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GPs go forth

Yeah, I know exactly what you are like


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Of all the phrases that patients use to rub saline into the wounds of us poor frontline GPs staggering our way through the primary care battleground, and God knows there are a few, I would like to nominate as the very worst, the following: ‘I know I should have come sooner, doctor, but you know what I’m like’.

This is absolutely always in reference to a symptom that not only should not have been presented sooner, but had no need to be presented at all. And in a patient who, yes, I do know what they’re like, and what they’re like is someone who attends repeatedly and unnecessarily and who spouts such self-martyring, self-justifying bollocks that consulting with them is not unlike having a red-hot poker repeatedly rammed up your rectum (I’m guessing here, obviously).

What I do know, GMC, look away now, is that it makes me want to punch them in the face

I’ve heard this phrase from patients countless times, yet I am still unable to work out whether:

1. They have absolutely no insight whatsoever and genuinely believe what they say.

2. They have total insight and are using this phrase as a kind of reverse psychology defence mechanism to protect themselves from the embarrassment that, here they are again, in a totally unnecessary consultation.

What I do know (GMC, look away now) is that it makes me want to punch them in the face. And for that, I feel deeply ashamed. On the other hand, this might represent the type of communication these patients genuinely understand, and could therefore alter future illness behaviour in a way that benefits everyone. So, patient, I should have done this sooner, but you know what I’m like….

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at or follow him on Twitter @doccopperfield

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Readers' comments (8)

  • Brilliant!

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  • Well put. Don't worry about the GMC unless you have a non estuary accent and type 4 skin.

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  • Suggesting they have a high pain threshold=no pain threshold whatsoever

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  • It’s 2 Tony. Punters know full well they are taking the mick with their symptom soup and are getting their excuses in early.

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  • Tinted glasses +ve and carrying walking stick/crutch as a fashion accessory rather than a walking aid?

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  • I would love to have a patient start with 'it's probably nothing, because, as you know, I have a very low pain threshold, I'm a wimp, and also a terrible nonobjective judge of symptoms.' But, oh no, the unstated message is ' if I am complaining about it it MUST be serious, because I NEVER make a fuss (if you exclude the last 10 years' worth of weekly consultations for trivial symptoms) (my parentheses)

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  • As phrases go, don't forget:
    Something's GOT to be done (one of my dad's favourites)
    You never see the same doctor twice.
    If you knew how long I've waited to see you (time wasting rant alert)
    I hardly ever go to the doctor (justifying expecting to be seen today)
    You're busy today doc! (How DARE anybody else do what I intend to do, take 25 minutes for a 10 minute appointment)
    Where shall I start? (The end please)
    I've been told NOTHING about my problem (if you ignore the 2 page letter from the consultant)
    My fibro's playing up today (more drugs please)

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  • "...but you know what I'm like"- this confirms the immaculate beauty of the GP-patient relationship where yes, we GPs can effortlessly recall the subtle nuances of every single patients' personality disorder traits. What galls me even more than this opening gambit which would have me think of the flair of the chess grandmaster Kasparov is the next part of the interaction when I'm told they've had the problem for "a while". This has all the precision of a barrel-bomb lobbed out of a helicopter.

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