You may remember the cheerfully upbeat but slightly vague young man who has visited us from time to time over the past few months and extracted prescriptions for relatively modest amounts of diazepam and codeine each time. I mentioned that he recently experienced a degree of resistance from the heroic Martha. Meanwhile, Myrtle has done some digging and become convinced that he is registered with several practices in different parts of the country, and possibly other practices as a “temporary resident”. He came in today and told me that he had been recently admitted with his problem to a hospital in Shining Town, which is not too many miles from Urbs Beata. He also told me that during his admission the consultant had told him to ask me for a referral to a surgeon locally to treat his condition. One can see where this was leading. I would have busied myself in arranging this referral, which would fix the severity of his condition in my mind, but also its temporary nature. For once he has been operated on everything will surely clear up and there will be no more need for diazepam and codeine. It would have been a simple matter to extract a further prescription from me, almost as an afterthought, as he left.
However, thanks to Myrtle's undercover work I was able to point out that during his admission he had given an address in another part of the country altogether. He looked slightly vague and said “oh yes, I used to live there”. Then something happened that I have never experienced before. He ignored me completely, turning his face away and saying nothing for over half a minute - which is an extremely long time to ignore the doctor during a consultation. He was clearly thinking hard and did not want to be interrupted. I have known patients stop to think during a consultation, but it has always been in response to a question I asked and no-one has ever totally ignored me or thought for such a length of time. I am certain that he was thinking about the implications of what I knew and how he could best extricate himself. When his attention returned to me I said that I would ask his consultant to fax me a copy of the discharge letter and then make the referral. He looked pleased, and left quickly without asking for a prescription.
So top marks to the redoubtable Myrtle who was clearly not born yesterday, and has more “nous” than a coachful of Yorkshire folk. And that's a lot of nous, believe me! She will shortly spread the news of these events to everyone in the Health Service who has the right and need to know.