Often homeless, alcoholic, and with personality disorders, “recurrent attenders” at an emergency department present a considerable diagnostic challenge for doctors. Many seem to attend merely to get out of the cold, but they are well practised at giving histories, often causing inappropriate referrals to other specialties.

Unsurprisingly, they may be regarded with cynicism by hospital staff and occasionally may be triaged to “outside the department” if the absence of serious pathology is strongly suspected. There they can wait, often in bitter conditions, for a cursory consultation by a doctor hellbent on discharging them so …