`It gives me a feeling of confidence and personal safety,' said the GP of his replica .38 Smith & Wesson

As a medical student I had my fair share of beatings; mainly on the rugby pitch, and once when Douglas Bowley let off a fire extinguisher on the locals of The George. It wasn't pretty - a head butt from an angry man with froth all over his two-tone Galliano sweat-top - but I fought back with Paddy Sinnerton's trumpet, so by the time the police arrived the officer was able to surmise that there'd been "a bit of give and take all round" and no charges were pressed. Douglas had his glasses smashed and I thought Paddy was going to hit me again when he saw the state of his horn - not even Dizzy Gillespie could have played it - but these were isolated instances in six years of uncontrolled hedonism.

I was once ordered out of a theatre for not knowing the nerve that runs alongside the carotid artery*. The surgeon was so incensed at my ignorance that he cuffed me on the way out. My revenge was to steal his brogues from the changing-room and wear them on every ward round for the next eight weeks.

Other students complained sporadically about being manhandled by a consultant, but it was unheard of to be hit by a patient - or at least it was in 1984. Now it seems like an everyday occurrence. Last year, a survey of GPs by Pulse magazine found that three-quarters of respondents had been verbally abused and a fifth had been physically assaulted in the previous year. Held at knifepoint, armed demands for drugs, arson attacks on the surgery - it makes you yearn for the simple head butt.

Serious assaults are mercifully rare, and it may be a while before streetfighting skills find their way into the medical curriculum. But some doctors can't wait. "It gives me a feeling of confidence and personal safety," said a Stoke GP in 1994. We're not talking tampons here, but a replica of the standard-issue US police handgun - the 0.38 Smith & Wesson - which he carried in his black bag. In an interview with Pulse, he described how a drunk drug addict came demanding temazepam. "I tried to appear calm, but a chill ran down my spine. `Let me just examine you,' I said, very deliberately, as I opened my bag. I took out my stethoscope, slowly giving him a chance to see my revolver. The effect was stunning.'"

Dr Peter Schutte of the Medical Defence Union was less enthusiastic. "I think on balance I would advise against doctors carrying replica guns, from the common-sense point of view." And perhaps even the legal one. Last year, 5ft 9in Dr Mark Payne employed 6ft 2in Ira Emelianova, the 14-stone millionairess Russian Sombo wrestling champion, to accompany him on visits to areas of Birmingham where "a white, middle-aged, middle- class doctor stands out like a walking cash machine". Ms Emelianova, by contrast, was "very discreet".

Women GPs, too, have been taking bodyguards on night visits. In York, they pay pounds 3 an hour to hire from a pool of former ambulance drivers or ex-policemen. As one GP put it, "I'm not sure if they're tax-allowable. It's cheaper to take the husband or the dog."

Occasionally, more radical surgery is needed. Some practices have installed perimeter fencing, video surveillance and security men ensuring safe passage to and from the car park. Alas, the vandals find high security more of a challenge than a disincentive. Doctors, too, are uncomfortable with the concept of practising family medicine in a fortress. Most GPs still work in isolated rooms where they are stuck behind a desk with the patient blocking the only exit. Hardly a recipe for safety.

So what can you do if you're trapped? A training programme that described "bash and dash" techniques provoked a media storm. Besides, a doctor finds it difficult to switch from "responding to your emotional needs" mode to "scraping my heel down your shin" mode.

Thankfully, I've never had to do it, not even when I worked in a rough area. The reason, I discovered, was the receptionists. They took the stick that patients wouldn't dare give the doctor. Yet many GPs are unaware of what goes on out the front of shop. Once, when surgery was running half an hour late, I saw a female patient march up to the counter and yell, "Why doesn't Dr Morris get a fucking move on?" Remaining completely calm and in control, the receptionist picked up the phone and said "Dr Morris? Mrs Jenkins says `Why don't you get a fucking move on?'" Now that's how to handle aggression and educate the senior partner at the same time.

*The vagus, since you ask.