You know that a duty surgery is not going well when two or three GPs pop their head in and ask you if you are OK. I was a registrar in a large urban practice that was surrounded by pockets of supported and social housing.
The screen said, “New patient, needs to register, needs medication.”
He didn’t sit down, but paced around the room, shouting at me how he’d been sectioned and then been seeing the Home Treatment Team. But now he’d moved house and needed some more medication, now.
Flustered, I tried to talk to him, and also register him on the computer system so I could generate a script for him. The delay just aggravated him even further.
“Why didn’t you just write a script on the pad you take for home visits?” asked my trainer later that day.
“Because I’m stupid!” I answered, “I hadn’t even thought of that.”
“When the alarm bells are going off, and you have a potentially difficult patient like that, you just do what you need to do to get them out – whether that’s a script, the alarm or whatever,” he advised.
I nodded. Had I become so reliant on computer-based prescribing that I thought I needed it to write his prescription properly? I didn’t think so, I simply hadn’t thought of an exit strategy.
“Just give me my meds or I’m going to kill myself!” he shouted, “If you don’t believe I need them, then call the Mental Health Team.” He didn’t hit me, but pushed up against me, as if we were packed in tightly on a commuter train. He shouted the telephone number, which I recognised.
I dialled, and for once I managed to get through to the duty worker. They knew the angry young man and spoke with him whilst I carried on with the superfluous task of registering him. To this day I don’t know if I did it correctly.
I took the phone back off him, “We’ll see him later this morning, just ask him to make his way over here.”
“Great, thanks” as I hung up the patient stormed out the room, swearing at the top of his head.
He never did get his script off me. A series of concerned faces appeared at my door. The consultation had been somewhat surreal; I remember being convinced at the time that everything was going to turn out fine – perhaps a coping mechanism, or just wishful thinking. I wonder now if by fixating on the script-computer issue I had become blind to the potential danger I was in and to other ways of solving the situation. I guess mistakes like that are what registrar years are for.