A serious case of a second opinion

Mrs Cross was not happy. Her blood tests were all normal.

I had done my spiel on calories and she still wanted to know why she had a big stomach. Someone had scanned it, so determined was she that its growth was independent of her energy intake, but our colleagues in ultrasound had convincingly demonstrated a hearty layer of fat and now Mrs Cross wanted to know how I was going to get rid of it. She had put on half a stone.

The news that the words 'all' and 'bugger' described my planned response did not go down well. Mrs Cross thought I wasn't taking things seriously.

It's a GP problem. We hone our strategies for dealing with this sort of query until they are as shiny as a policeman's helmet badge, and then we offer them up with care. Yet sometimes it goes down with the gently convincing charm of a 30 foot concrete hippopotamus fired from a catapult.

There is a point, though, when we can do no more. What then when the patient glares challengingly, elbows the metaphorical hippo aside as if it were a feather boa, and says: 'Well I'd like a second opinion.'

What are the options? There's plan A - tempting - to respond that my second opinion is exactly the same as my first. Plan B - give her what she wants. (I wander, Dr Who-like into a parallel Universe in which I cry: 'My God, I should have seen it at once. Your Serious gland is exploding. We must rush you to Colchester for a panproctoseriousectomy, from which you will emerge looking like Claudia Schiffer, only with even better hair.'). Sadly there are obvious problems with Plan B and I regretfully ditch it.

Plan C involves passing her on to a consultant who will hate me until he retires, and I don't yet know who's the oldest consultant in Colchester, and there isn't a Plan D. I meet her gaze squarely and explain this until she leaves in a huff. There are days when without chocolate I am nothing.

Dr Selby, a GP in Suffolk. You can write to her at GPcolumnists@haymarket.com

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