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Consultations have fifty shades of grey



When I was a houseman, I once spent a drunken evening talking to a burnt-out middle-aged hospital doctor. He enlightened me on many things, but most memorable was his assertion that, at his age, ‘straightforward sex’ (his words) no longer ‘cut the mustard’ (also his words). He went on to describe a sex life so lurid it makes Fifty Shades of Grey look like Frozen. Mind you, he was an orthopaedic surgeon.

Trouble is, the same thing is happening to me – not with sex, but with consultations. Conventional interactions with patients leave me bored and dissatisfied. I can only endure the average surgery by contriving some thrill or jeopardy to get the juices flowing. Thus far, I have devised three specific techniques:

1 Provoke an argument

This is easy when you see a patient in your emergency surgery because she’s been feeling TATT for the past six months. Because, if she really has been feeling tired that long, then she had plenty of opportunity to book one of the approximately 2,500 routine appointment slots with me, which means she deserves a bollocking regardless of protests. More rewarding is to provoke a patient’s indignant rage by deliberately blurring the boundaries of what’s reasonable – such as when I refuse to do something a private specialist has asked me to – not because it’s inappropriate, but because I don’t like their assumption that I will.

2 Go deaf 

Recently, an ear wax crisis rendered me unable to hear anything during consultations. It was wonderful, and the patients didn’t seem bothered. I would simply nod and mumble non-specifically at various points until, after a bit, they went away. This was so satisfying that, if I fancy a quiet day, I’m going to deliberately render myself deaf, perhaps by salvaging some wax from the ear syringe and ramming it in my ears. By coincidence, that same week, I received our patient survey, in which it was repeatedly reported by patients that ‘I listen’. Maybe, but I don’t always hear.

3 Meta-consult

The idea is repeatedly to refuse to deal with the patient’s presenting problem and focus instead entirely on the hidden agenda, even if there isn’t one. Thus: ‘Sorry, can I stop you there? I’m not interested in your catarrh, nor in treating it; I want to know what made you consult today. No, I don’t want to see the contents of your hanky and no, I don’t care that you’re breathless. Tell me instead what really made you book this appointment, what actually drives a fully grown man to consult about a cold. Of course you’re hoarse, you’re shouting at me. Let’s face it, shall we? The real reason you’re here is because you suffer premature ejaculation, and that’s all I’m prepared to discuss.’

Meta-consulting of this sort is great fun, but works less well when, to use the above example, the diagnosis turns out to be laryngeal carcinoma.

Anyway, if you’ve reached that dull and seemingly endless plateau in your career, give one of these three techniques a go. Failing that, try spicing up your sex life. I know someone who can help.

Dr Tony Copperfield is a GP in Essex