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Gold, incentives and meh

Richard Ma

  • Should GPs ask proactively about patients’ sexual orientation?

    Richard Ma's comment 06 Dec 2017 4:14pm

    I think many in LBGTQ community would be disappointed to hear comments from GPs belittling this issue and saying it is meaningless.

    It is not irrelevant for the patients who are missing out on vital care because someone has not considered it.

    If you don't want to ask 90 year old Maude or a night club bouncer that's fine. If you want to check your boiler and it is cold, I won't stop you.

    You may think patients would just volunteer everything; we know in reality this doesn't always happen in a lot of other contexts. How do you know if it is relevant and yet they don't feel comfortable telling you? It might give you a clue to some maladptive behaviours - eg depression, risk taking, substance misuse, etc. How would you know if you don't consider it?

    I refuse to believe Dr Cobblers treats all their patients in the same way and not give special attention to some vulnerable groups. I am sure Dr Cobblers also recognises that not all vulnerable people are "ill" either.

    Perhaps I have not made it clear, we are talking about sexual orientation, not gender identity. While they are not the same things, there are clearly some overlaps.

    I have heard enough complaints about their care from LGBTQ community to know it is important. What we need to work out is how to get this information - whether routinely eg on registration which means it is there already, or opportunistically which, like many new things, could be an awkward conversation until you have done it a few times.

  • 5. Dr Samantha Wong

    Richard Ma's comment 31 Aug 2017 8:52am

    Well done Samantha and congratulations! We need more young GPs like you!

  • Life as a new GP partner

    Richard Ma's comment 21 Aug 2017 7:26pm

    Good on you Phil.

    Yes I agree being a GP principal/partner is hard work but the job has its rewards. Up to people to look for what works for them.

    I have been a principal for 16 years. I have had ups and downs but I am glad I chose this as a vocation.

    Shame about so many negative comments from anonymous users. I am sorry they are feeling miserable and bitter but it isn't fair to take it out on you.

    Good luck with being a GP Trainer. New doctors need people like you to inspire them into the vocation!

  • Four ethical issues to consider before offering HIV tests to your patients

    Richard Ma's comment 21 Dec 2016 1:40pm

    Please see the response from British HIV Association supporting GPs to test for HIV:

    London, UK - 21 December 2016 Professor Chloe Orkin, Chair of the British HIV Association said: "Every HIV diagnosis that is overlooked or missed by any doctor is a failure of clinical care. People whose HIV is diagnosed late have frequently been seen by a doctor prior to their diagnosis without an HIV test being offered. Nobody dies from being offended, but by overstating the 'ethical issue' of offending patients when offering HIV testing, this article risks HIV infections being missed or diagnosed too late. This oversight means that people fail to receive the treatment and care they need which in turn leading to unnecessary illness and in some cases death. HIV testing is important in preventing onward transmission as people who are diagnosed and treated are no longer infectious to other people. NHS Trusts are reporting missed HIV diagnoses as serious untoward incidents and performing root cause analysis on each one. Surely missing a diagnosis of HIV is a greater medico-legal risk to the medical profession than offending someone by offering a test. This article risks re-inforcing the HIV associated stigma that we have spent 30 years fighting.

    "The recent recommendations (1 Dec) by NICE and Public Health England to expand GPs remit in offering HIV testing are based on robust evidence that shows an urgent need to increase the awareness and uptake of HIV testing in England. The advice will also help make HIV testing a routine investigation and – we hope – help reduce the stigma that allows HIV to flourish.

    "HIV currently infects 17 more people each day in England, many of whom will remain unaware of their infection precisely due to the stigma which still clings to this undiscriminating and life-threatening condition. We don't have a vaccine or a magic bullet, but we could potentially stop nearly all transmission of HIV, nearly all new infections, purely by diagnosing people earlier and putting them on treatment (and by using PrEP), but we are signally failing to do this. More extensive testing, without wasting too much time on risk assessments (which are too often wrong) is the key part of this. This testing cannot be done just in GUM clinics, where there is very little extra capacity, so MUST be done in other settings – particularly in primary care. Without this increased testing, we will never change the epidemiology of HIV in the UK, and every year there will be another 6000 new diagnoses.

    "We believe that GPs are perfectly capable of negotiating complexity in all areas of their practice as well as understanding the critical importance of HIV testing. Let’s not exacerbate this by adding our own preconceptions about who needs testing. It’s time to implement the evidence-based NICE guidance that all doctors are expected to follow to deliver best outcomes within safe, competent practice."