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At the heart of general practice since 1960

The strong, violent type

When a patient’s beating hell out of the walls, the receptionists put him down to see Phil

When a patient's beating hell out of the walls, the receptionists put him down to see Phil

I'm an imposing bloke. I was six foot three last time I measured, something like a decade ago, and about 15 stone. These days I wouldn't like to say, but it's a fair guess that I'm still around six foot two and what I've lost in height I have made up for in three or four stones of endomorphic growth.

I have a natural Neanderthal glower that dissuades our newer receptionists from approaching me directly for a couple of years until they realise I'm ‘all right', which saves me the bother of having to learn any names until they are settled in. I can get a cup of coffee faster than anyone in the building.

It has its advantages; I don't get disturbed much. But on the other hand, when I get disturbed, I can get seriously disturbed.

Our superb receptionists are our front line, but when they receive an assault that is beyond what a receptionist might be expected to cope with, the responsibility tends to devolve to me.

‘I've had to put this one in with you, doctor,' says Liz, and if Liz tells me that I know that there's no other option. ‘He's punching the walls and the children are crying. Can you see him soon?'

Well of course I can, but I'm enough of a student of human nature to understand that adrenaline is better expended on walls than on me. I'll generally give him 20 minutes; 10 if he fractures a metacarpal.

This patient, 35 or so, is radiating aggression and wearing a suit. Possibly, by the look of it, his grandad‘s demob suit. This in itself is an event worthy of comment, and so I make one. ‘Due in court this morning, are you?'

‘How can you tell?' Violent frustration has given way to sullenness.

‘Call it a gift. Let me guess the rest; it's quite serious and you might be locked up. You've put a suit on because you think, probably correctly, that the judge is less likely to send someone to prison if they are smartly dressed.

However, you've called in here on the way because you think 1) I might give you something soothing to help with these horrible feelings of impending doom, 2) I might give you a sick note so you don't have to turn up in court, and 3) I might write a letter to say you're suffering from depression and that's why you did it.'

I can tell by his slowing breath rate and hopeful eye that I've hit three nails on the head. Unfortunately I have to quench the dawning hope. ‘I'm sorry but I'm not going to do any of those things. You'd better get along there now, you don't want to be late. I'll let you out of the side door so you don't have to go through reception again.'

I stand up to get the door, incidentally showing him I'm a foot taller than him and obviously not intimidated. He's now nearly crying, which is as close as this type of man gets to actually crying.

‘Look, I haven't asked what you've done,' I tell him. ‘When this is all over we'll still be your doctors. Come and see me and we'll talk about it. As long as you don't break anything on the way out.' And off he goes, swearing, but not loudly.

I sit down and take a deep breath. This is an odd job and we can have some tense encounters, but at least when that door shuts he has to go outside and continue being him, while I am free to continue to be me, and I'm thankful for that. I inspect the panic button, which has never been pressed, and wonder if it is actually connected to anything. I hope I'll never have to find out.

Dr Phil Peverley is a GP in Sunderland and PPA Columnist of the Year 2006

Phil

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