This site is intended for health professionals only

At the heart of general practice since 1960


  • The Government must tackle the root causes of medication errors

    Rory's comment 26 Feb 2018 9:14am

    Unless everywhere I have worked is abnormal, the system where repeat prescriptions are passed to GPs in a large pile having been printed off by a non-clinical person and are then signed off at speed with little, if any checking of the patient records is extremely dangerous.

  • Does the NHS have a problem with BME doctors?

    Rory's comment 26 Feb 2018 9:03am

    Why have you not addressed that other factors such as English as a second language and cultural approaches? This is of course true for all persons not from the UK, but these tend to be BME. The trainee that struggled the most in the exam was Colombian as his English was weaker than everyone else's.

    Rather than put this all down to race with what amounts to some extremely small numbers and as it stands hearsay it would have been better if you had excluded other causes and had this as a remaining explanation rather than the only explanation you choose to write about.

  • Cheer of home visits has become a chore

    Rory's comment 19 Feb 2018 3:11pm

    Welcome to demographic shift.
    Be grateful that you had those good times in general practice. They'd pretty much dried up by the time I was a medical student and things were certainly not better when I was training.
    Any service that is free at point of use rations on time and availability.

  • Why this new flu jab is bringing out the chills in me

    Rory's comment 19 Feb 2018 2:50pm

    Opt out of the service. You're a business. If any other supplier was treated in this way by the main contractor they would quickly leave.
    If you're worried about the patient safety aspect, raise that with the CCG et al.

  • Bawa-Garba: how can we curb this culture of blame?

    Rory's comment 19 Feb 2018 2:43pm

    So doctors should be completely separated from the work environment they find themselves in? Ethical treatment reduced to "do your best". The legal obligation to admit to errors that have killed people yet none to draw attention to these issues in the first place.
    In an office, if a plug is dangerous the employer and employees both have a duty of care to ensure that this is rectified to ensure no one is electrocuted. There is no grounds to baldly state that the company generally does a good job and the occasional jolt shouldn't be a reason to do anything about it.
    There are probably many Doctors in situations where they are well aware that people are dying daily due to substandard of care and hope that they can move on to the next part of their rotation before they are involved and of course protecting their patients might affect their career.
    There was a massive protest in Doctors hours being altered - with the protest being of course regarding "patient safety". Now this is completely about patient safety and doctors seem in the main to be mostly concerned about themselves.

  • Plug the NHS cash sinkhole before pouring more funds in

    Rory's comment 19 Feb 2018 2:34pm

    PFI is not inherently "evil", nor are private service providers... IF there were persons within the NHS who are able to understand the nature of the contracts they are signing up to.
    When I was interviewed in 1997 at Medical School I was asked if I thought that there should be any business / economics in the Medical Degree course. I of course with the confidence of youth said "of course not". And then was educated after 5 minutes the importance of at least some understanding. This of course was then not covered at any point from being a fresher to getting my CCT.
    More rigour and expertise is undertaken in choosing a car insurer than is taken to spend money that runs into the billions.

  • Let’s not throw the Gabas out with the Benzos

    Rory's comment 19 Feb 2018 2:21pm

    As with most studies, the results you get are dependant on the patients that are recruited along with the metrics that are used to assess the endpoint.

    Who it is appropriate to treat and for how long are of course difficult questions to answer. But if it was straightforward a dispensing machine would be adequate rather than a healthcare professional.

  • We must be forced to care for ourselves

    Rory's comment 07 Apr 2017 11:23am

    Senior colleagues help? Really??!? When I was a PRHO and an X-ray had not been completed that the Registrars had requested they in front of the consultant asked why I didn't take them down to radiology at 8pm. I responded the reason was I finished at 5pm. Their expressions indicated that this was not the expected answer.

  • Of course GPs in A&E won't improve access

    Rory's comment 23 Mar 2017 2:38pm

    Until there is a financial cost to attending A&E and GP, there will always be too great demand and too little resource.

    Increasing resources is of course good - but will also mean more people will get things seen since the time lost is lowered.

    A system closer to that of Ireland where there are charges for accessing healthcare - albeit heavily subsidised - would help convince the family of 5 with the sniffles that there is no need to book an hour with the GP for the self-limiting illness.

  • Can I refuse to treat a dental abscess?

    Rory's comment 01 Mar 2017 1:41pm

    As Dr Brigg blithely appears ignore is that sometimes the problem is not as simple as a well meaning, untrained amateur might think. Thus giving well meaning - but utterly inappropriate - treatment will do more harm than good. More people get morbidity / mortality from overly (and inappropriately)confident doctors than from any other cause.

    The examples given to back up this poorly thought through position are hilarious - what one would do with no recourse to expert assessment is always going to be different to what one will do when experts are available.

