This site is intended for health professionals only

You don’t know your luck

Phil's patient this week gets top-drawer treatment – but still complains.

‘You're a difficult man to see,' was my patient's less then cheery opening gambit. This left me slightly nonplussed.

I'm a big bloke by anyone's standards, and I was wearing a bright blue jumper.

I would have thought I was more than averagely easy to see, even from quite a long distance away. ‘I'm over here,' I said. ‘Now, how can I help you today?'

‘I've got this bunion on my foot' he said, and bared the offending member.

‘That's not a bunion, it's a verruca. Would you like me to freeze it for you? If I irritate it enough, your own body might get rid of it in a few weeks.' I got the cryo gun out and froze his verruca, then told him he had a fungal nail infection. ‘You're diabetic. You need to keep your feet in good order. Take these pills for a month.'

‘I've got another bunion on my wrist. Look at this,' he said.

‘That's not a bunion either. It's a ganglion. Would you like me to drain it for you?' I swabbed it with alcohol, stuck a green needle in it and squeezed all the jelly out. ‘Are we done now?' I asked.

‘There is this other thing. I've got a rash.' I had a look at the tinea in his groin area and gave him another prescription. ‘It's been nice seeing you,' I told him, and started shuffling the papers on my desk.

He didn't leave as I'd hoped. ‘While I'm here, doctor...' he started, and my heart sank. Apparently he'd been getting palpitations. I listened to his chest, and his heart beat was irregularly irregular. BP OK, no signs of CCF. ‘We'll do an ECG and some blood tests,' I told him. ‘I'll see you next week for the results.'

‘I'll get this ECG today, will I?' ‘Before you leave the building, I promise.' He stood up and looked suspicious. ‘My bunion feels like it's still there.'

‘Well, yes, it is,' I told him. ‘It might disappear in a few weeks, if the treatment works.' His disappointment was palpable. ‘Oh, well, thanks anyway,' he said, and if there's a more dispiriting end to a consultation, I don't know what it is.

But after he'd gone, I sat back and reviewed one of the most productive 10 minutes of my medical life. Five new diagnoses, two (possibly) cured, two treated, one investigated. Where else are you going to get that sort of value? Your walk-in centres and your NHS Direct just can't compete.

I decided to amuse myself by going online to see what all that would have cost privately, but it's surprising how coy our private colleagues are about their up-front prices. I managed to get the price up over a £1,000 for just the surgical procedures and the investigations.

What a lucky chap my patient is, I thought to myself, to have the benefits of the NHS at his fingertips.

Then the phone rang. ‘It's Mr Git,' the receptionist said. ‘There's a 20-minute wait for his ECG, and he wants to go to the bingo. He's not happy.'

I took a couple of deep breaths. ‘It is not my job to make him happy,' I said. ‘It is my job to provide him with general medical services. Ask if he wants to make a complaint, and if he does, give him an appointment with the practice manager.'

Dr Phil Peverley is a GP in Sunderland

Click here for more from Phil Peverley Phil Peverley