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?
Oh, I do love to start the day before surgery with a good laugh! Just sets you up for the day...
Second Dave Banner's appeal - c'mon Pulse - run your own "what do you think of appraiasal" mini-poll
There IS a simple answer to this - stop taking it all seriously and personally. I consider myself a professional, interested, diligent and careful GP, as are 90%+ of GPs around the country. Why do we seek external validation from the press/NHSE/appraisal etc., etc. - if I go home and consider that I have worked well, done my best by my patients in a crumbling system then I consider i have "done my duty" and have a clear conscience. That the Daily Mail et al will continue to have their hissy fits about how crap we all are isn't my problem - and to be fair, most of our patients still seem to rate us pretty highly. Stop looking for pats on the back from a press geared up for bad news - it won't happen!
I feel that conflating a vicious hunter with zero empathy and a horrible tendency to play with its prey before causing it's untimely demise in horrible circumstances is pretty unfair to our feline friends.....
"Patients who had false-positive results had around 10 GP appointments in the six months following the test, compared with seven in patients who had true-negative results. The false-positive patients also had around 24 further tests requested, compared with 14 in the true-negatives." - this is an observation study - perhaps this cohort was genuinely more unwell, or older, or smokers, or, or, or... since when did we start conflating observation with cause and effect?
I would build that dome in air,
That sunny dome! those caves of ice!
And all who heard should see them there,
And all should cry, Beware! Beware!
His flashing eyes, his floating hair!
Weave a circle round him thrice,
And close your eyes with holy dread
For he on honey-dew hath fed,
And drunk the milk of Paradise.
Idealistic bollocks which we just know will not be as smooth as all that - especially given that we are still running on nhs net that hits the dizzying peaks of 2meg on a good day with a tailwind. And PCNs are as yet an untried, untested and unknown quantity so to laud them as seems to be the habit of the day as the saviour of general practice seems a little premature, decent IT or not....
@Angus Podgorny - I'm going to be finishing even later having just sprayed coffee over my keyboard... thanks for that! :-D
Surely in this age of tech, there is a computer record of who leaves the country and doesn't come back in again?? Not quite sure why it's us GPs who have to police the system... if a patient registers with us and goes abroad, surely that's the remit of our beloved government to flag up. After all, I don't want my precious afternoons on the golf course taken up with expensive phone calls to non-attending patients... :-/
Tinted glasses +ve and carrying walking stick/crutch as a fashion accessory rather than a walking aid?