Patients are like the wildebeest, and we are the lions; we have to split them from the herd, take ’em on one by one, separate out the old and the young and, of course, the sick (we are doctors after all). If they stick together in a herd you might spook them to flight, or they could become aggressive and you could be in for a stomping.
It’s even worse when they are smiling, emboldened by their numbers. Patients should look pensive and worried, or at least shifty.
When they are smiling, you know they have something planned, and they employ tactics designed to confuse.
‘Have you got a cough?’ I’ll enquire.
‘No, but he has,’ they’ll say, pointing at someone who has sneaked up behind you, perhaps carrying a sharp object or a bludgeon or, even worse, a list; as Hercule Poirot used to say, a weapon can always be found.
A rope can strangle, a candelabrum can crush your skull, a list can bore you to death — it is the motive that is all-important.
You swivel round to face the new enemy, desperately trying to maintain control of the consultation.
‘Are you bringing up phlegm?’
‘No, but she is,’ and you realise you are surrounded on all sides, jackals snapping all around.
But as Sun Tzu, the Chinese military strategist who wrote The Art of War in 500BC, once said — we studied his writings as part of our GP training scheme, it was Northern Ireland during the Troubles and we had to know these things — ‘always do the unexpected’.
‘Phlegm?’ I’ll say, my tone rank with fake concern, ‘Phlegm? That’s awful; you definitely need an antibiotic, no, not just an antibiotic, a strong antibiotic, you poor thing, and here’s a cert, take a few weeks off work, put your feet up, lie on the sofa and watch TV,’ and then turn to the first complainant and say dismissively, ‘Absolutely nothing wrong with you, fluids and paracetamol will do you rightly’.
At a single devastating stroke the opposing force has been divided and emasculated, their strategy dismantled and impotent.
Those with antibiotics feel validated and superior, those without feel disgruntled and envious and under suspicion of malingering and exaggerating their symptoms.
All that remains is to disembowel your enemies, drink their warm blood and rejoice in the lamentation of their womenfolk.
Sun Tzu would have been proud of me.
Dr Farrell is a GP from County Armagh.
Email him at GPcolumnists@haymarket.com