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.