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Gold, incentives and meh

Treating a chronic sense of self-entitlement

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She’s sunburnt, elephantine and heavily tattooed. Which may or may not be relevant, but is a fact. She’s also new to the surgery.

Your freedom lies in one word, and that word is, “No”

Waiving all the conventional niceties, she launches straight in: ‘I need a prescription for all my usual meds plus some extra sleepers. And supplies of milk for the baby. My sickie’s overdue and I need a letter from you to help my appeal. How can I work with these knees? I need them X-rayed. And you need to do something about my weight. And while you’re doing the prescription, you can put on some nicotine patches,’ she pauses for breath, ‘And you can do me a rehousing letter. I need a ground-floor flat coz for some reason they’ve put me on the second floor and the lift never works.’

I take a step back mentally if not physically, though the latter’s tempting. This, I reckon, could be fun.

‘I think I can see the overall problem here,’ I say, ‘You’re suffering from a chronic sense of entitlement.’ She narrows here eyes, but I plough on, ‘You’re confusing wants with needs, and because no-one has ever explained the difference, you’ve developed a learned helplessness and dependency which you’re locked into. I suspect no one has ever had the time or inclination to liberate you, but that’s what I’m going to do. Your freedom lies in one word, and that word is, “No”. So that’s what I’m saying. No. To everything.’

I sit back and wait for the fallout. The fact that I’ve folded my arms really isn’t a sign of smug self-satisfaction. It’s actually self-protection. So’s the tin hat.

She leans forward, looks me in the eyes, and begins: ‘I think I can see what you mean, doctor. You’re saying that over the years, I have developed the attitude, perhaps reinforced by health professionals, that I’m entitled to anything and everything. In turn,’ she continues, ‘This has undermined any vestigial ability or inclination I might have had to sort out my own problems, with the result that I’ve developed this unrealistic level of expectation and intractable passivity. The fact that everyone has bowed to my demands has simply, in the long term, led to my own disempowerment. I’ve become a victim of those who have tried to help me, because they have effectively rendered me helpless. So I understand why you’re saying “no”. Indeed, I appreciate the irony that your refusal is, after all, simply a reflection of your own entitlement, as a responsible professional, to tell what you see as the truth. I respect the stand you’re taking and will try to move on from here. I bid you good day.’

With that, she got up to leave.

Hand on doorknob, she turns and asks, ‘Any chance of a prescription for Calpol?’

‘Sure,’ I say.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

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Readers' comments (28)

  • As ever, BRILLIANT! Thanks, Dr. Copperfield, for brightening up my day. I once went to a Study Day given by GPs called "Heartsink Hotel" - it was all about what to do with Patients EXACTLY like this. It was hilarious.

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  • Even though I completely get, identify with, and even like the article here. I would like to throw in two other perspectives (and even frustrations) of my own.

    1. As a practice nurse, I observe two GPs I work with, encouraging this behaviour with zero resistance. Running round in circles with no structure, still giving AB to keep the patient pacified, requesting wheelchairs when exercise is needed, referred for conditions which are self limiting and often recover in a few months (e.g. plantar faciitis), which I had for 18 months.

    2. On the other hand, I have a daughter who has had ME for 16 years, and when confronted by her GP (who we have always liked), when she failed PIP, he commented "But you're not that bad are you?". And his junior colleague, "I'm tired too. I just have to make myself get up sometimes."

    It scares me that many GP's appear to also have a sense of entitlement, to what they see as "Their independent business". Charging £25 for letter of support to GENUINE disabled patients who are not only struggling to cope with day to day life, but these days have lost possibly ALL their financial support. My daughter's comments after failing PIP was, "Mum, if it wasn't for you being here I would have to top myself, because I have no means to buy food, or anywhere to live, or energy to deal with all this."

    These are NHS patients that are ill, moderate to severe ME sufferers cannot work or plan any life and £25 charge for a letter would take away food for the week.

    Paradoxically, I agree with the article entirely, and that if me, I would start with the weight control and education on reduction of pain, BUT please GP's out there, please try to see the wood from the trees because to judge those few you may tar with the same brush might just be not coming to your surgery because there is no reliable diagnosis, no respected or unchallenged NICE Guidelines, no treatment except your valued support to fight their corner.

