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Telling patient the truth need not be a cosmetic exercise

Phil Peverley asks how to explain to the patient that you have decided to deny her request for cosmetic procedures (Peverley, 31 May)?

My advice, Phil, is to tell the truth. You can't have a flash car, a big house, two foreign holidays a year and expensive jewellery for Christmas if you earn £30,000 a year.

The NHS is no different. There is only so much money. I always find putting the ball in the patient's court will convince most of them.

Try saying: 'If we pay for your face, this woman will have to stay in pain for the last 10 years of her life and will be confined to a wheelchair. If you tell her, we might have a deal.' Then watch her squirm.

I truly believe that if I was lying in a gutter late at night, bleeding to death from a head injury, some passing patient would kneel at my side, look into my face with compassion and sympathy and then say: 'Can you just look at this rash Doc? I can't get to the surgery in the day.'

Most patients are not like this and are very reasonable, but the ones who would fight for facials rather than hip replacements will never be happy.

Tell it as it is and you can't go wrong.And as for the possible legal suit: you can't sue a party who has not been negligent, you can't complain about a party who is not in breach of their contract and you don't get an apology from someone who has committed no wrong.
From Dr John Wotherspoon, St Helens, Lancashire

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