“My back’s flared up again — can you send codeine to a chemist up here and refer me for physio?”

Don’t inherit the patient’s label. Loin pain with fever, rigors and vomiting is pyelonephritis (or an obstructed infected kidney) until proved otherwise, and features such as rigors, a temperature near 39 °C and a pulse over 110 put her at moderate-to-high risk of sepsis — needing same-day face-to-face assessment, not remote antibiotics. Away from home, send her to the nearest emergency department (in Scotland, NHS 24 on 111 is the out-of-hours route; 999 in an emergency). Always ask exactly what painkillers someone has taken: combination products (co-codamol, cold remedies) plus plain paracetamol cause unintentional staggered overdoses. A staggered ingestion of more than 75 mg/kg in any 24 hours needs hospital assessment, paracetamol level and LFTs, and usually acetylcysteine. Renal colic needs imaging within 24 hours; fever with suspected stone needs same-day urology assessment. Pregnancy must be considered in any woman of reproductive age with abdominal or loin pain.