Dr Phil Hammond

Every now and then, a reporter will try to collar a few doctors and ask them to tell the camera which patients really piss them off. No names, of course, just the personalities. I've never known a doctor foolish enough to fall for this caper, although some have started to reply before thinking better of it: "I tell you who really gets my goat - that stroppy git with the perm and the truss. Oh no, can you scrub that one. I'm seeing him on Friday ..."

Most of us hide behind the confidentiality clause in these situations. We must speak only in general terms that don't allow a specific patient to be identified. Even if you leave out the name, letting slip the patient's job or hernia size or the fact that she only ever visits the surgery at 5pm on a Tuesday may allow someone to twig who you're talking about. Patients are often told that each and every consultation is "completely confidential", but interesting encounters frequently resurface in the coffee room, the car park, the postgraduate centre, the after-dinner speech, the research paper, the media campaign, etc. Within a practice, names are mentioned, but outside of it anecdotes are supposed to be shorn of all identity tags.

So when a GP tells the press that he was called out by a patient at 3am to rescue a hamster, we can comfortably assume that the occurrence is so common that none of his hamster-loving patients can be certain their confidentiality has been breached. "No, it's not your hamster I was talking about, Mr Jones. It was Miss Marple's ..." This confusion can be avoided if the doctors themselves refuse to be identified. There are 6 million hamster owners in the UK alone, all of whom regularly call in the GP when one goes missing; unless the hamster's name or unusual markings are mentioned, the anonymous doctor is relatively safe to tell his or her story.

So here, then, are the bona fide stories of anonymous difficult patients, from a group of anonymous GPs. If you recognise yourself, you can rest assured that there are plenty more like you out there.

"As a female GP, I see mainly women and children, and men are a rarity. The ones I find difficult are the businesslike older men. They make me feel inadequate, and I'm not sure why. Perhaps I don't see enough of them to feel confident, but I find it very hard to tune into their - wavelength. I'm sure they perceive me either as a nurse, or of lower status than a male GP, and it's not uncommon for them to try to pull rank on me."

"I'm the token man in my practice, and I get really thrown if a woman comes to see me to discuss HRT. I think 'Why me? What's going on here?' I know it may just be that I've seen them for something else and they're being loyal, or perhaps they prefer seeing a male doctor. But I'm not convinced. I mean, what woman in her right mind would go to a man to discuss vaginal dryness?"

"I find it hard to deal with people who are similar to me. I mean other educated, middle-class professionals. They tend to be more demanding, less grateful, less tolerant of the shortcomings of the NHS. And they're used to being in control. I find it very difficult to get the doctor-patient relationship right."

"I get stressed out by polysymptomatic patients. People who come in with a great list of diffuse symptoms covering practically every body system. A wave of despair comes over me: how the hell can I sort this lot out in eight minutes?"

"If anyone comes in and demands that 'something must be done', it immediately gets my back up. Usually it's a relative rather than a patient, and often they feel guilty because they themselves haven't done more. It really grates when they live 200 miles away, do a flying visit on Mother once a year and then throw a wobbly about the state she's in. It makes me angry because they're implying I'm not doing my best - but I also worry in case I'm not."

"I hate patients who think - or pretend - they are your friends, when you don't know then from Adam. They call you by your first name to try to worm their way into your affections. Perhaps they think they'll get better treatment, but it just puts me off."

"Doctors as patients are really stressful, especially when they're consultants. I immediately get stuck in the role of junior colleague, and I feel as if I'm being tested all the time. It's even worse if they consult about their own specialty; I've just seen a chest physician with a cough." "What did you say?" "There's a lot of it about." "And?" "It's probably a virus - but then I ordered loads of inappropriate tests and X-rays. You know - because he was a consultant."

"I'm very uneasy seeing members of staff as patients. The doctors are all registered at other practices, but no one else. Last week I had to do a rectal examination on the practice manager."

"I hate picking up other doctors' mess. Last week, I saw a woman who'd been in hospital for a routine operation. I hadn't had a letter back from the surgeon so I asked, 'What did the doctor tell you?' 'He said I was going home to die.' She looked quite well on it, but I presumed they'd found something awful when they'd opened her up, so we had a long chat about making wills and pain relief. When I got back to the surgery, I called the doctor for more details. He was very surprised and very Australian: "I told her she was going home today." *

*Note: there are lots of Australian doctors working in the NHS, and this misunderstanding is extremely common. It is also equally likely in a Scottish accent. Hence, it is not possible to prove a breach of confidentialityn