“I’ll have you, you smarmy git; you’ll treat those faggots out there, but you won’t treat me.” That menacing threat was unmistakable. I was at a loss as to how to deal with this threatening 35 year old. He had become convinced that “some slag had given him syphilis” and he was demanding treatment for it. This was now the third occasion I had seen him and syphilis serology was repeatedly negative, as was everything else, but he had this fixed delusion. The other staff had the common sense to decline to see him but, as the consultant, I felt obliged to provide care. I arranged several appointments with Liaison Psychiatry and discussed the case with the consultant psychiatrist who described the situation as a common fixed delusion—a bit like a compulsive disorder. The patient, of course, …