Take this scenario, for example: patient is seen in glaucoma clinic by ophthalmologist, who notes a cataract in said patient and asks if GP can refer to cataract clinic.
Even more bizarrely: ENT doctor sees patient and asks GP to refer to audiology (which is situated next door to ENT clinic).
Feeling rather like a manager submerged under NHS red tape, I decided to do some telephone triage instead.
'I really must see you today, doctor, it's really important,' J says, anxiously.
'Is it your sick note? Although it would be nice to catch up with your Christmas news, I could do your note without seeing you today,' I say, fishing for clues. I can hear the the build-up of feverish children crying in the waiting room and I am loath to part with an urgent appointment for a non-urgent problem.
'No, doctor, I'll tell you when I get there,' he says, adding ominously: 'Can I have the last appointment of the day so we don't have to rush?' Knowing J's unpredictability (he is either after some orlistat or harbouring a deadly disease), I cave in.
Later, he strides into the room and brandishes what looks like a long bank statement at me.
'It's my credit card bill, doctor. It nearly gave me a heart attack and blocked all my stents, what with the shock and all. I said to the wife, no tree this year, just recycle the plastic one from the attic, and no presents for the dog. I think I've been hit by credit card fraud. We all know what banks are like.' He seemed genuinely upset.
I scratch my head, at a loss to offer suitable advice. 'Did you ring the bank to check the figures?' I finally ask.
'Of course. I told the bank there must have been a mistake, and how my anxiety had gone through the roof as soon as the letter hit the mat.'
'And what did the bank say?'
'See your GP.'
- Dr Aziz is a GP partner in north-east Bristol.