Maybe as part of the revised crappy GP training revision taking trainees away from vital experience in hospital medicaine we could introduce 6 months of magic tricks, song and dance training and stand up comedy to increase popularity?
BREAKING NEWS: PCNs will solve climate change, reconcile the Palestine problem, unify religions to live harmoniously beside one another and turn water into wine, starting with Lake Windermere which will become the first "direct to tap" finest Rioja in the world.... All Hail the Great MattHandjob!
The one metric which has been impossible to tease out for all the research done in mental health is the likelihood of suicide. I suspect many GPs at the older end of the profession with years of experience have got a "surprise" suicide or two in their minds. It's an impossible dichotomy; over caution and incarceration for those at minimal risk vs allowing personal freedom and with that the risk of an unwise decision. The act of suicide may be made impulsively after, for example, an argument with an ex, or a drunken night and loss of innate inhibition. The actual drivers for suicide are hidden and unpredictable, and as the commentators above have stated, to castigate the poor sod who "got it wrong" is to give credence to the idea that suicide is always preventabel and predictable. Agree this piece would be more suited to the Daily Mail than Pulse. Shame on you.
And of course, as a comment on another thread points out, this pales into insignificance next to the 160 thousand million pounds being poured into shiny new train service to shave f*ck all of the Birmingham to London journey... which apprently is far more worthy than the health of the populace. Better that Crapita strike a few more invalids off benefits, and GPs see an extra few patients and break under the strain...
Jeez - what about those entries like "To whomever sees this patient next - his wife reports he's drinking 4 bottles of whisky a week but would kill her if he knew she had disclosed this" - can see all sorts of issues ahead. Not to mention the entries from years back when we were less careful with language... "clearly histrionic and putting on a good show of back pain" anyone?
Soren, the daily mail article is simply the musings of one man who is clearly uncomfortable with the outcome of the original bill. To turn the argument round, one might say 90% of dogs die by euthanasia, therefore euthanasia is wrong. Human behaviour has normalisation bias, and the fact that euthanasia has become an accepted DECISION for more people with unacceptable levels of suffering would, for any pro-euthanasia supporter, be seen as a positive. As always in these arguments, it boils down to one's underlying belief system how one interprets the data. I, for one, like many others, would love to be able to choose the time and modality of my death, and as a free thinking individual, I do not believe there is any role for governments, professional institutions or individuals to denigrate my choices.
"At the time of its launch, with the blessing of the then primary care trust, it was heralded as an ‘innovative approach’ to a growing problem locally - an increase in unscheduled admissions to A&E, 50% of which were regarded as being able to be treated in the community." - so people who are able to get to A&E but magically unable to get to their GP surgery...
I thought we were moving away from industry sponsored expert panels?!?
As David Banner alludes, if I were to treat my pets the way the law demands that I treat patients, I would be in court for cruelty for denying them the relief of a painless death. And yet we continue with this debacle of moralistic patriarchal "we know best" which resolutely ignores the wishes of the individual. With proper safeguards in place, as per Holland, we can give *those that want it* the dignified, painless death they wish for. For the RCGP to maintain its didactic stance is typical of an organisation bereft of any real connection with the population it should rightly be supporting. Neutrality is the only moral stance; allow the individual to make choices in accordance with the individuals beliefs and wishes.
This is not strictly accurate; the statement "In patients with moderately severe infection, prescribe amoxicillin with clarithromycin, or erythromycin if the patient is pregnant." in the actual guidelines is stated as "If moderate severity (based on clinical judgement and guided by a CRB-65 score of 1 or 2 and microbiological results when available), and it is appropriate for the person to be managed in the community, for adults:
Prescribe oral amoxicillin 500 mg three times a day for 5 days (higher doses can be used — see the BNF) and (if atypical pathogens suspected) oral clarithromycin 500 mg twice a day for 5 days, or oral erythromycin (in pregnancy) 500 mg four times a day for 5 days.
Alternatively, in penicillin allergy, oral doxycycline 200 mg on the first day then 100 mg once a day for 4 days (total course of 5 days), or oral clarithromycin 500 mg twice a day for 5 days." The problem here is that a the CRB score is not very well validated in community (See review article 2010 BJGP) and is more a hospital tool, and b anyone over the age of 65 is automatically a 1 so should be considered for dual amox + macrolide treatment purely on the basis of age - despite atypical pneumonia being more prevalent in a younger cohort. More meaningless twaddle from NICE....
I just saw the last line... 6000 new doctors (which we all know is pie in the sky territory) to create 50 million new GP appointments?!? Assuming a WTE GP is 8 clinical sessions with 6 weeks holiday = 46x8=368 sessions x 6000 = 2,208,000 additional sessions. This equates to each new GP seeing 22.6 patients per session or 45 patients per day! Nice to see the government taking seriously the over working of the jobbing GP....
"that goodwill is dangerously close to running dry" I think is underestimating the disinvestment that disenfranchised NHS workers now feel towards the NHS. The working capacity of the NHS as an institution and individuals within it it is like a Frank-Starling curve - the more pressure is put on, the harder everyone works to plug the gaps... however I think we have truly tipped over into "decompensated NHS failure" and little short of a massive injection of funding, manpower resource and organisational overhaul to remove the inane bureaucratic chains which prevent individuals and organisations from getting on with core work will have any effect on resuscitating this frail and dying edifice.
@Cobblers - agreed - not a mental image to spend any time dwelling on.....
Couldn't disagree more, and agree wholeheartedly with Nick Mann et al. In an age where hospital docs are specialising earlier with less generalist experience, the role of GP should be to become the expert general physician of yore with a broad clinical knowledge which requires experience. I was fortunate to come to general practice from being a medical registrar and barely a day goes by that I am not grateful for that. We hear endless whinging that the younger docs are too trigger happy to refer, but that is no surprise when their experiential learning within specialties has been so brief, even more so since the (much needed) working hours directives were implemented.
To place the onus on 5 years of GP training seems ludicrous - yes, 5 years may be a good idea, but that should consist of 3 month rotas in medical specialities - the learning curve is steepest at the start, and a stint in endocrinology, cardiology, dermatology, renal medicine, gastro, neurology coupled with a "proper" MRCGP more akin to the other MRC exams would produce well rounded, erudite and confident GPs of the future
D'you know - if some people want to give themselves unecessary cataracts and diabetes for vanishingly small NNT values in primary prevention, let them. For too long we have tried to be the pastoral role for our patients - informed decision making, of course, but gently guiding some of the more over-enthusiastic towards the "lose a bit of weight and move around more" camp than the "pill for every ill" camp. It appears that is not what is wanted - and the populace is allowed to drink too much, not get enough sleep, not exercise, take drugs which whilst not legal are freely available, eat the wrong things, spend unwisely and generally live an unhealthy life. Why should we stop them taking unnecessary and potentially harmful medications to boot?
sorry - for a moment I thought you said "not more than 1 unit of alcohol when cooking dinner...." - presumable a typo for "bottle"...!
Another great case of the powers that be addressing unmet WANT not unmet NEED. Pandering to the worried well, the hypochondriacal and the terminally PITA neurotic
and then what about school absence? The HPA advice is exclusion from school until 48 hours after antibiotics commenced, or until lesions have crusted and healed. So parents to keep kids off school for 2-3 weeks under the above guidance - I'm sure that's going to go down well on the school attendance record!
No caffeine on night shifts?!?! Jeez... what planet are we talking here!
Do any of them have an elbow crutch used as a fashion accessory rather than a walking aid?