‘They did. At one point he believed his lungs were disintegrating. He lost a massive amount of weight and with that, many of his symptoms became real, but in a self-fulfilling circular way. His blood pressure became so low that he would regularly pass out, then suffer injuries as a result. You can imagine. Anyway, on that occasion, my colleague also recommended a psychiatric referral. He disappeared from view very quickly that time. Thereafter, we heard nothing from him for eight months.’

‘And then?’

‘Then a young man registered with the clinic. As part of the context, you should know that we have over 5,000 patients registered with us and twelve doctors. We’re busy, we perform both clinic and home visit practices, with a high turnover of administrative support staff.’

‘Okay,’ Connie murmured.

‘So, earlier this year, one of my colleagues came to me for advice. We do this whenever necessary, as well as conducting formal weekly reviews. The more junior doctors in the practice have an opportunity to discuss their complex cases with the team, get a second opinion and see if the right approach is being taken. The doctor in question reported that he was treating a young man who was presenting with a series of increasingly serious but unconfirmed complaints. He’d ordered all the right tests, so I recommended continuing to treat as and when he presented.’

‘It was the same patient?’

‘Yes, and alarm bells should have rung then, but we were in the middle of an inspection, and when I read the file, it didn’t occur to me that it was the same man.’

‘But why …’

‘Because he’d given a different name. Presented new documentation. Re-registered. And had specifically asked for a male doctor when previously he’d been treated by women, so he was guaranteed not to see either myself or the other doctor who’d treated him before.’

‘Active avoidance facilitated by fraud,’ Connie said. ‘Clever, organised behaviour.’

‘Indeed. Had the junior doctor not become concerned whilst the patient was still in his office and come to find me under the pretence of his stethoscope not working, we might never have figured it out. The patient had declared himself to be rotting internally. The details he gave were utterly convincing. He seemed to be completely immersed in the illusion. I went to see him myself and recognised him as soon as I entered the room. Of course, he recognised me, too, and left immediately.