Always set the tone early on

When I was young I used to play gaelic football, and it was a real man's game. I wasn't skilful, but when I pulled on the same red and black that my father and my father's father had worn I was very effective.

At the start of each match I would fake as if to shake hands with my immediate opponent, then give him a thump and say - editing out the expletives - 'There'll be plenty more of that when the ball comes, pal.'

Nasty and vindictive and morally reprehensible, yes, but winning that first ball was vital, because it would set the tone for the whole match.

Many years and qualifications later that little life lesson remains true: first impressions are best, start as you mean to go on, shoot first and ask questions later, you can bring a horse to water but a pencil must be lead. OK that makes four lessons.

Being traditionalist where I come from - a more politically correct term than 'backward' - we are firm adherents to the concept of open surgeries; appointment systems are viewed with suspicion, undermining the right of every patient to queue, the queue being not just a line of people but something much greater, the ordinary man in the street's forum for complaining about life in general and the health service in particular, a sign that the liberal pinky communist elite - probably all homosexuals as well - were at their clandestine work again.

So if I peek into the waiting room and see, for example, six people waiting, the first few I'll call will be those whom I know can be sorted out most expediently.

This sets the right tone for rest of the queue, creating the right level of expectations; if everyone else is coming in and out like a jack-in-the-box, hopefully the average patient will think hey, I'd better do the same or suffer the opprobrium of the masses on my exit.

The smart patients, of course, have learned to play the game equally well. They know that, in the early hours of each day, my desperation for speed means they can ask for and receive whatever they want without prolonged discussion and argument.

Antibiotics, sleeping tablets, sickness certificates - during these crucial first few minutes I fire them out like confetti. In return the patients co-operate and do not renege on the unspoken bargain. They run in and out of the room like they're being fired from a revolving door, cranking up the energy, emphasising the necessity for rapid turnover.

Their motives are not altruistic, of course, but self-interested; I have taught them well.

- Dr Farrell is a GP from County Armagh. Email him at

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