There’s no cure for pedantry

Chronic pain is a big problem. Non-drug measures are inaccessible and expensive, paracetamol has no placebo value, codeine causes constipation and statistics regularly admonish us that patients are dying like flies due to our over-use of NSAIDs.

But now the problem is solved: we can prescribe patches.

Joe entered the surgery with a heavy tread. Constipation, I thought, he’s got the look, but I was surprised.

‘I’m confused,’ he said.

‘Welcome to the human race, Joe,’ I said. ‘What’s the problem? The meaning of life? Why are we here? What do health visitors actually do?’

‘I can’t argue, those are real good questions,’ he agreed, ‘but actually it’s about this patch you prescribed. I use them twice weekly, right?’

‘And?’

‘Call me pedantic, but last time I checked a week lasted seven days, and if my maths is right, 2 into 7 does not go.

‘So, if I start on Monday, do I change the patch on Thursday after only three days, and risk an extra dose of the drug, with all the side-effects, or wait until Friday and suffer the pain again when the patch runs out? Of course, if I do take the patch on Thursday, it runs out on Sunday, so either way I’m buggered.

‘Now, if a week was eight days long there would be no problem, stick on the patch every four days. Or six days long…

‘OK, OK, I get the picture,’ I said, trying to remember what the rep had told me.

She was young and vulnerable-looking, like a newborn fawn trapped in the headlights before it gets hit by a truck, and her manager was hovering menacingly in the background (I don’t mind seeing reps, they have a job to do and are paid to be nice to me and anything is better than seeing patients), so perhaps because of this I had not been sufficiently inquisitive.

I vaguely recalled some colourful graphs and cheap pens, but nothing of practical help, so, as is often the case in general practice, I had to improvise.

‘On Thursday evening, I believe,’ I said accusingly, ‘you go poaching salmon with your cronies, a hobby which your apparently intractable pain does not prevent you pursuing with undiminished vigour.

‘That is the time, therefore, to put on your new patch, because the week is neatly bisected; and don’t look so surprised, a GP has his sources.’

He eyed me for a long moment. ‘I’m glad we understand each other, doctor. I won’t bother you any longer,’ he said, getting up. ‘By the way, I’m awful constipated.’  

Dr Farrell is a GP from County Armagh. Email him at GPcolumnists@haymarket.com

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