Tale of a chill and a chancer

Medical Matters:'Are you a doctor?" he asked, just on the suspicious side of aggression. Despite the fact that I was standing at the out-of -hours co-op door with a stethoscope around my neck, nobody was going to put one over on him. He entered the room, ignored the proffered seat and began as I knew he would, with: "I'm not the type who usually comes to doctors".

Of course not, his wife made him.

"My wife made me." Why would he go to doctors? He was in his 30s, as strong as an ox. Did he think that I would think less of him if he did go to doctors? This was one on whom health promotion had missed out. His eyes roamed around the room in a shifty kind of way.

"I don't know if it's a flu or a cold. My mother says it's a flu, but my wife says it's a cold. And someone else said it's a chill. I don't know. It might be a chill, but it feels more like a cold."

The average time it takes a doctor to interrupt a patient is 21 seconds, but in this case it would probably be understandable to do it more quickly. Nevertheless, I let him ramble on like this for a few more sentences until he abruptly changed tack.

"Anyway I need an antibiotic, and not penicillin, it's no good. It doesn't work."

I mildly suggested that it had been found to be good in quite a few cases when he interrupted. "No it doesn't work on me."

I started to explain that the antibiotic was supposed to work on the bacteria, not on him, but as he was looking increasingly impatient I cut it short. As I checked him over I reflected that it was probably the fault of car mechanics. A man like this would be likely to tell the mechanic what was wrong with the car and how to fix it, and so cut out unnecessary time and expense. And the mechanic would resent it, and take him to the cleaners. Years ago doctors probably blamed blacksmiths, or carpenters . . .

"Well?" I was brought back to the present.

"Well what?" I said.

"Is it a cold or a chill or the flu?"

Let me see, no previous history of note, no temper- ature, normal examination apart from a slight runny nose.

"It's a cold," I said. He wasn't convinced.

"So what antibiotic do I need?"

I had been here before, so often. "None. It's a virus. Antibiotics don't work on viruses." I had a longer speech, about taking it easy, about droplet infection, and garlic and vitamin C, about how antibiotics had side effects, and what I would do myself if I had a cold. But what the hell, it was 11 o'clock on a Friday night, he had the symptoms for five days but thought them not important enough to miss an hour's work, but conversely important enough to drag me out to see him. He wasn't listening anyway, being too indignant to take it in.

Of course I had to ask him for money. Receptionists, sensibly, are averse to working weekends, and he showed every sign of departing without paying.

"Fifty euro!" he exclaimed. "Fifty euro! You have it handy, is all I can say."

I would have gladly have forgone the money to have been rid of him and his blasted cold, or chill, or whatever the damned thing was.

"What do you do yourself?" I asked sweetly.

"I'm a car mechanic." Bingo.

"How much do you charge for a call-out?" "Well, it starts at about €80 and goes up from there, but I have to pay for premises and equipment, and there's overheads and staff."

As we walked towards the door my point visibly dawned on him. He stopped in his tracks, and stared at me. Then a big and not unfriendly smile spread over his meaty face. "I know what you're getting at, you chancer you. But you see, there's a lot to what I do. All you have to do is look at an ould throat and tell me I'm grand."

He hit me a resounding punch on the arm at the good of it all. I resisted the urge, with difficulty, to punch him back .

At any rate, he seemed to have overcome his initial hostility, and now seemed rather fond of me, as if he respected my cheek.

He climbed into his gleaming car, which towered over my modest motor, and affectionately shouted out the window, "You're some chancer," then drove away, shaking his head in an appreciative sort of way.

As a consultation it was hardly textbook. But look at the positives. I had excluded major pathology, reassured the patient, contributed to his education. He had a story, I had a story. There have been worse transactions.

Pat Harrold is a GP with a practice in Nenagh, Co Tipperary.