'I'm still depressed. I'm not getting better. You're a useless doctor and this clinic is a farce. I'm writing a letter of complaint." I smile warmly. "And what the hell are you smiling about? My wife says I'm suicidal, and it'll be on your head."

This nasty scene raises interesting problems. Firstly, it is quite possible that I am a useless doctor, although I'm not sure how you'd measure that. In general medicine, when a little old lady is grateful for your help getting over pneumonia, you know where you stand. In psychiatry it's more dangerous: you can't derive your sense of how well you're doing from how much the patients like you.

For example, in this morning's clinic, if I had prescribed the lifetime supply of valium that one person was demanding, they'd probably be writing to their MP as we speak, recommending me for a knighthood. I could have exaggerated another person's illness on a form to the council and got them one step closer to a bigger council house. I could have conspired with a hypochondriacal patient and ordered them a whole pile of hospital tests.

Actually, on reflection, I can't be bothered to lie to you. I did both of those last two things. But I was trying really hard not to.

Oh God. I'm a terrible doctor. This patient really hates me. And I'm not even professional enough to help him take responsibility for his feelings. The way he's staring at me, I can't think of a word to say. I can't see how he could ever get better. Even I think it's my fault this man is depressed. And I can never remember the side effects of quaxipram.

Oh God. I bet they all commit suicide before the weekend. My consultant will sack me and they'll put my photograph and my parent's home phone number on the front cover of the local paper.

And suddenly here I am, eating a Happy Meal with my new consultant. You maybe don't know how odd that is, so you'll have to take my word for it. "Of course, my wife is an orthopod," he says. "She thinks anything other than surgery is a waste of a medical degree." He smiles warmly. An orthopod, incidentally, is an orthopaedic surgeon: they're usually very male, and their hobbies include assuming traditional gender roles. At parties, when they meet psychiatrists, they shout things like "only steel can heal" before quaffing more beer and becoming sexually inappropriate.

And then we talk about my patient. "Sometimes, you know, when people make you feel like that, especially if they're blaming you for everything, they might have some" - he looks out of the window - "some quite maladaptive personality traits." He says it so neutrally. Like it's all just part of the clinical problem. Like no one is at fault. Which, of course, I knew all along. Which is, of course, part of the job. I just forgot somehow, stuck in the clinic room with those toxic stares. "It might be l a long run getting him to deal better with life. We could talk about how you could approach it, if you like. Are you seeing him some time next month?"

I look at the floor. I was so freaked out, I made an appointment to see him later this week. This is not boundaried time management. I ask what will happen when he complains. He smiles warmly and drinks some coffee. "You'll be ever so slightly demoralised, I'll have to stay late to go through the notes, and lesser doctors would think about leaving the profession." He pushes his glasses up his nose and smiles. I want to be that man.