Here we are again, working away at the coal face of human misery with a teaspoon. We all move jobs every six months, in February and August. So, another job, another set of nutters to work with, and a new set of patients. That's my really funny joke about mental-health workers. I immediately spot that I have been shafted by my predecessor in my first morning's clinic when I see a set of five social problems in a row. One is a new patient follow-up. The handover plan says "refer to community team", and I couldn't agree more. Unhappy mother, no money, no friends, no hope, depressed, reasonably suicidal. I potter down the corridor to see the social-work manager and make a referral.

"So what exactly do you want us to achieve, Mike?" she asks. It's a fantastic question: goal-directed and focused, multi-disciplinary work at its best. I ponder the answer to this excellent question. I flounder. Of course, we both know that the answer is this: "Umm, spend a bit of time with her, do a couple of visits, you know, reach out, make friends, offer a bit of nonspecific support and hope she doesn't kill herself in the meantime." She looks at me as if she is equably pondering the suggestion that she eat her own poo.

"Well, I don't really see what we can offer her as a team, over what you're doing in your outpatients appointments." She's getting weirdly angry. Now the response to this is clear: doctors have a caseload five times that of community nurses and social workers, so we can't see people as often. That's just the way it is. I've been in this job for three hours. This is not the time to start a fight with an assertive social worker twice my age.

I gently try to push my case. She pushes back: she gets - and I mean this - seriously aggressive. I'm a bit scared. I push harder. This has never happened to me before. I'm not asking her to deskill her staff. The patient just needs a bit of nonspecific support. She starts shouting.

I retreat to my room for a think. I've got six months in this place. There's a blank page in the notes. The patient has gone, with a four-week follow-up appointment. I look at the empty page with my pen in my hand. There's this vague idea going around among doctors that you should always picture yourself in the coroner's inquest when you write your notes.

"Dr Foxton, you were the last patient to see this patient before she killed herself." The judge looks down his glasses at me across his nose, as I fill my trousers. "Your notes read as follows: 'Impression: severe depressive episode plus social problems. Plan: refer to social worker.' " He frowns and looks back at my notes. "You then continue: 'Outcome: social worker shouted at me. I realised that I had to work in this place for six months and she scared me. I'm only little, and I look about 19. I realised that I did not have the social skills to deal with the situation and retreated to my room in search of an easy life. Impression: I am flaky and weak. Too embarrassed to telephone and offer patient follow-up any sooner. Plan: review in four weeks. Work on assertiveness skills. Hope patient not dead by then.' "

I'm sure they're overstretched. Maybe she's had bad experiences with poncy doctors in the past. I've got on all right with social workers everywhere else I've worked. Maybe I should have buttered her up with a bit of chat about public-sector pay and the war in Iraq first. I phone the patient up and get her back in a week. It looks like I'll be filling out the benefits forms and talking to the school myself. I'd rather drink bleach than try to refer to the social workers again. Who cares about going home before seven? I'm 26. Stroll on retirement.