QOF targets will be health priorities, not political
'I've got a bad back Doctor,' the patient says.' Great, I think. Try having mine.
'Come in and take a seat' I say to my next patient, as he glides gingerly into my consulting room. 'I'd rather stand, if you don't mind doctor. You see, I've got an awful bad back'.
This is bad news, and my heart sinks. Another bad back.
As GPs, back pain is the commonest problem we have to deal with. There's a lot of it about.
Some surveys contend that up to 80 per cent of us will suffer with a bad back at some point in our lives, and I believe this to be a conservative estimate.
I've got a bad back right now as I type this, and I think that sitting here typing is a big part of the problem.
General practice used to be a much more dynamic profession. We used to move about more. Only 10 or 15 years ago, we would be up on our feet and walking to the waiting room to call our next patient. Now, we sit here and push a button. If we wanted to consult a textbook we would get up and walk to the bookcase.
Now, a few clicks of the mouse and we don't have to shift from our hunched position at the desk. Previously, we would spend a significant proportion of our working day out and about, visiting the punters.
In many ways it is a good thing that I now only do about two home visits a week, but as far as my spine is concerned, it's a disaster.
For a while I considered getting one of those orthopaedic stools that you see advertised in the Innovations catalogue. You know the ones no back to it, there's one angled plank for your bum and another for your knees. In profile, you look like Billy Elliott in mid-air.
I decided against it in the end. I thought it would damage patient confidence if they had to consult with a GP who was apparently perched on a birthing-stool.
So, dosed up to the eyeballs on ibuprofen, I consider my patient and try to work out if his back pain is any worse than mine. He appears to have feeling in both of his feet. So far he's doing better than me.
I give him my usual spiel about evolution, because it's worth a try. 'Your back,' I pontificate, 'is badly designed. As a species, we have only been walking upright for about two million years.
'Our spines are not designed for this. Give it another million years or so, and your back pain will not be a problem.'
For some reason this does not give him much comfort.
At this point, I used to offer drugs/ physiotherapy/ hypnotherapy/ chiropracty, in fact anything to get the patient out of the surgery in order to waste time until the bad back got better by itself. But now I've come up with a better idea.
'Drive over to the Angel of the North and stand with your back against it for half an hour,' I advise. 'Take your mobile phone, and if you don't feel any better afterwards, call me back from there.'
Then, if they phone me up, I tell them that they are now outside my practice area and they will have to register with a local GP as a temporary resident.
Dr Phil Peverley is a GP in Sunderland