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  • Joe Mcgilligan

    You probably think it a joke that my son has Asperger Syndrome. (as well as my daughter with ME as above) but it took me 10 years to get my area to even recognise it existed, after a visit to local MP around 8 years ago. Our stupid GP at the time thought it was depression and told me he needed to get a life.

    I recognise that when he was born in the 80's, health professionals were relatively uneducated in behaviours (indeed some apparently have it themselves!), but being so individualised, not all succeed in getting work once diagnosed as a n adult which we why we parents are desperate for our children to get every achievement they can to compete in the jobs market. So why mock them?
    Sadly, because my son's behaviour became entrenched because he was diagnosed so late, it is almost impossible to get him to do anything now he is in his 30's. This is in spite of going through grammar school, getting A levels, a BSc Hons in Computer SCience...then 2 hours a week voluntary helping the Salvation Army local office with IT!

    I believe the RSGP have just sent out packs to all surgeries impressing the importance of identifying this group of patients.

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  • Any chance that you are a partner or of good position in your surgery ? I was told by my supervisor that my consultation was bad and I wouldn't pass my exam when these patients went to him demanding the same when I declined their demand . He gave what these patients wanted .

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  • Dear Practice Nurse,

    In spite of working in a GP practice, you have very little understanding of how practices are funded. GP Partners DO run a business - they are not a charity. If the books don't balance, it is the partners who take a cut in income - no-one else. This has happened to me twice in my time as a Partner, the first resulting in me selling my flat.

    Why do you expect GPs to work for free in response to the failings of health and social care caused by this Tory government?

    Put the money aside, are you not aware we are facing the biggest GP workforce crisis in history? Most practices decline to do this work for even for a fee because they just don't have the capacity and the priority is to patients who believe themselves to be sick.

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  • All my professional life I have tried very very hard to be true to myself and my profession as a GP
    As a result I have had several complaints none of which were upheld or came to anything but of course were upsetting
    *I refused to give a sick note to a 16 year old who on leaving school never wanted EVER ! to have to work. She had had several years of care under CAMHS without a diagnosis
    I insisted work would be therapeutic and in the end got a job met her future husband and came and thanked me and apologized for the complaint her mother had made against me
    * A lorry driver came for a sick note at the beginning of December but I was able to show him on the computer that he came with various complaints every beginning of December for the past 12 years !! and refused.Needless to say an examination was normal and the history bizarre
    *I refused to refer a patient yet again with medically unexplained symptoms/hysteria with the same symptoms to a neurologist.She had just been discharged after a 3 week inpatient stay in a neurology ward with the same symptoms
    All efforts by me to help her in ways other than referral to yet another neurologist were refused
    I could go on but my point is we help our patients as much by saying no as anything else we do
    If we collude with their version of reality we
    are damaging them in very serious ways
    You need "balls" to be a GP.
    Complaints are part of life as a GP but be thorough keep good records and you will help more patients than you would dream of

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  • Excellent article. Like many others above I have tried to do the right thing and for 10 yeers I fought the good fight, in the process getting complaints, threats of GMC referral and one actual referral (for daring to stand up to an abusive patient, thankfully dismissed). Burnt out, I nearly gave up GP land. The support from the local CCG wasnt there, nor the medical directors in many of these cases. ALL complaints have to be reviewed, relearned, and for the bean counters, they just weigh the letters to determine whether you are a risk.

    So, last year, I made a decision. Stuff them (the entitled demanders who damage their own health, and suck the NHS dry). If they want to harm themselves, let them do so. I now give in to demands in the majority of cases. I dont like doing it, realise its bad medicine, but thats because a system that hangs us for trying to do the right thing is breathing down our necks.

    I sleep much easier at night as a result. 8 more years of this hell to go.

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  • This is so true

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  • Patronisingly ridiculing patients does nothing to address the problem of some people working the system to their advantage (supported by GPs who haven't managed requests appropriately over the years) which impacts on those in genuine need. This sort of article won't attract any sympathy for GPs from the rest of us.

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  • Shaba Nabi | Salaried GP11 Jun 2016 6:27pm

    I certainly do know how GP funding works. I also was brought up in a shop, and my parents never got a lump sum per head per customer in those who came in the shop. Neither does Tesco.

    General Practice land attracts a sum per head, then enhanced payments if chooses to take on additional services.

    To charge £25 to an NHS patient as evidence of medical need is an abomination.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder