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The odds are against us all

Copperfield muses on the great game of life – and how patients are so often losers

Next to the flowers and rain-sodden teddies fastened to lampposts along the arterial road that links us to the metropolis, there's a new distraction – a sign detailing the number of injuries suffered along that particular stretch in the previous year.

It warns ‘68 casualties in 2009'. I wonder how many drivers pass by and think, like me, ‘Hey, I like those odds....' considering the thousands who use the road every day.

A lot depends on what is classed as a casualty. As far as I'm concerned, sprained ankles or Colles' fractures on icy pavements shouldn't count, even if the council does include them to bulk out the figures.

There are similar signs along the roads running out of Manchester to the south through Moss Side – ‘56 injured in 2009' – but, with typical Northern directness, there's also a supplementary hand-painted sign, ‘and 10 were drive-by shootings innit?' The warning is clear – drive down here and you take your chances.

Everyone knows that life is a crap shoot from cradle to grave. This message was lost, though, on the bod from the Royal College who told listeners to Radio 5 Live that GPs are failing ‘patients who have gambling problems' (also known as ‘losers').

And I'll bet you can guess what came next… we have to do more. When patients turn up with crippling debts we have to ask how many scratch cards they've bought in the previous week. When I get QOF points for it I'll think about it.

A compulsive gambler told the BBC that he'd gone to his GP shaking and depressed, hoping that, and I quote verbatim, ‘they might have an inkling as to what was going on'. The idea that he might reasonably be expected to tell his doctor why he was thousands of pounds in hock obviously never crossed his mind.

Of course, we GPs are famous for our clairvoyant skills. We know that out of an entire morning surgery only one or two patients will present with problems that actually need our help. We know any e-mail from the PCT marked ‘High Priority' will be dross, and so can successfully avoid opening it. We know that the new drugs are unlikely to be any better than the old ones.

But even though we possess astonishing powers of prediction we augment them with a bit of voodoo known as ‘Recording the History of the Presenting Complaint'.

Put simply, we ask the patient what is wrong, in this case, ‘I'm depressed because they've repossessed my BMW' and then, brilliantly, we ask them what they think the reason might be for this occurrence.

This is the patient's chance to fess up that their infallible system to break the bank at Monte Carlo wasn't infallible after all, that a tip on a 33-1 outsider at Kempton Park isn't usually a safe bet and that the Lotto has turned out to be nothing but a devious form of indirect taxation on the poor and greedy.

But like all addicts covering their tracks, they'll lie. There's always an excuse. A cash flow problem, hassle from the VAT man or the Inland Revenue. Always, I'll wager, it'll be somebody else's fault.



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