(I can't get no patient) satisfaction

Following the news that GP satisfaction levels are rising, Copperfield recalls a disgruntled patient who was not so satisfied when he cleared him for skin cancer

So, GP satisfaction levels are rising? Well, that doesn’t seem to have trickled down to my Essex backwater.

In comes a 50-ish bloke. With barely a word of explanation, he lifts up his vest and indicates a lesion on his chest.

‘Ah, nothing to worry about,’ I say. ‘It’s perfectly harmless. Not a skin cancer. No chance of turning nasty. Best left alone. It’s called a seborrheic keratosis, if you want to impress your mates.’

Brilliant. 30 seconds, job done. Next!

‘How do you know?’

I’m stunned. How do I know? How do you mean, how do you know? What’s going on? Has he misconstrued my certainty and efficiency as being dismissive? Should I have been more performative and wandered around to view it from every angle, using a light source and magnification, ruminatively rubbing my chin like I was trying to authenticate a Van Gogh? But surely all that umming and ahhing really would have given him cause to doubt me?

Also, note, I have 10 years of training and 37 years of experience. I’ve come across skin before. I won the dermatology prize at med school. And (the clincher) my derm teacher was a Dr Cream. Honestly. All of which I tell him, to a) Lighten the mood b) Convince him.

His expression – that of a man who trod in an inexplicable cowpat in the corridor – remains unmoved.

‘I want to see a specialist.’ Uh? I appear to have landed in a Simulated Consultation Assessment. I turn on the empathy afterburners. So yes, it transpires he is worried about skin cancer and he wants proper reassurance. Which I am unable to provide, apparently.

I’m not done yet. This is a seborrheic wart, for Chrissakes – of all the primary care presentations, arguably the one least deserving anything but contempt. So I Google ‘Elephant’, show him the image and ask him what it is.

‘An elephant’.

Got him! ‘You see – you just know!’

Expression unmoved. ‘That’s general knowledge. Skin cancer is special knowledge. That’s why I need a specialist. You’re a GP.’

Hmmm. He’s quite good at this. And at least he didn’t say ‘just a GP’, in which case his condition really would have become much more serious.

In desperation, I explain the GP gatekeeper role and the way that undermining this lengthens waiting lists, that even if I do refer him it’ll get bounced back, and that even if it isn’t he’ll get an appointment with a photographer rather than a specialist. And has he considered going privately?

His deepening frown suggests he’s already composing a complaint.

So I relent. The only doctors who completely satisfy their patients are those who say yes to everything, immediately. Maybe I should have done that and saved myself ten minutes. But caving in is to be complicit in destroying the NHS. Also, trying to win these battles is quite fun, especially when you’re bored and truculent like me. And there’s our satisfaction to consider.

Dr Tony Copperfield is a GP in Essex