I discussed this issue with Mr Ashworth- his reply was "Golly, that's exciting!"
A totally rhetorical question, did you partake of alcohol with your meal?
(Note to self- time to do the BMA Burnout Questionnaire again).
Mr Ashworth will need to establish a few gulags and Uighur-style "vocational centres" to help convince medical graduates of the errors of their beliefs about General Practise.
Plus- all GPs who are keen growers of roses will get allocated 50kg of unicorn manure per financial year as a token of appreciation for being the bedrock of the NHS.
Remember guys-prevention is better than cure.
Ergo- our practice should change such that we do our utmost to prevent old age and the corresponding co-morbidity thereby easing the pressure on the system. We should also applaud the inordinate waits for an ambulance, because preventing admission is better than getting patients in for a cure.
Personally, I await with interest to see how the UK populace, who will not be patronised as not knowing what they voted for in the EU referendum, choose to cast their votes in the election.
A wise person once said people get the leaders they deserve.
I want to know what is meant by "appropriate withdrawal program"- if the job is to put patients through a prolonged period of subacute withdrawal without any consideration for the psycho-social aspects for each individual patient (key considerations for success), then I have full confidence that the approach will be successful. I choose to deliberately not consider how this will push some patients towards using "street Valium" (eg Etizolam and other terrifying agents such as Clonazolam) and heroin to keep them functional and able to meet their responsibilities.
This is truly a complicated and nuanced issue, and I am sure that many dependent patients, with proper support, could get free of these agents. Without such support this kind of "moral policing" will just cause broader and more destructive issues.
Guys, don't be so negative.
Don't see it as a barricade; see it as a bridge (/s).
Licence to kill? Really?
This is a wholly personal opinion but if one starts out pre-supposing that the constellation of symptoms are "random" then you are setting off on the wrong foot.They might be random, but 10 minutes and superficial knowledge are hindrances to properly evaluating whats going on. With a more complex patient populace, older and with multi-morbidity and the often overlooked fact that advancing age invariably means more pathology and oft-times subtle indicators of issues which are commonly not picked up. Late cancer diagnosis being a real-time indicator of what I refer to.
"Robust clinical protocols" is a garbage phrase which fails to recognise that for example GP perusal of hospital correspondence is not great, and these "pathways" cannot be slavishly followed to fully extract the key information from the letters and is typically asking the junior James Bonds to perform a task they are not trained for.
Bottom line- the system is fu##ed, bandaids don't work in the anticoagulated and bleeding system, the patients are the biggest losers and any personal satisfaction that one is doing the job to a standard one would wish for ones parents/kids is a delusion.
There has never been a better time to be a GP, to quote one of our colleagues whose disingenuity and failing visual acuity must be of concern to his/her patients.
"Currently, the service there cannot be criticised because it is without any flaws". If CQC did their thing in Scotland they would have to be delighted by such a review.
Clinical examination? Pffft.
Like the good professor, I can confidently diagnose critical aortic stenosis by looking at the eyes,and the body language.(/s.)
GP monkey @5.14pm.
"Even in 10 mins..." says a lot. I know you have 10 minutes but really, hand on heart, are you saying that you have considered the secondary causes carefully before concluding its a primary case (ie cut booze, eat better blah blah).
There can be more to "gout" that meets the eye.Heres a snippet for you- patient with gout getting more episodes despite taking the pills and cleaning up his life.Urate checked and up after being normal. Have more pills was the treatment. Lymphoproliferative disorder diagnosis delayed because "its gout" and patient was not examined or a rpt FBC taken.
Ten minutes is inadequate time to do a proper job, and even simple stuff can be indicative of more serious issues.
John Cooper Clarke, punk poet, opted to take a lump of opium the size of his head as his luxury item when he appeared on Desert Island Discs. I think he forgot to ask for Docusate and Anusol though.
This is awful for all the reasons cited.Addisons if it was truly autoimmune in this case is one condition which often niggles subacutely with vague but recurrently presenting symptoms, and should always be somewhere in the clinicians mind as a possible differential in recurrent attenders.
It depends on the density of 5HT1a autoreceptors in the dorsal raphe nuclei ie low density as in adolescents and some adults is thought to produce increased anxiety with SSRIs on initiation.
Fancy PET scans can show this but we just dish them out and observe the effect. Patients are in effect guinea pigs.
Great article which echoes some longstanding concerns I hold.
Examples- "Dr, my ankles are swollen but my BP is great on that amlodipine stuff"; "Have some frusemide".
"My anxiety is better on Sh#talopram but I have a cough with mucky spit";"I see you are allergic to penicillin- have some erythromycin" (QTc anyone?).
I could go on and on and then some.
I have found that in the presence of polypharmacy considering iatrogenic causes pretty early can frequently be a high yielding input, and a glance at the BNF vey worthwhile.
The title asks a question the response to which is best framed in terms of the patient (answer-often not), the doctor (answer- beneficial if you want to get on with your session and make the patient feel somethings been done), and the chosen timescale (longterm- both patient and doctor lose).
And the spineless "Ever so humble, me'Lord" BMA should have the balls and knowledge to also see what appears clear in terms of the failings.
The head honchos of the BMA should have "RTFN" tattooed on their hands: "Read The Fuc@@ig Notes", and whilst the tattooist is at it, the junior hospital doctors and consultants too. Make it a tax-deductible expense.
The coroner is not focussing on the source of the problem re the lithium although I recognise the info given is patchy.Its a case of super-specialisation only focussing on their bit,kicking people out when scarcely patched up without having carefully read the notes which if they had, sending him back from Stents and Co back to Arrow Parke would have been wise where liaison between his original team and psychiatry to address the clearly unresolved item of his mental health medication could have been addressed. Informing the GP that lithium had been ceased would achieve noting because a GP is prevented from resuming it in any case.
Sending more people more paperwork when the paperwork which exists already is not read properly is no answer.
Mr Coroner- if you feel you must "do something", ponder my words.
Paragraph 10, line 2- depravity? WTF use of English is this?
Call me cynical but I'm beginning to suspect that my mantra "There's never been a better time to be a GP" might not actually be true.
Plant-based solution? Once upon a time they said that about opium....