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If my patient really wants to be over-investigated, she can pay for the pleasure

‘Dear Dr Copperfield,

Thank you for referring this charming lady for a private opinion regarding her rash…I suspect this is blah blah…though of course it might be blah blah blah…I’ve suggested some emollients and I will review her in due course. In the meantime, I’d be grateful if you would arrange a full biochemical and haematological screen, a urinalysis, stool for ova, cysts and parasites and a chest X-ray.

Yours blah blah

Private consultant.’

‘Dear private consultant.

Many thanks for giving me the opportunity to be your unpaid community houseman. I’d be delighted to do this work on your behalf while you earn some fully deserved private cash. Oh no, wait, what I mean is, “sod off”.

As for “charming”: well, obviously, you’re entitled to your opinion.

Yours sincerely

Dr C

PS Emollients, eh? That’s brilliant. What made you think of that?’


Because of the demographic I work in, it’s disappointingly unusual for me to need to fire off a reply like this. But, for some reason, I’ve recently had a flurry of private referrals and letters – which presumably means either that the country really is emerging from its financial black hole, or that the NHS really is heading straight for one.

And the other thing I’ve noticed, as illustrated in this example, is that private specialists seem increasingly happy to delegate any spadework to everyone’s favourite community dogsbody, leaving them more time to meet, greet, pontificate and fleece.

Which leaves us GPs where, precisely?

There’s useful guidance on prescribing requests from the private sector – useful in the sense that it aligns with what I already do, which is to prescribe if it’s what I would have prescribed anyway, and refuse if it isn’t. Which usually means refusing.

But other donkey work?

It’s harder to make the distinction between appropriate or not, which is perhaps why this is a guidance-free zone. So it does leave me conflicted when the punter presents me with a private consultant’s wishlist when I thought no investigations were needed, or the patient arranged her private second opinion without deigning to allow me one first.

The peacemaker in me says, look, just bite the bullet and get on with it.

Whereas the contrarian in me says, if the patient really wants to be over-investigated to the point of submission, she can pay for the pleasure, and if she doesn’t, she can charmingly argue the toss with her private doc.

Trouble is, there is no peacemaker in me.

Dr Tony Copperfield is a GP in Essex