with stiff neck to cold bacon sandwich. Home for hot bath and early night.


PBC Meeting – musculoskeletal review. We want patient self-referral to physio telephone triage, that'll keep them out of the waiting room. Plus primary care pain management with TENS, acupuncture and nerve blocks. Ok, we'll have joint injections if you like. But who'll do the carpal tunnels? Better talk to Orthopods.

Feeling much less stiff and almost cheerful drive to Newcastle for PCT meeting. Pass The Angel of the North. (Hmm. Nice buttocks) Drive back feeling considerably less cheerful after 2 hours of theory on 18 Week Pathway, Choose and Book and orthopaedic waiting lists, littered with statements such as ‘we have an opportunity' (meaning ‘you have a problem'?)…

Feel strangely sympathetic with Mr Angry.


Surgery. Neck hurting.

Mrs E again, beaming: ‘the Nurse gave me a tenner, marvellous!'

Oh? A treatment modality we've missed from the pathway? (Cheaper than an outpatient referral) but she means TENS. (Damn, too good to be true) ‘Yes – and I've given that chap a good talking to, he won't bother you again'.

Poor Mr Angry, next, meekly requests machine. How can I refuse? Better try one myself..

Drive home with heat pack and TENS. Not a patch on Chardonnay.


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