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My formula for handling the heartsink with 101 problems

A record set of symptoms in one patient prompts Copperfield to express his agony through a universal formula

A record set of symptoms in one patient prompts Copperfield to express his agony through a universal formula

This week, I'm indebted to Heartsink CHJ/2001/LHC/48X. She presents with an interesting opening gambit. This is it, verbatim: ‘Doctor, I've got 101 problems for you.'

I'm a man who knows the pain of ‘I've brought a cutting from the Daily Mail' and the despair of ‘what the breakfast TV doctor said'. Yet I still reckon ‘I've got 101 problems for you' wins the prize for the most ominous opening line in the history of general practice, ever.

But I like a challenge. So I calculate how much time I can allocate to each problem. As she gets into her stride (‘Urinary incontinence, sore nipples, ingrowing toenail...'), I figure out I have 5.94 seconds per item (‘… piles, headaches, hair loss...'). Except that the calculation took a short while, so the available time is immediately reduced to 5.84 seconds (‘… tremor, cold hands, breathlessness…').

Idly, I work out the general formula for this scenario: T (in secs) = 660-N over X where T is the time available per list item, 660 is the number of seconds in the average consultation, X is the number of items on the list and N is the delay caused by your shocked pause plus the time taken to do the maths (‘… belching, rumbling, itchy bottom, vomiting…').

Then it occurs to me that there must also be a universal equation to calculate the agony caused by any consultation, (‘… swollen ankles, gout…'), expressed in the International Unit of Anguish (the Aaaargh!). Space doesn't allow me to publish the full proof (‘… blurred vision, dizziness, sore tongue, a funny smell, a rash, feeling anyhow, a brass band playing in my ear…'). But it's final form is:

A=P(LxVx1,000/T)+F+M+H, where A is anguish in Aaaarghs!, P is the number of annoying things the patient says (while I'm here, I don't know where to start, there's just one more thing, and so on), L is how late you're running, V is the number of visits allocated to you that day, T is the previously calculated time available per item, F and M are constants of 100 Aaaarghs! each, added if it's Monday morning or Friday evening, and H is the number of days since your last holiday (‘… palpitations, loss of sex drive, toothache, flushing…').

In which case, my easiest consultation ever (a pill check on a Wednesday, first patient on first day back from holiday) involved only one Aaaargh! of anguish.

And this one (‘… pins and needles, foot pain, weight gain, blocked nose…') has already racked up 20,738.

I haven't just derived this formula for fun – it has all sorts of applications (‘… blurred vision…'). It could be incorporated into the QOF (‘… dry skin, scabby mole…'). It could be used to give doctors a mandatory rest after a certain number of Mega Aaaarghs! Or it could trigger a punishment for patients who push it just too far (‘… hives, trembling inside, oily urine…')

My body language – maybe the way I'm holding the gun – tells her that time's up. ‘But I've only done 36 of them,' she protests. ‘I haven't mentioned that searing pain in my heart.' Oh, that one I can explain, I say, pulling the trigger. Then I draw a line through CHJ/2001/LHC/48X.


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