Instead, we must persuade Mrs Jones of the merits of a diuretic then refer her to the continence services using a four-sheet faxed form to SPOR, who will reject it if we omit to sign a statement saying that she poses no immediate threat to their health, what with her axe wielding murderer past and all that.

However, the challenge inherent in the new, micromanaged NHS is never more vivid, the disease illness model never deeper, the agenda gap never more pronounced than when Miss Freely Available comes to ask for breast enhancement, and I am overpoweringly aware of the giant bucket of chlamydia screening kits placed deliberately in my line of vision by the nurse. We have a testing target and we haven't hit it.

Miss Available has a healthy dislike of taking any drug that she cannot buy in a nightclub and an unhealthy appetite for the kind of bad boy that got Olive Oyl into all that trouble with Popeye when I was a child and spinach was still good for you.

She is, she says, pyschiatrically distressed, because she is hoping to be a celebrity and this is no longer possible without breasts that stop other people from breathing on the underground.

You would think this would be simple, but it isn't. As her rage at the ridiculousness of being a C-cup washes over me, I wonder how to introduce chlamydia screening with delicacy and tact, without implying that her regular requests for the morning after pill suggest she is, in medical terms, at risk?

What clever phrase will help me make the mental leap from patient's unmet demands to doctor's unwelcome questions with aplomb? I dive in with a gentle reference to the difficulties with modern sexual relationships, but it goes badly. She leaves upset because she never knew he was seeing Chlamydia and even if she had known, with her breasts she has to take every man she can get.

• Catch up with Mary's Road to Revalidation blog