A routine referral

GPs are an amazing repository of anecdotes. Sometimes these relate to some amusing encounter with a patient or how things used to be in a mythical golden age of medicine. Stories can be a powerful means of stimulating reflection and the current state of health care is providing a generation of doctors with plenty to think about. Let us admit to ourselves that change is inevitable; technology, information and societal expectations have already changed what being a GP really means. Accepting this does not mean we cannot be powerful and influential agents of the process. What anecdotes will this new GP decide to share? Is the narrative of how we arrive to the future already written or can we make changes today to create a different story?

A routine referral

This week I was confronted with a patient who confidently asked to be referred for telomerACE therapy. He’s seen a targeted advert online and predictably it told him to speak to his GP for further information. Of course, I had no idea what he was talking about but luckily I didn’t need to. Since the patient notes had become primarily a means of conversation documentation instead of a record of concise medical information, all clinical interactions were audio transcribed verbatim. Not only did this have great value in automatic litigation claims, it also had the benefit of creating algorithms for the computer to recognise my ignorance. A live chat window appeared on my monitor and a member of the medicine management team was now party to this increasingly challenging consultation. I don’t know his or her name, or even if they were really human (the heavy investment in NHS artificial intelligence had hit a snag when it was realised that blaming a computer for a mistake would never do). Regardless, the rapidly emerging screen text informed me that I really should have been aware of the implementation of The telomerACE Strategy. Another pop-up appeared stating that a multi-source feedback comment would be automatically completed about this transgression and then quickly disappeared. The patient increasingly inpatient told me that he suggested I complete the mandatory online module and that I could give him a text message if there were any problems. I clicked on the link which appeared on my screen:


telomerACE: A revolutionary cure for ageing

Learning objectives:
1. Understanding the mandatory implementation of telomerACE therapy
2. Understanding the mandatory acceptance of telomerACE therapy
3. Understanding the mandatory unquestionable benefits of telomerACE therapy

Clinical research has proven that age is the leading cause of death in the civilised world. Evidence has shown that amending the telomere gene sequence results in a cessation of aging and can perpetuate life indefinitely (excluding death by accident or suicide). The telomerACE Strategy provides patients with an option of age prevention therapy in lieu of fertility and older age financial benefits. Economic models have predicted that the increase in taxable revenue over an indefinitely extended working life will probably be at worst cost neutral and at best miserable. Therapy is mandatory for healthcare staff due to the workforce shortage and the inevitable pension crisis which can now be indefinitely postponed.

Testimonial 1: I suppose it’s just like the mandatory flu vaccine really, I would be a bad doctor if I didn’t have it.

Testimonial 2: I always thought that death was the most cost-effective outcome for the NHS. I realise now that I was wrong and you are too.

Testimonial 3: Just before you quote me, what did you say would be the best way to convince them?


I continued through the module and it became apparent that The Gods of Medical Conduct had determined that telomerACE therapy for healthcare staff was obligatory and that a new tickbox would appear in my appraisal portfolio right next to my probity and health declarations. At that moment, the window shutters in my consultation room automatically started to drop down indicating that my next patient had arrived. My consulting room was at the end of the corridor, so I had a few seconds to reach into my desk draw to retrieve my vitamin D tablets and swallow one of them before the door opened.

-by Dr Sati Heer-Stavert

Sati is a GP and blogger at Unexamined Medicine. He has an interest in philosophy and its relevance to healthcare. His blog contains short tutorials for doctors and trainees. He in no way endorses the fictional drug telomerACE nor the catastrophic social and political consequences it delivers.

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