Hidden agenda is the name of a patient's game

Our patients deserve our respect; they know how to play the game, and exactly which buttons to push.

A few weeks ago I was called to a family party which had degenerated into a scrap. Although we're at peace now, old habits die hard, and calling the police can make things messy. As a non-punitive referee, the doctor remains a better choice.

Initially I declined the invitation, but this, I knew, was just the traditional opening gambit. A whispered conversation went on at the other end of the phone, counterpointed by the merry sound of breaking crockery, which ended with; 'You'd better come anyway, Joe is having chest pain.'

'What is the pain like?' I asked, aware I was being played like a fish on a hook, the difference being a fish has a chance.

'Central, crushing, radiating to the left arm and associated with breathlessness and sweating, probably hypotensive, plus an at-risk history, smokes, drinks heavily and is as fat as an elephant.'

Textbook stuff from the university of the street, I thought, if only our medical schools were half as good.

So, willy-nilly, I had to go, though on a hunch I didn't summon the cardiac ambulance. I hadn't been at one of these for a while, so it was with a small but pleasant sense of nostalgia that I wandered though the heap of struggling bodies untouched, apart from the occasional assault, idly noticing that despite the general devastation, the Sky box, DVD player and TV remained untouched; plus ca change, plus c'est la meme chose.

Mindful of Pendleton's consultation model, so beloved of our GP Training Scheme (back in the 80s, it was, a bit of academia then was a real thrill), I ventured a trifle of opportunistic health promotion. 'No biting,' I called. 'You don't know where he's been.'

I stood magisterially at the end of the room and gradually the combat subsided, no doubt quelled by the authority of our ancient profession and also, perhaps, because the football was starting on Sky Sports.

Ignoring Andy Gray's sexist remarks in the background, I dragged Joe out from under a table. He looked around, checking that (a) the fight was over, and (b) the TV was safe.

'Chest pain gone, is it?' I said.

'Never better,' he said. 'I didn't want to miss this match.'


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