Dealing with one problem at a time
I think more and more commonly you will find that the test or treatment given will be for the worst case scenarios rather than most likely cause. Despite this indemnity fees rise year on year. I used to have little sympathy for doctors who practice defensive medicine and now I do it more myself. To be honest I would feel happier and feel a less stressed out clinician to test eveyone for everybody who comes in about XYZ. There are no prizes for saying no and saving reasources but dire consequences for odd occasion you get it wrong.
As above prescribe NOAC refer everything else to secondary care. Next
How about this for a guideline. No need for GP involvement at all and patients can go direct to pharmacy and get emergency contraception. If entitled to free they get it free and if not they pay up just as you would if you got a parking fine.
Here is how it should work. Patient comes in with a problem let's say dry skin. Dr recommends a treatment that cab be purchased OTC. Patient says can I have on prescription. Dr says yes no problem here's the script. Patient takes script to pharmacy. Pharmacy gives bill for patient to pay for cost of item. Patien says but I have hypothyroidism I get all medications for free. Pharmacist says yes but only for thyroxine. Aveeno you'll have to pay for my friend..
As somebody who really struggled as an FY1 and nearly never got my career off the ground due to burnout. Its the only time I've ever really suffered from real stress in my life. I was referred to a training support union which I had to attend or else I would have been referred to fitness to practice, where I was met by a lovely lady about to go off on maternity leave who was asking me how I could better deal with stress. I was working 15 hour days. She didn't really have much of an answer to that conundrum. I was then referred for coaching... by the time I saw them I had changed rotation, had a manageable workload and my life wasn't shit anymore. So whilst this is a lovely gesture and some people find this stuff useful I would much prefer it if you funded general practice properly and curbed unrealistic demand. That is all thanks.
Ive done 8 sessions since qualifying in 2 different practices and Ive never done 12 hour days. 11 on the days Im on call then doing extended hours but not on a normal working day. If something doesn't need doing that day I leave it till the next. Fortunately we get 1 admin session in the week . My colleagues often do go way over hours. I guess we have different styles. Im precious with my time, I will not visit a patient who can get to the surgery, I don't spend forever writing referral letters if there's a clinic letter in the notes that summarises the problem perfectly, I don't let the patient drone on about 5 problems, I force them to stick to task. I don't ring every patient about every test or letter unless it needs action that day otherwise they have to make an appointment. If I don't do these things I would burn out. As above said for 70K for 60 hour week are you even indemnified to work those hours?? seriously quit and locum. Life is too short
Seriously we are doing this now? No offense to any of my eastern European Colleagues many of whom are excellent clinicians but the point is the overseas doctors who work in GP land for the NHS have trained for and worked in the NHS on the wards, emergency departments and OPD clinics in the UK in the NHS. Thats how you learn about the NHS and how it all works. The free at the point of use culture is unique around the world and massively changes the patient doctor relationship thus we have to act as gatekeepers and manage a multitude of chronic conditions ourselves. No other health care system in the world does this and to be honest a lot of patients don't like it and its the source of much conflict but its the job. Now in a privatised system with no Gatekeeping on the other hand... yeah cheaper foreign doctors make perfect sense but why they would come for rubbish pay and working conditions to be moaned at by patients for not referring them for full body scan for the symptoms they have just woken up with is beyond me.
Consider offering ibuprofen as well as paracetamol. Are we insinuating that patients are too stupid to have tried that before they make an appt to sit in a waiting room full of sick people before seeing their GP. Well patient satisfaction rates will be going through the roof i can already see the 'customer reviews' on our website. 'my GP is wonderul managed to drag myself in to the surgery all though i could hardly walk and he told me to keep taking the pills i had in my pocket and go for a run. Grade A service!'
Great idea shall we do the pre test counselling, breaking bad news and contact tracing as well? I mean we are all twiddling our thumbs as it is. Who's up for learning all the new HIV drugs for the 'shared care' protocol that Follows? Or maybe just maybe sign post these people to their local sexual health clinic where they are already set up to do this kind of work. Fund them properly for it and fund us for all the rubbish you've already put on our plate.
But if you put 5 days worth of butter on 7 days worth of bread you can have toast every day. Sure it will be dry, taste awful and you probably don't want toast on a Sunday as you're leaving room for your roast but it was a manifesto pledge so it needs to happen.
What effect would the increase in consultation have on our indemnity? 50% more time spent per patient less patients seen overall less risk. Will defence unions take this in to account? As colleagues state above its not just about patient satisfaction but also job satisfaction which knocks on to patient satisfaction. Its not rocket science
We encourage more and more people to present early illness soon we will encourage people to go seethe doctor to see what their risk of developing a chest infection in the next 10 years will be, but we still say no antibiotics even when it happens. When my clairvoyancy fails I'm hung out to dryad everybody else picks up the bill when their indemnity needs renewing. Why does a short history of cough or sore throat come to a GP anyway? GO and see somebody else well below my pay grade first if you must who will follow protocol and come back to me if and when it gets serious.