I sometimes write patients' comments verbatim in the notes, particularly if what they say gives a flavour of the consultation that would be missed in bald summary. So here are a few things that my patients have been saying to me recently.
A cheerful, plump and slightly simple woman came for a review of her medication. She told me enthusiastically about the new friends she has made in forums on the internet. I could relate to that. It seemed that she was aware of some of the dangers of using the internet, and that people are not always who they claim to be. She told me about a story she had heard on the news concerning a man in his forties and two very young teenagers: “he was groping them on-line”. This delightful malapropism made me smile.
Then I saw a confident, cheerful and slightly vague young man who, I am almost certain, has been pulling the wool over our eyes. We have seen him frequently over the past few months, each time prescribing a small quantity of diazepam and codeine. There has been a compelling but slightly vague story as to why he needs them which alters slightly each time. There have also been a number of convincing reasons why he needs the tablets earlier: accidents with washing machines, suddenly having to go away for urgent reasons, that sort of thing. And on one occasion when a partner was firm with him he registered with another practice nearby, only to rejoin ours a week later. I don't know why we fell for it this time, we are usually quite good at detecting this sort of manipulation - as shown by the fact that we rarely see such patients. Perhaps we have grown slack, or perhaps our defences are down because of the stress we are working under at present. It would be good to discuss his case at a Significant Event meeting.
During our latest consultation he was talking optimistically about things getting better soon so that he could return to work. He then asked for more tablets because he had to go away urgently. I told him that I would give him a few more codeine but no more diazepam, and he should tail them off using the ones he had left. He accepted this with his usual airy cheerfulness, and as he left he said “I'll maybe not see you again”. In context this related to his assertions that he was getting better. What I think he was actually saying was “so long, and thanks for all the fish”. I have made a note in his record so that if his next practice rings us about him the staff will be able to report my suspicions.
Another man came for his annual review, which took very little time because he only takes one drug for one condition. He is just a little older than me and each time we have a congenial chat about how he is getting on in life. I am secretly a little jealous of him because he has switched easily between occupations and his retirement is coming up before too long. Each time our conversation picks up where we left it the previous year, and each time I think “is it really a year since I last saw you?” He evidently thinks much the same, for his opening words were “another year gone by!”
The same idea cropped up last week when I saw my retired professor of English with whom, you may recall, I have an excellent relationship. She mentioned that it would soon be time for the annual 'flu jab, and I ventured to say “I have measured out my life with 'flu vaccinations”. This was of course an allusion to a line from The Love Song of J Alfred Prufrock by T S Eliot. “That doesn't scan” she snapped. I then had the colossal cheek to reply “Eliot rarely does”. Her attitude immediately changed to that of a tutor dealing with a much liked but woefully ignorant pupil. “More often than you'd think, actually” and she went on to point out that “I have measured out my life with coffee spoons” is actually a pentameter. I must have looked crestfallen, for she generously added “it's my job to know that, not yours”. Our relationship is good, as I said, but it certainly keeps me on my toes!