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Make yourself at home

Phil's feeling more like a receptionist at a posh hotel this week, as one of his patients insists on repeatedly checking in

I've got a discharge letter from the local hospital in front of me about one of my patients, and I'd like to share it with you.

This is what it says: ‘Admitted to Ward XX following an impulsive ingestion of paracetamol 500mg x2 and tramadol 50mg x2, with no suicidal intent.'

I'm a generalist. I don't set myself up as a toxicologist and my pharmacological expertise is limited to what I learned as a student and what I have picked up during 16 years as a GP. But I'm going to stick my neck out here and postulate that this, analysed by whatever means you may choose, cannot be considered as an overdose.

The letter was written by a nurse from the A&E/Mental Health Intervention Team. No doctor seemed to be involved at any point, but if I wanted further information I should phone the nurse on this number. So I did.

Nice bloke, as it turned out. He told me that his team of seven had been reduced to a team of three, and they no longer covered A&E in the evenings. Instead, anyone exhibiting ‘self-harming behaviour' was routinely admitted to an observation ward and assessed by them the next day.

He agreed that this woman should not have been admitted, and if he had seen her in A&E he would have sent her home.

But instead, she occupied a £500 bed for the night. By chance, I saw the young lady in question this morning.

She's an immigrant from Iraq, and she's a ‘frequent flier'. She's never away from our doors, despite being perfectly healthy, and, shall we say, is a bit more Westernised than her husband and family would prefer.

‘What was all this about?' I asked her. ‘Pah,' she said, fluttering her hands dismissively. ‘I had another fight with that bastard. It was just like the other times.' ‘Other times?' I asked.

‘Twice before he slapped me and I took some pills.' I had a look back through her notes and it was true enough.

There were two other nominal overdoses and overnight hospital stays. ‘I'm going to leave that twant before long.' Her English has come on a lot since she arrived, but she's still not got the swearing quite right.

‘What was it like in Iraq?' I asked her. ‘Did you have to pay to see a doctor?' ‘Oh yes, we couldn't afford that very much.'

‘How do you like the NHS?'

‘Ees brilliant! I love it here. You call an ambulance, it comes.'

‘What's going to happen with you and your husband?'

‘He slap me again, I take a few more pills, I go back to the hospital. Anyway, can I have some more of that nice cream for my skin, and some more shampoo? I nearly run out.'

Maybe we should issue her with some free bed and breakfast vouchers for the Savoy. It would cost about half as much. Welcome to the NHS, dear lady. Make yourself at home. Oh, you already did.

Dr Phil Peverley is a GP in Sunderland

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