If the patient is self funding then refer away
" A fool and their money are soon parted"
If it's on the NHS the doctor has a duty not to waste tax payers money
If we were paid by our patients we would not be having this conversation
All of our ills and those of the NHS is are because of the absurd way we are paid
I don't want to be treated better or paid better than a plumber or electrician I want to be treated the same as them
Mea culpa mea culpa mea maxima culpa
• no nights or weekends when our patients need us ie the dying
• accepting money for practicing basic medicine I'm talking QOFS here
• accepting nurses to do our work and thus ending treating " the whole patient " enter QOFs again and clinics not patients
• not having the balls to fight for reasonable list sizes and thus protecting the standard of our work
I could go on but you know I am right
Brilliant as usual but can we admit the mea culpa part
• allowing more and more to be put on us so we had to give up out of hours or die
• our enthusiasm for nurses to do lots of our work so we lost the " whole patient bit"
• allowing the complaints process to get too onerous so we are bullied by our patients
• accepting fund holding and its offsprings so we become accountants and not Doctors
• accepting bigger and bigger lists all for money so the size of our lists are more important than the quality of our work
• the truly terrible and degrading fact of QOF and its spawns paid for what we should be doing anyway abandoning any traces of being a profession
I could go on but it's all too depressing
Can I please tell everyone why young Doctors are shunning General practice
• They are idealistic and see through the bullshit of no continuity of care no out of hours
• Nurses doing all the chronic care and a lot of the unscheduled care as well
• how GP's have sold their souls for money ie QOF etc and much more degrading stuff as well
• They want to be DOCTORS !! not manage budgets and manage practice populations
They see through the crap
General Practice is NOT a rewarding career
The young deal in real and will not do anything for money unless they wish to raise families and see this as the bigger prize
Oh dear oh dear oh dear
So no weekends or nights
No terminal care ( we are not around )
No chronic illness ( all done by nurses )
No minor illness ( all done by nurses )
Very little minor surgery ( too risky )
No obstetrics ( of course )
Nothing which is important or serious ( better refer remember the GMC is hovering ) refer fast
NOW NO PSYCHIATRY !!!
GOD GIVE ME STRENGTH
Let us look carefully at how we got here
• our own self esteem is/was so low that for money we caved in to allow unqualified persons to do our jobs ie nurse practitioners of different shades and training
• we abandoned our patients out of hours when they needed us most ie when dying etc
• we took on more and more ( again for greenbacks )and consented to systems of payment any plumber or bricklayer would laugh at ie QOF
• we accepted list sizes that were too large again for money
. We allowed ourselves to get unreachable by our patients
But most of all we lost our pride and any sense of self worth we refused to fight because deep down we know we are worth fuck all or rather that is what we have become
All three of my sons no longer smoke cigarettes now using just e cigs with low nicotinne content
We have over many years lost control of our professional autonomy
"The fault dear Brutus lies not in our stars but in ourselves that we are underlings "
Shakespeare Julius Caesar
The only way is resign you fools
What I find worrying is that with such severe and live threatening disease you had a " uncertain " stress test
In 1947 a terrible mistake was made when primary care was made part of the NHS when only secondary care should have been part of a free at point of care service
Had this not happened the following would have occurred
• terms like " heart sink " and " worried well " would not exist
• Preventive care ie screening would only happen to those that wanted it
• the very poor would pay nothing as they would be subsidised by paying patients
• GP's would naturally specialise to increase their income all sigmoidoscopies etc would be done in primary care
• GP 's would get paid for activity not per capita and boy would we love our work
• secondary care would only do a fraction of what it does now ( look at the massive improvement in procedures etc now done by Dentists who have left the NHS )
• The best Doctors would flood to General Practice as they would DO !! something and not be medical " office boys "
• We work at present under intolerable pressures all while our patients pay vast sums at B and Q etc WHY ? In the name of God
• Get back your souls and pride be Doctors again you were once as SHO 's etc
What is happening to clinical medicine and what has happened to our pride and vocation ?
The job we trained so hard for is being done by nurses ( badly in most cases)
I did one year as a Paediatric SHO and I heard a GP say with pride and relish that the nurses in his practice see all the sick children of any age
And he calls himself a Doctor !!
It is only by regaining our pride and rejecting the bribes of the politicians to lose it that our patients will get the Doctors and medicine they need and deserve
And you know what ?
Secondary care will be winners as well
The NHS had a design fault in 1947 at its birth
Primary care should not be any part of the NHS
Look at the dentists their range of care has increased procedures undertaken etc and their income and job satisfaction
If General Practice was private you could shut most of the A and E depts in the country
GP's could manage vast amounts of present inpatient care with the aid of consultant domiciliries ( remember them ) and the incentive to keep the patient out of hospital ( which does not exist at present )
Talented and experienced Doctors would flood to General Practice
Your " heart sink " patients would disappear
But most of all we would be Doctors again not the NHS " office boys "
We GP's have consistently over many years aided and abetted the lie of the NHS that a good primary care service can be funded through taxation
If we fought as the junior doctors have done with what is best for patients we would not be in the sorry position we are
We have accepted for money ( ie bribes) not to tell patients the truth that we are being forced to deliver a rubbish service
We have arrived where we are from a lack of a deep belief in our work and its value
We have lost our balls and our destiny to be doctors to be proud of
"The fault dear Brutus is not in our stars but in ourselves that we are underlings "
Julius Caesar Shakespeare
Do NOT do a PSA on men with LUTS
They have hypertrophy of the middle of the prostate cancer of the prostate affects the outer rim of the prostate
If you do a PSA on men with LUTS you are screening and should by that logic do a PSA on men with eczema
All governments want electoral popularity
How is this achieved ?
By low taxes of course
And how is this achieved?
By bullying all public sector workers and paying them below the market rate
This is all part of a vast eternal plan for electoral success
Sorry Mr Hunt we won't play ball
You want a 24/7 NHS
You pay for it !!!
Junior Doctors have " balls"
Oh how I wish their world weary greedy whinging GP collegues had some
I did A level history on my tortuous path to medicine and later General Practice and I promise that every current Ill of General Practice is due to us opting out of out of hours work and history will decide this
• our lack of street cred to our patients and our hospital collegues
• our lack of clout in negotiations with the government
.• the flood of none doctors into primary care if a nurse can see and treat a sick baby at 3 AM they can see and treat anybody
• we invited in more and more rubbish use of our time during the day after all we get a good nights sleep don't we not like proper doctors in hospital . Before we could say steady on not now
• If we farmed out out of hours why not diabetes COPD depression all provided by nurses in mobile home type vehicles like roadside fast food
All is not lost we could go back to full 24/7 medicine all we did was make a massive massive mistake
There is no need whatever for a GP except as a personal 24/7 doctor
Unless we go back to this or something very like it we are dead me walking
The late John Fry who dis so much for General Peactice in his lifetime said
"The GP will survive as a personal doctor or not at all"
They are all barking mad but rich and how the politicians love them because the GP is not each patients advocate but a manager of health care delivery to many patients
ie an accountant and not a Doctor
Poor misguided fools