  • F*** QOF

    Rory's comment 01 Mar 2017 12:32pm

    Surgeons were once asked if they would like strict lists of checks to be undertaken prior to surgery in the same manner that happens prior to flights. Most were vehemently against them.
    The surgeons were then asked if they would like others to have to do this prior to surgery that they were receiving. The majority would.
    The intent of QOF is that it ensures a basic standard of care to all patients. The reality is that it is often viewed as a way of generating income and that as long as the boxes are ticked, that is all that matters - calling up patients to ask regarding smoking and the single letter to asthma patients for a review I doubt was the intent.
    But this is not a failing of the system, but those who are intentionally misusing it.

  • The problems of being a millennial doctor

    Rory's comment 24 Feb 2017 10:39am

    The children now love luxury; they have bad manners, contempt for authority; they show disrespect for elders and love chatter in place of exercise. Children are now tyrants, not the servants of their households. They no longer rise when elders enter the room. They contradict their parents, chatter before company, gobble up dainties at the table, cross their legs, and tyrannize their teachers.

    Attributed to SOCRATES by Plato

  • One in three GPs have offended patients by talking about their weight

    Rory's comment 24 Feb 2017 10:33am

    I agree - given the vast amount of evidence that demonstrates obesity as a risk factor for many medical conditions it should be addressed - just like smoking and drinking.
    There are probably persons who are fit, active and overweight but these are in the minority.

  • Final GP seniority payment figures published

    Rory's comment 23 Feb 2017 10:55am

    GPs might be technically private contractors but there remains the mentality of the Civil Service.

    That a GP has kept their seat warm for 30 years by itself demonstrates nothing - are skills up to date? Are they catching more illnesses earlier? Are they preventing more patients from needing hospital visits? Metrics?!? Evil Private Sector Blasphemy - turning up should be enough!

    That they are a senior Partner in their own business means they get financial reward from running the business well - surely?

  • Inhaled steroids in COPD: a classic case of overtreatment?

    Rory's comment 16 Feb 2017 10:43am

    Overuse is an almost definite long term risk to the doctor.
    Underuse is a rare short term risk to the doctor's career.

    Yes, everyone has a touch of asthma. Change the coding and move on.

  • The most pointless consultation I'll ever have

    Rory's comment 14 Feb 2017 10:41am

    "Haematuria" caused by beetroot soup was one interesting one I recall.

    A service that is free at the point of delivery will not have a perceived value. If he'd had to have a deposit to make the booking and could have it returned if he cancels 48 hours beforehand everyone would have saved time.

  • Perhaps better feedback is the key to improving GP trainee morale

    Rory's comment 14 Feb 2017 10:36am

    I once diagnosed bacterial meningitis over the phone talking to the patient's father. He dropped the copy of the pathology report he'd got in at reception for me. That was years ago and I still remember it.

    The rest of the feedback, whether appraisals, 1:1s is meaningless noise. And having worked in an environment where the app based feedback was undertaken this invariably descended into people trying to up each other's profiles.

    The patient who refused statins - the lesson you've learned is patient centred medicine. Do you know if he's had a cardiovascular event the statin might have prevented?

    Saying there should be "higher quality" feedback is meaningless since no one would disagree and it is not clear what this would entail. I am sure we would also all like world peace and no want but without the detail, it is pretty meaningless.

  • Donald Trump's thoughts on the NHS

    Rory's comment 14 Feb 2017 10:27am

    Trump has little grasp of most complex ideas. He is a bully who had the fortune to start with a fortune and has acted as a sociopath for decades - refusing to pay and then grinding people down with lawsuits, having entities declare bankruptcies when required - after asset stripping.

    He intends to Make America Great again - something massively more complex than the NHS.

    I don't really see how the Conservatives come in to this. Are we now going to blame them for Labour's PPI schemes?

  • Café? Fitness trainer? What’s your Plan B?

    Rory's comment 14 Feb 2017 10:23am

    I imagine historically retiring at 60 with a final salary pension probably ensured that there was no need for a Plan B, beyond a weekend retirement, pocketing the lump sum and then returning to work as a brand new sessional GP.

    Yes, there is more to life than sitting in a small room and seeing patients one after the other. If that insight requires being called a Plan B, so be it.

  • My big idea? Let's replace GP training with something more useful

    Rory's comment 14 Feb 2017 10:18am

    Medicine is year on year specialising, yet we still have a system that is woefully out of date where we pretend every student needs to learn a small amount about many different specialities, leading to many wasted years - paediatricians need very little understanding of care of the elderly, and psychiatry and ortho equally have little overlap.

    If specialities branched off earlier, this would in turn enable GP trainees to do more of the simpler activities in many of the specialities.

    But even this would only paper over the cracks of the lack of training GPs undergo in a field which is not only constantly changing, but are required to undertake increasingly complex decisions.