A major change in UK health care has occurred, quite quietly, and overshadowed by all the goings on with the White Paper. There are no more pens. That's right, pharmaceutical companies will no longer be giving pens, and Post-it™ notes for that matter, to those of us who have come to see these items as part of the furniture of daily practice.

Some might call this a milestone, reflecting it as a positive step. Frustrated others may find it easier to describe it as a turning point. I know that in my practice it has had a profound effect on staff and I fear the repercussions on patient care. You see, staff have become very protective of ‘their’ pen, highlighted the other day when I asked to borrow one. Yes, there were none lying around – extraordinary, I know. Ordinarily I’d have pulled open a drawer and pens would have come flying out in all colours of the rainbow like a multicoloured ejaculation. Just as drug reps' homes were filled to bursting with pens, so were our drawers. But not any more. Oh no, because yet another in the long chain of shifting of costs has taken place in the interest, as it always is, of better patient care.

The reaction of my member of staff to my request would have been appropriate if I’d asked her for her youngest child to offer up as a sacrifice to the gods. But I hadn't asked this, or asked her to help me put a condom on. Teeth bared she fixed me with her eyes and growled “It's mine”. This wasn't because, as I fully understand, as doctors we have a reputation for borrowing things – pens, tourniquets, and so on – and not returning them. No, this response was the result of there no longer being a supply of these items. They were disappearing fast, but she had one, and was not going to let it out of her sight.

Later that same day I found myself in an embarrassing situation with a patient – no, not that kind of situation. I’d wanted to write down the address of a good health information website for her to review to help her come to a decision about the most appropriate form of contraception for her. But I’d no Post-its™, so feeling somewhat embarrassed I wrote the address down on a scrap of paper I tore off a ‘Folic acid and pregnancy’ leaflet, and gave it to her. The following week she delivered a bag full of Post-it™ pads she'd acquired from various events she'd attended. Of course I was very grateful, but I do wonder what message we are conveying to our patients by using Post-it notes with the names of five-star hotels written on them? And what irony, because the pharmaceutical industry no longer offers these hotels either.

Honestly, when I’m writing with a pharmaceutically branded pen, more often than not I don't even see the name on it. Even if I do, because this is the brand name and we for the most part prescribe generically, again it's often meaningless. Even if I did recognise the name the pen is hardly going to take on a Disney role and magically start writing the drug name on a prescription. Yes, I know there's subliminal marketing, but honestly, it's just a pen.

Maybe I’m naïve, I probably am. All I can say is that this change has appeared to have had a significant effect on staff behaviour and relationships, which in turn if we're not careful could have a negative knock-on effect on how our patients are treated at reception, and on the standard of patient care they receive. Imagine what the response might be if a patient innocently commented “That's a nice pen you have”. This would add to the irritation caused by Pen Absence Syndrome, and the likely outcome of this is far more likely to be detrimental to a patient's well-being than it could ever have been from a drug-branded pen influencing what treatment they receive.

We now have a new dilemma because we can't go on like this. Do we buy boxes of pens and, if so, do we actually know how to go about doing this? Note to self – I must record this as one of my DENs in my appraisal folder. Should we issue staff each with a pen that they sign for and are responsible for and monitor how often replacements are needed? This could solve the problem of what to audit this year. So actually, from what some might see as a negative change appears to have come some real positives. So thank you pharma once again for helping to facilitate this change for us.

Now, there's just one more question to answer. These pens do seem to disappear with frightening ease so just where on earth do they actually go? Has someone been squirreling them away? Or maybe in the circle of life they find their way back to the person who gave them out in the first place. Or perhaps, they're sitting next to all the hospital patient notes that mysteriously disappear, or with the enormous number of condoms that have “split, doctor”.