A registrar writes... on patient choice

When it comes to prescribing, I tend to choose something that I am familiar with, or something that has been drummed into me as being the cheapest and most effective option.

However, life is not so easy when patients start asking me about options not listed in the BNF or MIMS. To be honest, a little bit of me wants to ask them if they don't think I have enough to do or how they expect me to know the answer.

Take, for example, Mrs H. She came in with a rash on her hands. It had started about the same time that she had changed her washing-up liquid. Perhaps she should go back to her original brand and use some gloves, I gently suggested. She launched into a discussion about which washing-up liquids got more grime off, which left the suds clinging, and which had a better fragrance. Trying to extricate myself from this was useless. Mrs H wanted to know which brand I use and would not leave until I had sold my soul. I was running 30 minutes late and giving her aspirations towards an ecological lifestyle - my particular vice - seemed sensible as an exit strategy. 'You're sure that's the best one?' said she as I showed her the door.

Mrs D came in next. She had had a miscarriage a few weeks ago, an unplanned pregnancy that did not happen, two children under three years old, another two in care - it would be a lot for anyone to cope with, especially at the age of 21. She was upset but I was determined to talk about contraception.

'But doctor, I think I should get pregnant again, it might help me to forget the child that I flushed down the toilet,' she said. I tried reasoning and I tried sympathy, but Mrs D really did not care what I thought; she was going to seek solace in the one thing that she was certain she could do for herself.

By now it is nearly afternoon and already I am exhausted by the weight of responsibility that people expect from me, and the lack of advice that is taken. We are told to give patients more choice. But if they can't choose their own washing-up liquid, how are we going to discuss which hospital?

Perhaps I shall look for a product that I can emblazon with 'as recommended by your doctor' and hand out to patients. Do you think that will fulfil my Choose and Book commitments?

- The author is a GP registrar in London.

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