Rheumatology clinic, where I see patients who tend to be middle-aged, female, and well-versed about their medical condition (because they've had it for ages) and some of them are the most bizarre patients I've ever met.

A middle-aged woman comes in with her husband. She is on a couple of long-term meds that haven't needed changing because she's been stable. Today, her condition is still stable. Her blood tests look great. She has no joint pain. This is great, I think. A quick and straightforward consultation.

Oh, how naive that thought was.

She tells me she has hair loss. How much? I ask. Oh, she doesn't know. But it's a lot. I check her medications. It's not a known side effect. And it's not related to her condition, either. Perhaps it's stress? Or age-related? I make a note to check her thyroid at her next follow-up. I explain my plan and she interrupts me.

She tells me she has very sweaty soles of her feet. Again, not related to her rheumatoid disease or her meds. I'm not exactly sure what I'm expected to do about these symptoms. Just when I'm thinking, she whips off her shoes.

She whips off her shoes. In my clinic.

She has no socks.

And she wipes her hands on the soles of her bare feet to show me exactly how sweaty they are.

I tell her that's not necessary in a consultation. She reiterates they're sweaty. They're sweaty. OK, I tell her. I'm checking your thyroid. She doesn't have signs of hyperthyroidism, but I'll check anyway. I try to explain my plan again, and, again, she interrupts me.

She tells me she has a foul smell in her nose.

For a second time in the same consultation, I'm not sure what she wants me to do about that symptom. It's ENT, if anything, and not medical. She has had a sinus infection recently. No fever and her blood tests are normal. I mean, she could have a collection of something pus-like after a really bad bacterial sinus infection causing a bad smell, but those usually have fevers and the patient wouldn't be well enough to wave sweaty bare feet in my clinic. I offer to refer her to ENT (which is not my job; referrals not related to her medical condition should be done by general practitioners).

She doesn't answer my offer to refer and just repeats the same thing about the foul smell in her nose.

I just start typing up her referral letter. As I'm concentrating and typing away, she repeats her symptoms at me again. Hair loss. Sweaty feet. Foul smell in her nose. Oh, and she has a bit of vertigo after her sinus infection (which is not an unusual event).

I tell her "OK, just let me type up this letter for you", insinuating that she should shut up and let me concentrate. I'm trying to formulate a letter in my head and she just keeps talking at me. It's a kind of rudeness I found intolerable but common in Hong Kong. There seems to be no concept of social etiquette where you don't interrupt someone when they're actively engaged in something, especially when it's to help you.

After twenty minutes, the consultation finishes.

Twenty minutes. For a stable rheumatological condition for which there is nothing new to be done, because it's stable. Remember my patient quota is usually around twenty for a half day session, meaning I'm meant to average at less than seven minutes per patient to avoid overrunning and excessive waiting times.

Twenty minutes during which I did the job of a GP without the training or experience or obligation of one.