I'm not one to make snap judgments about people. But I'm guessing that my next patient, a tattooed, shaven-headed geezer with the demeanour of someone who’s just been cut up on the A12, probably isn't stopping off on his way to the book club.
In fact, given his aura of aggression and entitlement, I can guess what's coming next: something along the lines of a demand for a sickie, a CT scan or 'something stronger than Viagra'. Or all three. My likelihood of caving in to such requests is inversely proportional to the length of the patient's neck. He doesn't have one. Did I mention that?
'I have a complaint,' he begins, menacingly. I'm genuinely confused. Complaint as in 'patient complains of pain'? Or as in 'patient complains to GMC'? I consider sharing this uncertainty with him. It might break the ice. Then again, he might break my legs.
'I'm disgusted with my last consultation here,' he continues. Okay, so that'll probably be: sees doctor with cough; told it's a virus; stomps off to A&E; prises antibiotic from casualty officer; casualty officer mumbles about 'pneumonia' and 'bloody GPs'; blue touch paper lit.
'Go on,' I say.
'The thing is,' he explains, 'the last doctor I saw here gave me a totally unnecessary antibiotic. I only came in with a cold.'
Huh? I've gone from 'confused, slightly' to 'bewildered, totally'. I scroll to the last consultation. 'URTI. Few crackles in chest. Amoxicillin.' Hmmm. So there was no A&E, no feckless casualty officer. The antibiotic pusher was my own partner – obviously running late that day.
The patient continues. 'I thought you doctors were trying to stop dishing out antibiotics. Especially for viruses.'
Incredible. What is going on? Here we have a man complaining that he was given antibiotics. This has never happened in the entire history of medicine. One question remains, though – assuming I'm brave enough to ask it. 'So why did you make an appointment if you knew it was just a cold?'
He looks sheepish. 'It was the missus. My birthday party was coming up. She wanted to make sure I was okay.' I clock his birth date. Of course! It was his big five-o. 'So you didn’t want antibiotics because it stopped you having a drink?'
His face darkens again. 'No ... I didn’t want them because they ended up giving me the squits. Ruined the day.'
Ah. I apologise, I explain, and, continuing to confound all expectations, he accepts gracefully.
Two things strike me about this consultation. First, the message about antibiotic prescribing really is getting through to the punters. And, second, I've made a series of assumptions about this patient, all of which were wrong. Shame on me.
'Well thanks, doc,' he says. 'Must be off – running late.'
A thought strikes me. 'I don’t suppose you’re off to the book club, are you?'
He looks at me as though I've just asked if he's a cross-dresser. 'Nah – the boozer. Can you have a quick listen to my chest first, though?'
Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com and follow him on Twitter @DocCopperfield.
