Second opinion

THERE is a scheme afoot, so I am told, to teach medical students the elements of literature. Once they have walked the wards, they will turn the pages — com- pulsorily, as a condition of their qualifi- cation. It is hoped that labour in the saltmines of literature will make them into better doctors than they would oth- erwise have been.

Flaubert and Chekhov have been sug- gested as appropriate authors for them to study, and who could object to the choice? But when it comes to dealing with the bureaucracy of the National Health Service, I should have thought a quick course in Kafka would have stood them in more stead. It is never too soon to make the acquaintance of the twilight zone of nameless dread, infinite regress and logical contradiction in which they are going to spend the rest of their pro- fessional lives.

The young daughter of a colleague of mine required a small operation, and the local hospital had promised to let the parents know in the near future when it would be performed. Three months went by, and still there was no news, so my colleague phoned the hospital to find out what was happening.

The young woman at the appoint- ments desk tapped something into her computer, and said in a tone of slightly irritated moral superiority, 'She was supposed to have had her operation two weeks ago, but you didn't bring her to the hospital.'

`We didn't receive the appointment,' said my colleague.

`Yes,' admitted the young woman, `appointments haven't been reaching patients lately. There's something wrong with the system.'

`Then how could we have kept the appointment?'

`You could have called earlier.' `Earlier than what?'

`Earlier than two weeks ago, before the appointment.'

It was clear that further conversation would not merely have failed to resolve the situation, but would have put my col- league's health at risk. It would, in the words of my prisoner patients, have done his head in. The fact is that appointment desk staff in the NHS are recruited solely on the basis of an inability to see any- thing from a point of view other than their own.

Last week, at about a quarter to one in the afternoon, I needed to speak urgently to a patient's general practi- tioner. The young receptionist who answered the phone had one of those sheep-like voices, so common in Eng- land, which tell you at once, from the very first word, that the mind behind the voice is utterly sluggish and only day- dreaming of the weekend, when the per- son to whom it belongs will go clubbing in cheap skimpy clothes.

`Could I speak to Dr S about one of his patients, please? I asked.

`Dr S is half-day today,' she replied. `Could I speak to the doctor on duty, then?'

`He's not on duty yet. Duty starts at one o'clock.'

`Then could I speak to Dr S?'

`He's half-day.'

`Then I'll speak to the doctor who will be on duty in quarter of an hour.'

`But the patient isn't his, he's Dr S's, and Dr S's half-day. And the duty doctor isn't on duty yet.'

By comparison, it is almost a relief to deal with patients. My next patient was in what he called bits because his girlfriend had just called the police to remove him from the common-law matrimonial home. He strangled her about once a week, and she was tired of it.

`Have you ever strangled her to the point of unconsciousness?' I asked.

`Oh no, doctor. I know when to stop.'

Theodore Dalrymple