Zara Aziz: When GP appointments are not routine

Start as you mean to go on, I have always been told. But it was only my first patient of the day and I was already perspiring terribly.

This particular patient was proving to be challenging: she had a rather deep implant in situ and an aversion to needles.

She had already jumped off the bed twice and nearly sprinted out of the room while I was still donning my gloves.

'How did you agree to have this inserted in the first place?' I asked; I was interested to know.

'I took some of my mum's diazepam beforehand and slept through it all. When I woke up, I had a bandage on,' she replied, helpfully.

'And did you take some diazepam today as well?' I asked her, hopefully.

No, she explained, her GP had stopped her tablets, he said she needed to have a medication review first.

I decided that it was time to take the bull by the horns and just go for it.

Thirty minutes later, there had been a lot of tugging and pulling, and that was just the patient hanging on to me for dear life. But finally, I had the elusive implant in my hands. I held it up in triumph, but the sight of the bloodied plastic was all too much for the patient to bear, and she was reaching for the vomit bowl.

At the end of all this, it was difficult to say which of us was feeling more traumatised.

The next patient had been kept waiting while this was going on and came in to the consulting room with a very determined look on her face.

'I really can't be doing with these 10-minute appointments. I have a list with me and I am going to talk until you throw me out,' she exclaimed as soon as she entered.

This made me smile. Was this a good time to tell her that our routine appointments are actually 15 minutes long?

'I want a referral to a gynaecologist and I need you to look at my moles and examine my breasts ... and I need a different pill ... I think that's all for today,' she announced. I felt myself deflate visibly at that point. But then there was a knock on the door and in came rescue, in the form of a nice cup of tea.

  • Dr Aziz is a GP partner in north-east Bristol.

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