The Menace of Specialism

Dear Doctor,

Thank you for making me see this pleasant man. While X-ray shows a moderate degree of arthritis he has the most beautiful set of knees. I remember enlightening this man last year that he may stake a claim for a new set knees only if he remains in pain despite maximal analgesia. You failed to try anti-inflammatories and have instead asked me to see him again. He has told me that anti-inflammatories were not tried as he has a history of bleeding gastric ulcer that nearly killed him a few years ago. I gently reminded him that I deal only with knees and for problems like that he needs opinion of a different specialist, namely gastroenterologist. This pleasant gentleman kept moaning how his knees were making it hard for him to care for his wife with dementia. Again, that is a wrong problem to tell me about. I am a knee specialist, but I think he and you should be contacting social services for that.

We had a rather animated 30 minute discussion. I have clearly explained to this man that my conscience does not permit me to offer knee replacement until he has done the sufficient amount of suffering. At this point this pleasant gentleman let out a loud cry and stumbled out of the room holding head with his hands. I think, he has suffered a subarachnoid haemorrhage and believe that he should be referred to the Emergency Department. I leave that decision in your competent hands.

I have made arrangement to see him in three months.

Yours sincerely,
Mr Knee-Expert



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2 responses to “The Menace of Specialism

  1. Dear Mr Knee expert
    You were wrong. This pleasant gentleman wasn’t pleasant. This was clearly an observation you do not have the expertise to make. In future, before making such an assertion, please refer these subjective matters to me or another psychiatric expert for an opinion.
    I have assessed his unpleasant status based on his repeated insistence, noted by you, that I see his wife with a view to her alleged dementia. I explained that accurate psychiatric assessment requires the ability to coherently answer questions, as we are not mind-readers!
    His wife allegedly lacks this capacity and is therefore unsuitable for psychiatric assessment. I have suggested she attend a specialist dementia clinic for diagnosis, which first requires an Aged Care Assessment, followed by a referral to one of this city’s two behavioural neurogeriatricians for treatment. It was at this point that I discovered that the pleasant gentleman was not pleasant.
    Unfortunately, following this discussion, I did not have time to assess the gentleman’s own potential psychiatric condition. I have therefore asked him to see me in four month’s time at my city office on the 14th floor. The building elevator will be closed for repairs at that time, so I would appreciate your prior assessment as to whether his knees are capable of facilitating his attendance.
    Yours sincerely
    Dr Psychiatrist

    (I blog at although do not suggest you waste your valuable time reading it. I never write about knees.)

  2. Dear Dr Psychiatrist,

    Thank you for copying me your letter to Mr Knee expert. Your blog is just the sort of reading we all benefit from. I have printed out your post “The non-linear consultation” and posted it to Mr Knee Expert. I hope you don’t mind.

    Happy Doctor 🙂

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