Search tips
Search criteria 


Logo of bmjThis ArticleThe BMJ
BMJ. 2007 April 14; 334(7597): 802.
PMCID: PMC1852046
The Best Medicine

No miracles in the NHS

Liam Farrell, general practitioner, Crossmaglen, County Armagh

“It's Our Lord,” said my receptionist, “and before you ask, He has ID, a gold credit card.”

“Hang on,” He said as He entered the surgery, “I'd asked for a doctor that believes in Me.”

“Nothing personal, Lord,” I said, “but to rational people you're slightly less believable than Santa Claus or homoeopathy, all that Samson and Goliath stuff.”

“Hey,” He said, “Samson was a decent hardworking man; runs a barber shop now—or was it then? Omnipresence can be confusing.”

“I'm feeling a bit depressed,” He continued, idly bringing my dead budgie back to life. “Two thousand years, and very little gratitude; when things go well they take it for granted—when they go badly I get the blame.”

“Boy, could I sing a few bars of that,” I said. “The real question is, just how depressed are you?”

“Oh, not too bad, I suppose,” He said gamely. “So I thought . . . maybe a few tablets . . . ”

“Alas,” I said, “the latest guidelines from the National Institute for Health and Clinical Excellence (NICE) on mild to moderate depression are unequivocal; no medications for you, Lord. Take plenty of exercise, eat a balanced diet, and try and get out some more.”

“What else do they suggest?” He said, visibly unimpressed by my lifestyle advice, further evidence of His human side.

“There's counselling,” I said.

“That sounds good,” He said, “I'd like counselling. Where do I go?”

“Hey, we can put the show on right here in the barn,” I said, hoping a Mickey Rooney reference might cheer him up. I patted him on the knee and said, “There, there.”

He seemed to find this unhelpful.

“Anything else?”

“Of course,” I said, “Do you think the fine people at NICE are idiots, that they have no idea what's really going on out there, on the streets? Cognitive therapy is a very effective treatment.”

“Great,” He said, “I'll have that?”

“I have more bad news,” I sympathised. “Because your depression is only mild to moderate, you're not an urgent case. I can't refer you directly, you'll have to see a psychiatrist first, and non-urgent psychiatric cases are usually not seen for about six months, and the waiting list for cognitive therapy is another six months after that.”

“About a year in total,” He calculated, biting his lip. “That's a long time to be depressed. Any other treatment options?”

“Nada, Zippo,” I said helpfully. “Nada, Zippo,” echoed the revivified budgie.

“So what NICE are saying, in effect,” He reasoned painfully, “is that there are no treatments for mild-to-moderate depression.”

“It is you that say it, Lord, not me. Have a NICE day,” I said, getting up and washing my hands.

Articles from The BMJ are provided here courtesy of BMJ Publishing Group