This chapter explores another area of difficult patient interactions and the issue of trust. Inappropriate requests are fairly common in primary care, but we need to consider who defines ‘appropriate’. Communication between professionals is again a focus.

Maggie Brookner, a nurse practitioner of 5 years experience, is working in a walk-in centre on Saturday evening with GP Dr Paul Mathur. Paul recently passed his membership examination of the Royal College of General Practitioners (giving him the qualification MRCGP) and has been working as a locum in different parts of the country while he decides where to look for a permanent practice.

Maggie’s next patient is Moira Whelan. She has not been seen in the centre before. She is a well-dressed and well-spoken 35 year old. She sits down with some difficulty and begins to tell Maggie about the pain in her back. his started the night before while she was bending down to empty her washing machine. She has been in discomfort all night and has just about managed a day’s work as a secretary by taking ibuprofen and paracetamol. She asks if she can have ‘something stronger for the pain’ otherwise she doesn’t think she will sleep at all for a second night.