Something bad has happened. Something so awful I can hardly bring myself to describe it. There’s no easy way to soften the impact, so I’m simply going to come right out with it…
I’ve been consulting with snot smeared across my face.
The background: I’ve had a cold and I’ve been blowing out mucopurulent material so terrifying it would have had most people begging for time off, antibiotics, exorcism etc. But we GPs soldier on. So I simply punctuate every few consultations with a sinus washout, and everything goes swimmingly. At least it does until, at the end, I glance in the mirror. OMG. There, on my cheek, is the result of a misdirected nose blow, now caked and dried and awful.
I’m no stranger to embarrassment. I’ve done a smear with my flies gaping. I’ve knocked a lever on my chair, plummeting me to floor height mid-bereavement counselling. But this incident is particularly terrible. I imagine this morning’s patients booking for me in the future with the words, ‘I can’t remember his name, but he was the doctor with snot smeared across his face’, and the receptionist nodding knowingly.
The fact that You Will Know Me By The Trail Of Snot is bad enough. But I’m also obsessed by not knowing exactly when it happened. Was I in this state for the whole surgery? Or did it happen after that particularly gratifying blow towards the end? I seriously consider phoning each patient, in reverse order, and asking ‘Look, when you consulted me this morning, did I have snot smeared across my face? I just need to know.’ That’s when I decided to get a grip and use this column as catharsis. But I can hear the editor saying: ‘Look, Tony, you can’t just write about having snot on your face, you’ve got to make a point.’
OK, um, well, the snot’s a, er, metaphor. Or something. For how patients might soon view us. Up until now, when I refuse to bow to inappropriate patient demand, I have something to hide behind. ‘I’d love to prescribe/refer/scan/whatever,’ I say, ‘but I can’t, because of NICE guidelines/the local prescribing incentive scheme/PCT service restrictions etc.’ But in the Brave New World of Commissioning, the public’s perception will be that we’ve seized the power and the purse-strings.
There will be nothing to protect me from a long and bloody consultation. By the end of which, the patient’s expression will suggest I have something very nasty – yes, like snot – smeared on my face.
Perhaps, say the mongers of doom, this look of default distrust is something we’ll have to get used to. And yes, that is a point, but it’s not the point. The real point is the opposite, that patients’ trust in their GP remains so profound and unconditional that they’ll indulge all sorts of shortcomings on our part – grumpiness, financial straitjackets, even snot smeared across our faces – so long as they can keep seeing the doctor they have faith in.
That’s so touching that you might find yourself welling up. In which case, careful how you blow your nose.
Dr Tony Copperfield is a GP in Essex