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Sticking it to the malingerers

Back in the day, we used to be an all-male practice, and consequently I was as au fait with the complexities of the menstrual cycle as any GP in the country. I’m not saying I enjoyed dealing with these endless problems (who does?) but I could handle it fairly well and even managed to look as if I cared, quite a lot of the time.

Now the demographics of general practice have changed for the better. Pretty much every practice, including ours, has a couple of Nice Lady Doctors to deal with all this tedium.

My total freedom from exposure to the menstrual diary comes at a price, however. The reception staff have identified another type of patient who they think might best be dealt with by me. Every time some swivel-eyed, sweating sociopath with benzo-hunger in his eyes rocks up to the front desk at 5.50pm, they say: ‘Aha! Another one for Dr Peverley.’

The reason for this (apart from me being six foot three) is that I tend to judge people, and act on those judgments. We’re not supposed to do this; non-judgmentalism is a touchstone of our times. But if someone’s behaviour is in my opinion self-destructive, anti-social or detrimental to other individuals or society in general, I will generally tell them. Of course, these days, you can’t write ‘worthless parasite’ in the medical records, so my notes are littered with phrases such as ‘this patient is disabled by inherent moral perplexity’. Well, I know what it means.

One such prize specimen joined our practice and handed in his repeat prescription to be filled. When he came in, it was immediately obvious that his walking stick was more of a badge of entitlement than a mobility aid.

‘My old doctor wasn’t giving me what I needed,’ he explained. That may or may not have been true, but after looking at his prescription, it was certainly the case that his old doctor had been giving him what he didn’t need. ‘Shampoo?’ I asked sweetly. ‘I’ve got a scalp condition.’ I had a quick look. ‘No you haven’t,’ I pointed out, and the black line went through that one.

‘I don’t want to know why you were getting toothpaste on prescription, but you’re not getting it from us.’ Another black line.

‘Have you got gluten intolerance?’ ‘What’s gluten intolerance?’ ‘Never mind that just now. But you’ll not be needing all this bread, pasta and biscuits from now on.’

Then we (well, I say ‘we’…) decided that the morphine, tramadol and diazepam weren’t really appropriate for a 23-year-old with a bad back (investigations all normal) so they went too. So did the protein drinks, because by now I was on a roll.

‘I need a sick note for the disability,’ was his next try. ‘What diagnosis shall I put on it?’ ‘Oh anything, I don’t mind.’ ‘I think I’ll wait for your records before I issue anything of that nature.’ I handed him his new repeat prescription, now comfortably fitting on one side of paper, and he looked at it with disbelief: ‘Where’s all me gear? I’m gonna f*ckin’ complain about you!’

He got up to storm out. ‘You’ve forgotten your stick,’ I told him.

Dr Phil Peverley is a GP in Sunderland