Patient arrives in emergency surgery clutching our standard, ‘You have got to be kidding me’ leaflet, dished out to rejected repeat-medication requests.
But the issue here is that she’s under the mental health team and wants a shedload of as-yet-unauthorised industrial-strength antidepressants, antipsychotics, mood stabilisers and sedatives.
I groan inwardly and then, when I explore further, outwardly. We have the list of drugs she reckons she’s taking, the list of drugs already on her repeat medication template, and the list of drugs recorded at her last appointment with the shrinkiatrist.
And guess what? They don’t tally. And simply reading through each list has already used up the time allocated for the appointment.
I try stalling, but she says, ‘I must have them today, doctor,’ in the tone of someone who knows that anything less would require a tantrum/threats of coming over all suicidal.
Muttering barely-concealed obscenities, I look back at the lists.
Of the few drugs that do match up, the strengths aren’t the same, or if they are, the dosage regimes aren’t.
In desperation, I phone her care worker, then her CPN, then, finally, her psychiatrist. After half an hour, I have managed to knock together a regime of drugs they rubber-stamp, and one which makes some sort of therapeutic sense. It could still floor a psychotic bullock, though, and the consultation has certainly floored me.
Exhausted, I set up the new repeat templates and finally print off the prescription, which takes another five minutes.
I hand it over, expecting her to say, ‘Thanks, doc.’
But she doesn’t. What she does say is, ‘Anyway, I don’t think the medication’s working.’
And that’s when I reach for the pistol.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield.