Mobile telephones are rarely switched off by young patients during a consultation, and are answered by them when they ring. In most cases, admittedly, the patient tells the caller that he or she is busy with the doctor, but not always: some proceed to make their social arrangements for the evening while unapologetically keeping the doctor waiting, sometimes for several minutes. A general practitioner friend of mine related how he was performing a gynaecological examination on a patient when her mobile phone rang, and she kept up a conversation about her social arrangements as he continued the examination. This was either admirable sangfroid on her part, or - more likely - a stark disregard of common propriety.

Many young patients now address doctors as 'Mate' or 'Man.'

None of this behaviour, while offensive to my sensibilities, can be said truly to harm others in any tangible way (though putting feet on the chairs is liable to render them unclean). But certain forms of un- or antisocial behaviour are likely to result in disputes that have the potential for provoking aggression. The ward in which I spend most of my time in my hospital is six-bedded, and has a rapid turnover of patients. They are of both sexes and are aged between sixteen and a hundred years old. Some are very acutely ill, and can be near to death, while others hardly feel ill at all.

The ward has a single television, placed on a ledge on the far wall. Whether it is on or off can become a matter of dispute between the patients and staff. If one of the patients suffers from an acute confusional state, there is a good medical reason why the television should remain switched off, for the swiftly moving pictures and the sound of the voices, music and special effects confuse and agitate them further, rendering them more paranoid and leading them to aggression, both against people whom they incorporate into their delusions and against property. But even when none of the patients is confused, the inescapable sound and sight of the television can grate on their nerves, especially on those of the elderly and seriously ill. They want calm and silence rather than loud bursts of pop music and the inconsequential verbiage of chat shows. They very rarely get it.

Many, perhaps most, of the younger patients want the television on constantly, from morning till night. If it is turned off, they protest: they want it on. If nevertheless the staff insist that it be switched off, giving as the reason that another person wishes to be in silence, or that there is a confused person whose condition would be likely to worsen if the television were left on, the young person or people who want to watch it grow angry and aggrieved (I have even known one patient to discharge himself from hospital against medical advice because the television was switched off).