Managing pilonidal sinus disease'Tips for GP trainees working in colorectal surgery' offers one sentence on pilonidal sinus disease (PSD). It is 'unusual in the over 40s '. 1 GPs need so much more knowledge about this relatively common, often poorly managed, disease. There is almost an acceptance that PSD is 'difficult to treat', recurrence rates inevitably high, and patients should not be surprised if their wounds take months to heal. Recurrence rates are high, but this is often iatrogenic harm following surgery. Mahmood explains that 'Early recurrence is due to failure to identify one or more sinuses at operation, whereas late recurrence is usually due to secondary infection, residual hair or debris not removed at operation, inadequate wound care or insufficient attention to depilation'. 2 Training for surgeons seems to be woefully inadequate. Fewer than half carrying out pilonidal operations considered themselves sufficiently trained, and more than 70% felt that PSD was an underprioritised, low-status area of medicine. 3 Training for GPs is inadequate too and, if you have never talked to your patients about pit picking 4 or cleft lift surgery, you are not alone. What practical advice do you give patients about wound management, cleansing, and hair removal?PSD tends to affect young people, with a deleterious impact on their physical, social, working, and emotional lives. 'Patient regret' can be high in relation to pilonidal surgery, 5 with patients reporting a poor understanding of their disease and little meaningful choice in terms of treatment options.Surgeons need more training, and we need specialist centres of expertise. As GPs, we must be advocates for our patients. We should refer to surgeons known to have an interest in PSD. We can empower our patients to ask the right questions. We can upskill our practice nurses, and have clear protocols, so they manage these wounds well. Post-operative wound care is a prognostic factor in recovery and recurrence. 6 We can, and we must, do our bit to ensure that patients with pilonidal disease come to no more harm.