Of all the phrases that patients use to rub saline into the wounds of us poor frontline GPs staggering our way through the primary care battleground, and God knows there are a few, I would like to nominate as the very worst, the following: ‘I know I should have come sooner, doctor, but you know what I’m like’.
This is absolutely always in reference to a symptom that not only should not have been presented sooner, but had no need to be presented at all. And in a patient who, yes, I do know what they’re like, and what they’re like is someone who attends repeatedly and unnecessarily and who spouts such self-martyring, self-justifying bollocks that consulting with them is not unlike having a red-hot poker repeatedly rammed up your rectum (I’m guessing here, obviously).
What I do know, GMC, look away now, is that it makes me want to punch them in the face
I’ve heard this phrase from patients countless times, yet I am still unable to work out whether:
1. They have absolutely no insight whatsoever and genuinely believe what they say.
2. They have total insight and are using this phrase as a kind of reverse psychology defence mechanism to protect themselves from the embarrassment that, here they are again, in a totally unnecessary consultation.
What I do know (GMC, look away now) is that it makes me want to punch them in the face. And for that, I feel deeply ashamed. On the other hand, this might represent the type of communication these patients genuinely understand, and could therefore alter future illness behaviour in a way that benefits everyone. So, patient, I should have done this sooner, but you know what I’m like….
Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield