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Where's the line between love and hate?

Geoff makes an exception in seeing a patient who is late, but is ticked off by his partner. Surely some patients most in need deserve a bit more of a break than the slackers after a sick note, he wonders.

Geoff makes an exception in seeing a patient who is late, but is ticked off by his partner. Surely some patients most in need deserve a bit more of a break than the slackers after a sick note, he wonders.

Well, it's been another love/hate week with the patients. One of the partners pulled me aside in the nicest possible way and said that I had seen someone who was 17 minutes late. She reminded me that the practice policy is ten minutes or no deal.

Now, ordinarily I'm all for this. But on this particular occasion I made an exception. The patient in question had been late for her first appointment with me by 70 minutes, had then DNA'd twice, and had finally come rolling in to this one probably a little inebriated. Not the best start to a working relationship. She then went on to explain that the first time (i.e. the time she came so late it was a different session entirely) she had come in to get her anti-depressants, having run out a few days previously.

She went on to explain in somewhat slurred language that the result of not having her meds was spending quite a bit of time inebriated and then shooting up with heroin. Now, had I been in a bad mood (which is usually the case) I would have pointed out that the one thing missing in her sequence of events was even a remote degree of personal responsibility.

As it was, I didn't even mention the lateness. In fact, we went on to hammer out a working plan of recovery. So, much as I would have liked to close the door on her, I showed a bit of love.

Don't get me wrong – not the kind of love that winds you up on front of the GMC.

As opposed to later that same session when I listened to this chap bang on and on about his work and his headache, the two intimately linked in his mind.

I told him it sounds like sinusitis and he should try decongestants, and then asked if there was anything else I could do for him. With an entirely straight face he said he thought two weeks off was appropriate. I informed him with an entirely straight face that I didn't agree with him.

"OK, how about one week?"

Right, let's get back to the love. How much is too much? I know a trainee who received a set of bloods showing deranged LFT's. So she phoned the patient. When he didn't reply, she went out on her lunch break to his house. When he didn't answer the door, she paced around the house then left a handwritten note shoved through his letterbox.

As a friend of mine said "That's a sure fire way to a slow, dependent, and painful relationship."

Naturally those of you with more experience will be well versed with drawing the line. Me? I'm still trying to place it.

Geoff tipper

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