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No excusing all these PUNs

Fluffy types obsess over patients’ unmet needs, but Copperfield worries we provide too much

Fluffy types obsess over patients' unmet needs, but Copperfield worries we provide too much

I'm sure you're all familiar with PUNs and DENs. If not, don't worry, you've not missed much. PUNs are ‘patient's unmet needs' and DENs are ‘doctor's educational needs'. Knowledge holes, in other words, that any self-respecting professional would fill during a routine surgery. But acronym-loving, PDP-wielding fluff-heads view them as some sort of educational holy grail.

So they'll probably be interested to know that I've discovered something new: a PUM. As with a PUN, a PUM leads to a sort of DEN.

Let me explain. Recently, I discovered our health visitors are running a flat-head clinic. No, really. Apparently, instructing parents to slowly rotate their sleeping babies, rotisserie-style, helps resolve plagiocephaly. Or something like that. The point is, it is pointless. Plagiocephaly is harmless – besides, a weird-shaped head is nothing unusual in Basildon and, post-Jedward, is positively de rigeur.

So have the parents of flat-headed kids been clamouring for a flat-head clinic? No. It's fulfilling a need that wasn't there.

Here's another example. Our counselling service has been suffering such delusions of grandeur that it decided to open access to the general public. Yes, that's the same general public that has been trained, in recent years, to view any emotion short of drug-fuelled euphoria as pathological and therefore requiring ‘therapy'.

So the inevitable happened. The service has been overwhelmed, and doubtless all the counsellors will be off sick with work-related stress. Voila. Another example of senseless service overprovision.

I could go on, so I will. Take pharmacists, and those glorious medicine use reviews. ‘Dr Copperfield, your patient is taking a statin. I recommend an annual cholesterol check.' Thanks for the tip – I had planned to assess his cardiovascular status with a quarterly audiogram. Pharmacists should stick to what they're good at, like flogging placebos. But then they're paid for duplicating our work and making dumb-assed recommendations, so we can't blame them. And although people need MURs about as much as they need rounder heads, the fact they're on offer creates a stampede.

Then there's out-of-hours. The old moan used to be that it was hard to access out-of-hours care. Now it's hard to avoid it. With NHS Direct, walk-in centres, urgent care centres and so on, you can barely step outside after dark without having your appendix whipped out. Little wonder that, faced with so many options, everyone has forgotten out-of-hours care was once synonymous with ‘emergencies only'. The issue's no longer access, it's excess.

Which sums up the problem. In all these examples, the NHS has generated an unnecessary service that the public, once roused, doesn't want to forego – just as work expands to fill the time available, so pathology inflates to fill appointment slots.

And that brings me to PUMs. What we're dealing with here are ‘Patients' Un-needs Met'. Which leads to ‘Doctor's Expletive Needs'. Because they're a f***ing waste of time and money.

Dr Tony Copperfield is a GP in Essex. You can email him at tony


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