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CAMHS won't see you now

ShefDoc

  • I'm a German GP and I'm having to review my circumstances

    ShefDoc's comment 29 Sep 2019 9:01am

    "Shefdoc why aren't you proud to be British?"

    I thought that was clear from my post. My reasons for not feeling proud: The increasingly hostile environment for immigrants. The rise of far right and nationalistic rhetoric. The unprecedented national self-harm that is Brexit. Our current Prime Minister who behaves like a dictator. The shrinking state. Austerity. Worsening inequality.

    That sort of thing. There is still much to be proud of, but for me, the UK is at a particular low point right now.

  • I'm a German GP and I'm having to review my circumstances

    ShefDoc's comment 28 Sep 2019 12:01pm

    Great article Roy. I'm Canadian. I applied for and got British citizenship a few years ago, because I was worried about the increasing hostile environment toward immigrants. At first I was proud to finally be British. I am no longer proud. Brexit shames us all.

    'Lateralthink' I am sorry that you believe Brexit can go ahead without the consequence that immigrants feel more marginalised and afraid. It's isn't the fault of politicians or civil servants; it is the fault of Brexit, and the racist motivations behind it.

    The UK is becoming a little bit smaller, a little bit meaner, and a little bit less relevant in the world.

  • GP pensions to be 'more flexible' to improve retention

    ShefDoc's comment 03 Jun 2019 3:23pm

    So, work more and get the reward of a smaller pension.

    Or, work less for the same pension.

    I know which I will be doing.

  • First-contact physio 'can deal with 99% of MSK patients'

    ShefDoc's comment 17 Apr 2019 8:34pm

    This is nice, and great. It won't reduce GP workload though. Only one thing will do that...

  • Dr Susan Hopkins: ‘We want GPs to educate patients about antibiotics’

    ShefDoc's comment 08 Apr 2019 10:30am

    "It also involves doing a set of observations on every patient – knowing what their respiratory rate, temperature, heart rate, blood pressure, is."

    Viral illness will give you: a fever and tachycardia. Please tell me what is the evidence that this will help me simultaneously 'detect sepsis', and reduce antibiotic prescriptions.

  • Dilemma: Partner says I make too many referrals

    ShefDoc's comment 08 Mar 2019 8:29am

    My referral rate when I locum is undoubtedly higher. The risk is greater, you have less facility for follow up, and are more likely to be complained about. I would only worry if it seemed your referral rate was significantly higher than other locums.

  • Overdiagnosis: how ministers and the NHS are fuelling a rising epidemic

    ShefDoc's comment 27 Feb 2019 12:27pm

    The more this is debated the better. It can be a lonely battle otherwise. The problem we have in GP is that we are told it is simultaneously our fault, and within our gift to solve. Reports like these that point to the various pressures are useful. It often feels like a losing battle though.

    Really this needs to be tested in court - 'trying to avoid over-diagnosis' needs to be a valid defence in court.

  • The health secretary’s vision for general practice

    ShefDoc's comment 31 Jan 2019 9:20am

    ‘I was struck by a figure when I first arrived as health secretary that in a hospital setting there are two nurses for every doctor. But in primary care, there are two doctors for every nurse. There are lots of things that can be delivered by other professionals that GPs currently do.’

    Sigh. This is because patients in hospital require a large degree of nursing care. They are very unwell.

  • We need to tackle societal problems to stem the tide of mental illness

    ShefDoc's comment 01 Dec 2018 11:24am

    Good article. In society we have decided that depression and anxiety are medical problems. For the vast majority there are significant environmental factors contributing (as you say in the article). And yet, in the mindset of the public (and many doctors), depression is a problem within the individual, that a doctor must solve. So often in consultation I am thinking "I understand that life has been hard. Why, oh why, is this a doctor's problem to solve?"

    Patients will, with no hint of irony, explain the list of contributing factors in their life, and STILL Believe that the problem is within them, or that a pill will somehow allow them to be happy with their horrific lives without being depressed by it. Time and again, we are told to "seek help" if we are depressed, as if some external agent (usually a doctor), can somehow modify your life resulting in "cure".

    I think we have got the approach really, dangerously wrong. I think patients get value from a caring doctor, because we bring some kindness and relief in to their lives. That's great, but, I think, a waste of resources and a backward approach. We've a long way to go.

  • GP's online low-carb model saw '40% of diabetes patients able to cut medicines'

    ShefDoc's comment 25 Aug 2018 7:56am

    The more we push lifestyle to treat diabetes the better. Drugs affect mortality little, they simply make us feel better about the numbers. It requires large investment however, to combat the huge marketing budgets of pharma.

  • Consultants to advise GPs on patients who fail mental health referral criteria

    ShefDoc's comment 19 Aug 2018 6:38am

    I am extremely cautious about secondary care advice for anything. It is often evidence-light work-heavy and dubiously informed. Having to do the work yourself rather focuses the mind. My rule of thumb is if talking to a consultant colleague, it is either to refer or to ask a very focused clinical question.

  • Dilemma: Practice criticised for having no male GP

    ShefDoc's comment 11 Aug 2018 11:20am

    Surely the best advice would be: ignore this nonsense criticism.

  • NHS England plans for GPs to test patients before prescribing antibiotics

    ShefDoc's comment 18 Jul 2018 9:08pm

    Terrible, terrible idea. This will increase demand as people begin to expect the 'antibiotic test' for every minor ailment going. Show me it affects outcomes, and I might be more interested.

  • GPs 'should consider cancer' in patients with upper-normal platelet counts

    ShefDoc's comment 23 Apr 2018 6:05pm

    Tricky to know how to usefully use this information. Over-diagnosis and over-treatment are the big challenges in modern medicine today.

  • Nine million patients told they can book evening and weekend GP appointments

    ShefDoc's comment 12 Dec 2017 1:16pm

    "Although patients may not see their usual doctor or nurse they can expect to receive the same excellent level of treatment and care."

    Er... No. They can't refer, follow up, they don't know you personally, might come up with plans in opposition to their own GP. The money should be spent on improving services at their own GPs.

    Jeremy Hunt says that he values the continuity that GPs provide. This contradicts that.

  • GP leaders fly out to tempt medical students studying in Bulgaria back to UK

    ShefDoc's comment 16 Nov 2017 1:02pm

    They are generally students who failed to get in to UK medical schools. I believe they self fund. Interesting idea, but seems to me that the focus needs to be on retention and making the job more attractive.