Óral rehydration sachets when reconstituted taste like Ribera and salt. Drinking ordinary tap water is another good way to become rehydrated - when your pee looks the same colour as the tap water you have rehydrated.
Bugger! Thinking of you, mate.
I am nearing the end of my first year post 24 hour retirement. When I did 9 sessions of work, 1.5 were endoscopy, the earnings going in to the pot. I ditched those when I hit 60 and now do 6 sessions of GP a week, and yes, I enjoy it. The interesting thing is that I actually do the same number of sessions that my 25 years junior partners are doing in their 'full time' contract!
As phrases go, don't forget:
Something's GOT to be done (one of my dad's favourites)
You never see the same doctor twice.
If you knew how long I've waited to see you (time wasting rant alert)
I hardly ever go to the doctor (justifying expecting to be seen today)
You're busy today doc! (How DARE anybody else do what I intend to do, take 25 minutes for a 10 minute appointment)
Where shall I start? (The end please)
I've been told NOTHING about my problem (if you ignore the 2 page letter from the consultant)
My fibro's playing up today (more drugs please)
I would love to have a patient start with 'it's probably nothing, because, as you know, I have a very low pain threshold, I'm a wimp, and also a terrible nonobjective judge of symptoms.' But, oh no, the unstated message is ' if I am complaining about it it MUST be serious, because I NEVER make a fuss (if you exclude the last 10 years' worth of weekly consultations for trivial symptoms) (my parentheses)
I feel sorry for those GPs that can't face retraining and are too young or poor to retire. Looking at it from the other side of the 24 hour retirement fence, and having seen 2 similar aged colleagues say 'Sod it', I can well imagine the top end of the workforce leaving en masse, followed by more closures. A new equilibrium will result with state run salaried posts - but how many will apply? Will the U.K. population drop as thousands of GPs emigrate?
Effectively we are working 15 minute appointments now, in that patients never stick to the ten minutes as it. I’ve given up telling to make another appointment to discuss the rest, because the rest are so far in the future! As implied in one of the above comments, it won’t mean 3 hour surgeries of 18 appointments becoming 3 hour surgeries of twelve appointments - oh no, it will mean 18 appointments over a nominal 3 hours becoming 18 appointments over 4.5 hours, which is what can happen to even the most battle scarred of GPs when confronted by a surgery of list waving heartsinks - so effectively just a rebranding of the status quo.
I got the MRCGP in 1997 (7 years after taking a partnership) so that I could take my turn being a trainer. I paid the compulsory first year's subscription, and after reading a couple of the journals I ditched my membership.
Went from 9 to 6 sessions when I hit 60. Most weeks are about 33 hours, so I reckon I'm getting off lightly. I don't count appraisal work, cpd, practice meetings - so it's probably more.
The reality is that telephone triage simply tells you which patients didn't actually want to be seen in the first place. Even the urtis come back a few days / weeks later when they have earned their appointment. I never believed that telephone triage would reduce demand, but what it does do is make it slightly harder for a patient to see a GP and makes them work harder, and possibly appreciate the service when they get it ? Naive?
That in a nutshell is my point - supply is most definitely limited, and if you want more of one type of appointment you get less of the other. The current contract had lots of good things about it, but sacrificing so much time on the altar of preventative medicine, especially the low/no risk stuff like mild to moderate hypertension, primary prevention treatment of hyperlipidaemia and clinics for the unwilling asthmatics (75% of them), was very wasteful. True we as GPs are less involved now, but it still generates secondary appointments and lots of admin.
We have been doing triage of same day requests ('urgent' in the patients' minds but usually not) for about a year. The receptionists rôle is key in that they get the basic reason when permitted from the patient, and from that the triaging doctor can fairly quickly decide who needs to be seen anyway, and receptionists phone them back, and who may be managed without face to face. To do this we have far more emergency slots and have lost a huge number of booked appointment slots, and that is the price the patients have had to pay - they can be fairly guaranteed to see a doctor today if they claim urgency, but if they want to see 'their' doctor they may have to wait weeks, and many do, adding problems to their list in the process. The patients are learning the rule of the penny and the bun - you can see Dr Anyone today, or Dr Popular in a month, but not Dr Popular today - yes Dr Popular may be working today, but then patients don't know that when they phone, and are not told. We encourage continuity of care for specific conditions follow up, (the doctors themselves make the follow up appointments) but traditional continuity of care where patients only ever see their own doctor started to die when we began to share on call, and cross cover for holidays, became terminal when we ditched out of hours, and died when part time work took off. I only ever hear about continuity of care these days when a doctor is trying to avoid seeing a patient.
Pain clinics are behind a lot of this.
The only thing I can suggest is that you ignore guidelines and most preventative medicine and practice clinically and using your judgement. The trouble is that younger GPS have grown up with guidelines and some cannot function without them.
Interesting what the NNT website says about primary prevention - not worth it, don’t it.
They won’t have any obligation to meet demand though and once their appointments have filled guess where the overspill will go?
If you believe the NNT website some of our current guidelines aren't worth it - treating mild to moderate hypertension, and primary prevention of CVD with statins to name just two.
Would be nice to know what the symptoms were that were dismissed too. Did she say 'I've got symptoms of bowel cancer'? Or were these symptoms mixed up with a host of others all raised at the same consultation?
Patients and politicians go to the same school of evasive answers.
Don't forget 'you've been busy today, doc', code for 'why are you running an hour late and delaying me?' before getting out a list written on a toilet roll.