Why did this woman come every Monday? Was it market day or bingo?

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Indy Lifestyle Online
Are you a supernova*, a freight train or a necklace? For your GP's sake, I hope you answered none, for they represent patterns of frequent attendance at the surgery. Supernovas come in incredibly intense bursts over the course of a month or so, freight trains come at regular spaced intervals throughout the year, and necklaces, bless them, come at regular intervals but without the spaces. These sparkling metaphors are the work of GP researchers at Leeds University, who analysed every consultation in four surgeries between 1990 and 1995. The 753,109 consultations encompassed 63,760 patients, which averages out at 2.4 consultations per patient per year. If only it were that simple...

The top attendee, Queen Necklace, pitched up at the surgery 250 times in the five year stretch. Others were not far behind, with the top 3 per cent of attenders hogging 15 per cent of the doctors' time. No attempt was made to record appropriateness of the consultations - patients with lots of problems need lots of time - but one can't help feeling there were a few doctor-dependent whingebags hidden among the chronically sick. Witness the following wailing room exchange: "I've made another appointment for three weeks' time" "What for?" "I don't know - but something will come up."

The mature doctor recognises that if you want to offer equal access to healthcare for all, then it encompasses the whole spectrum of human behaviour from "hide your lump at all costs" to "phone for an ambulance every time the dog farts". There isn't an awful lot you can do with those who refuse to see the doctor, except cry with them when they realise they've left it too late. As for the frequent attenders, you can strike them off your list if you think it's appropriate and you don't mind being lampooned as a heartless bastard in the local press.

An alternative is to apply for a research grant and study, categorise and pigeon-hole them. Hence Mrs Amy Perkins from 3, Bridgwater Avenue becomes Fanny Freight-train, but only in the privacy of the coffee room. Labelling patients is fun and makes doctors feel a lot more secure in the face of stress and uncertainty. Unfortunately, it doesn't make us practice better medicine.

Our friends in the north also looked at which days the frequent attenders attended. Queen Necklace came every Monday for three and a half years, with only a seven-week gap of respite. Was this for hospitalisation of patient - or doctor? And why did she come every Monday? Was it market day or bingo? Sadly, these questions remain unanswered. Some patients chose to invest all their attention in a single doctor, while others preferred to spread their bets across several. Within each practice, some doctors got lumbered with lots of frequent attendees, others seemed very adept at discouraging them. The sex of patient and doctor was not disclosed, but my guess is that most frequent attenders are women and most of the doctors they choose to see are women (more empathy, more patience, more guilt).

Also undisclosed was whether any patients were related. If Queen Necklace is Fanny Freight-train's sister, they're likely to catalyse each other, and you can predict a double supernova at Christmas. Family behaviours are very deep-rooted (my mum always took me and my sour throat to the doctor, so I still go and so do my children) and are very hard to change. The Leeds team are busy gathering more information, with the aim of understanding, predicting and perhaps modifying these bizarre patterns.

I say bizarre because I know very few people who enjoy a visit to the doctor, or who can't think of something else they'd rather be doing. I don't just mean my nice middle-class friends with comfy, interesting lives - patients with uncomfortable lives and no disposable income don't like it, either. Some have to come regularly by virtue of their illnesses, but otherwise, would you pay a social visit to a pompous man in a tweed jacket? I hope not.

I predict that in Leeds, as in the rest of the country, the regular attendees will be found to have genuine problems which are beyond the scope of medical science. Fatigue, flatulence, freckles, whatever - we can't cure you. A Hertfordshire GP tells a story of such a patient who had plagued his practice over many years with headaches of unknown origin. Every test had drawn a blank. One day, the GP finally cracked. "The only way to find out the cause of your headaches is an autopsy." "Anything, anything," replied the patient. "I'll even go private."

* that star which catastrophically explodes on the scene, suddenly becoming millions of times bigger so that it can dominate a whole galaxy.

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