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Get ’em off – and be quick about it



‘I’ve got this rash on the top of my foot. I don’t know what it is.’

I roll my chair back for a better view of the complicated leather high-heeled boots that go up to her knees. I try, though the medium of waggling one eyebrow, to suggest that my superpower X-ray vision is not working too well today.

She gets the message. ‘Would you like me to take my boots off?’

I give her a reassuring smile. ‘It would help. Take your time. We have the day ahead of us.’ She starts to undo the first buckle of six.

I get 10 minutes with a patient. TEN MINUTES. During that time I have to establish some sort of relationship, find the problem, take a history, examine the relevant part, make a diagnosis, formulate a treatment and a follow-up, prescribe, and document the encounter. It just does not bloody help if six of those 10 minutes are taken up with my patient removing a pair of boots. I’m as keen on a lady in leather boots as the next man. But there’s a time and a place. And it’s not now.

Another patient is distressed by her acne. ‘It’s awful, doctor. Look!’ And I do look, I really do, but I don’t see it. Because she is wearing the kind of mask-like make-up that might make a geisha think: ‘That’s a bit much’.

‘Look,’ I explain. ‘I have no idea what you are on about. The bogs are down the hall. Wash all that off and we can talk about it.’

Because, these days, I am forced to do more and more in the time available, I am increasingly aware of the time wasted by a lack of forethought by patients. You’ve got a problem with your piss? Why not bring a sample in, rather than acting surprised when I ask for one during the consultation? Some do bring one, admittedly. That minority generally get a hug.

A friend of mine ran a hypertension clinic in Romania. Romania is colder than the UK, but if you’re turning up to a hypertension clinic, you might reasonably expect to have your blood pressure taken. So why wear seven woolly jumpers? My friend found 75% of her time was taken up with first, the patient trying to roll seven woolly jumpers up to the antecubital fossa, failing, and then taking them all off, in an entirely unsexy eastern European version of the dance of the seven veils. Just one minute was left for all the clinical input.

‘My knee hurts, doctor.’ If your knee hurts, you daft bugger, why turn up in jeggings that you bought when you were significantly thinner?

‘I’ll need to have a look,’ I tell her. After a couple of minutes flopping around on the floor like a seal at a marine show exhibition, she has got one leg out. ‘I’ll need to see the other for comparison,’ I tell her, and off she goes again, while I do a Sudoku.

As for my original patient, in the time it has taken you to read this article, she finally gets her boots off. I look. ‘That’s nowt,’ I inform her.

‘Oh thank goodness,’ she says, and goes to put her boots back on, but I am too quick. Grabbing her around the waist, I throw her into the corridor, and moments later the boots clatter the wall above her head.

‘Come back any time,’ I call, as the door slams.

Dr Phil Peverley is a GP in Sunderland.