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How to advise and guide your patients

How to advise and guide your patients

E-consultation 3am 1/2/22:

Dear GP, I need tests for allergy, the menopause and my thyroid because my fibro is playing up, I’m tired and I’m putting on weight. I’ve also been feeling dizzy which must be my blood pressure so I’d like an appointment for a thorough check-up.

GP reply 11am 3/2/22:

Thank you for reaching out to us. We are enhancing our offer to patients using ‘Advice and guidance’ as an initial triage. As your symptoms are compatible with stress and lifestyle issues, you do not need an appointment. Instead, look at your diet, lose weight and exercise more. Please also explore this link which I hope you’ll find helpful.


Dr C

PS Sending emails at 3am will make you tired, so I suggest you don’t.

‘Working towards QOF kitemarked ‘Purely good experiences’’

E-consultation 3am 4/2/22:

Dear doctor, I did not find your reply helpful. I’ve tried all that and it doesn’t work. I need blood tests and scans. This is stressing me out and I want an appointment.

GP reply 4pm 7/2/22:

Thank you for your further message. From your description, this is clearly stress. Currently you do not fulfil our criteria for an appointment. Please work though the following advice:

  • Drink 4 cups of camomile tea per day
  • Take a walk at least hourly
  • Listen to classical music (we suggest Wagner’s Ring Cycle)
  • Get a pet (a dog is ideal; or a hamster or fish)
  • Hum to yourself
  • See attached leaflet on ‘Achieving mindfulness in as little as six months’
  • Visit the following resources:,,

Please come back to us only when you have completed all the above.


Dr C

PS I note you emailed at 3am again and would refer you to my previous advice.

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‘Working towards world class primary care in an environment of sheer excellence’.

E-consultation 3am 7/2/22:

Dear doctor, I’m emailing in the middle of the night because I’m angry and I’m not well. You are completely rubbish as a doctor and an utter moron as a person. I’m going to complain to the GMC.

GP reply 3am 8/2/22:

Thank you for your further econsult. May I remind you that we have a zero tolerance policy to abuse and aggression? As you can see, I have been so disturbed by your message that I cannot sleep. Please take the online course at and send me a certificate of completion before we try to move forward.

Dr C

‘Working globally towards a patient-centred universe’.

PS If Wagner didn’t work, try ‘Thrash-metal anthems’.

E-consultation 9am 8/2/22:

Get lost. Just refer me to a proper doctor at the hospital, dickhead.

GP Reply 9am 1/5/22:

As you requested, I referred you to the hospital consultant a few months ago and I transcribe below his response, just received:

“A&G response: This sounds like stress. She just needs to look at her diet, lose weight and exercise more. She does not need an appointment. If that fails, try Wagner.”

Dr C

‘Working towards holistic, seamless practice providing the right care to the right person in the right place at the right time and doing tomorrow’s work yesterday’.

PS: How did we do today? Please click on this link to rate our Advice and Guidance service: A&Giscompleteshitisnt

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at



Please note, only GPs are permitted to add comments to articles

Patrufini Duffy 21 February, 2022 11:34 pm

Brilliant. Wait until the E-consults arrive from the privileged poolsides of Malaga, A+E of Cancun and at happy hour in Lanzarote. Covid’s over – it’s Me-Consult time. Definitely at 3am. I just stood on a sea urchin, can you send my pill to Benidorm, my toenail is still ugly, I’ve got an old/new/dunno mole on the tip of my nose. One struggles to find clinical codes like lazy, seems bored and testing my patience. Medicine feels like some surreal soup of “ei, you said what?!” at the moment. If you’re stuck in a PCN recruit an arrs Bot called Sally or Derrick. Problem solved.

Pamela Barcella 23 February, 2022 3:04 pm

Brilliant— ever so true!!!

Jamal Hussain 24 February, 2022 1:57 pm

Thanks for introducing me to Wagner’s Ring cycle. All 12 hours of it.

Nicholas Moore 2 March, 2022 12:25 pm

This is so perfect. Had me in tears… the ‘inspirational’ mission-statement footers are a particularly awful touch.