Wake up at the back. We’re suffering an insomnia epidemic in our practice. Not among the partners, you understand. It remains as simple as ever to take a nap between consultations – or even during, if I prop myself up on one elbow and turn up the air-con loud enough to drown out my snoring, though my tendency to dribble is a bit of a giveaway.
No, it’s the patients who are suffering sleep deprivation. And it all started, oddly enough, with conjunctivitis. To explain: we’ve stopped prescribing antibiotic eye ointment or drops for this particular day-duty staple, driven a bit by EBM (apparently it makes sod all difference) and a lot by Q&P QOF (scrabbling for prescribing ideas).
So it’s not ‘all about money’, as one stroppy mum of a gummy-eyed toddler insisted – not at a measly £1 per tube – though it is about having fewer consultations with the stroppy mums of gummy-eyed toddlers.
Anyway, bolstered by this success, we resolved to take another bold prescribing leap forward, thereby putting more ticks in QP1&2 – this time by prescribing fewer drugs beginning with ‘z’.
Sounds a bit random, I know, but bear with me. Our policy of not prescribing sleeping pills, which dates from the Cretaceous period, is currently being sabotaged by the local shrinks.
They’re routinely dishing out ‘z’ sedatives to psychiatric patients who have problems sleeping, which is all of them. Next stop: our surgery, for repeats. Hence the epidemic.
So we decided to put our prescribing foot down, and all was going reasonably well... until this consultation today.
‘I can’t sleep, doctor,’ he says. Which, as we all know, means: ‘I’m not leaving here without some sleeping pills.’
Cue my autodoc spiel about the practice no longer prescribing sleepers, whatever letter they start with.
To which he replies: ‘But I’m not looking for sleeping pills, doctor.’
You’re not? Really? What are you looking for, then? A dose of OTC cocoa? Your car keys? The way to Amarillo?
No. Supposedly, he just wants my advice. Except that the sleep-inducing nuggets I lob his way he bats back with a dismissive: ‘I’ve tried all that.’ He then launches into a monologue about his intractable sleeping problems, which is so long, dull and soul-destroying that I find myself enjoying the irony of drifting in and out of consciousness.
At one point, in a rare moment of lucidity, I find myself wondering if he’s ever tried listening to himself, as it works for me.
But before I can decide whether it’s a good idea to say so out loud, I find myself distracted by the need to a) conceal the pool of drool that has appeared on my desk, and b) divert the consultation onto something more worthwhile.
So I never discover what’s at the root of it all, because I use the standard GP bail-out of: ‘Look, is there anything else I can do for you?’
‘Yes,’ he replies. ‘It’s my eyes. They’ve been inflamed and sticky for the last few days.’
Bloody hell. If things carry on like this, I’m going to revoke our precious prescribing policies. Q&P is fine, but it’s not worth losing sleep over.
Dr Tony Copperfield is a GP in Essex
