Being unable to do your job year-in and year-out, due to overwhelming workload or insufficient resources, is an extremely frustrating experience for anyone, and inevitably leads to rapid burn-out.
I must say that I have always thought what is described in the article to be the role of a GP in relation to ANY patient, children, the elderly and persons with chronic disease all included.
Be assertive. Ignore these perceived attitudes and get on with your job, aiming to do the best you possibly can, and to learn from the greatest teacher - experience.
It's difficult to understand from the abstract what lessons are to be learnt from this study, and the article is not available without subscription. Mention is made of failure to make a proper diagnosis, in other words false positives and false negatives. These instances ought to be expanded upon in more detail, to be useful.
Times have changed. When I was an undergraduate and we had examinations on which promotion depended, most of the students who failed were convinced one or other of the examiners 'had it in for them'. There was never any appeal process, and no one ever complained about this. No one went through our examination papers to tell us in what areas we were deficient; and the only check on bias was the presence of an external examiner, who we all thought was there to ensure that our professors were not too lenient..
I suppose a lot of dissent is to be expected from the public (the same as happened with, for example, the fluoridation proposals), so clearly the publicity needs to be handled very carefully, constantly stressing the benefits to be obtained from this development.
Clearly there was no blinding here.
Do we really need cash incentives to provide good quality care?
The very nature and purpose of this examination pretty well ensures the veneer of bias, which is inherent in any professional evaluation. Minimizing this is extremely difficult. What educators have learnt in recent decades is to incorporate techniques of objectivity, eg referring to candidates by numbers rather than looking at names, pictures of their faces and recordings of their actual voices; by recruiting multiple examiners, who score totally independently; and by using multiple-choice questions as adjuncts as much as possible. Ideally, questions and scenarios used need to be published openly after the event, with answers given; and new questions thought up each time the exam is given. Videotaping is also essential, so as to explain confidently to candidates later what it was that caused them to lose marks, and which of the examiners thought so.
Finally, a good review session lasting a fortnight or so immediately prior to the exam can be invaluable. Perhaps some entrepreneur can organize this.
Measures such as these are the only way out, although even they still won't ensure that more candidates pass or that there will be fewer lawsuits.
Yes, it would be good to know that objective evaluative evidence is being collectd.
I get the point about reducing an entire practice to a few measurable parameters. The trouble is that unless you do this, you run the risk of being deemed judgmental.
I'd like to see more information on appropriate point-of-care testing: what is available now and what are the possibilities?
I would prefer to see the side effects evaluated against the effects of NOT taking statins.
Some years ago a series of articles was started in the Journal of the American Medical Association entitled "The Rational Clinical Examination" (it;s probably still going). It commenced by lamenting a trend in patient encounters, involving the competion of an extensive form by the patient in the waiting room (insted of proper history-taking by the physician) and the ordering of various tests (instead of actually examining the patient), and of course diagnoses being founded on the results of these.
The general consensus amongst correspondents at the time was that physicians were in danger of losing touch with their patients, and that the 'hands-on' approach was what was most appreciated by patients.
Perish the thought that pretty soon we shall have patients going through a diagnostic 'scan' as they walk through the door to the consultation room.
Surely it must be the triple vaccine that deters the parents from bringing their children in to get immunized. Can't you make a monovalent vaccine available? Also reveal how many children have had to be hospitalized, got complications or even died. Tell people to bring their child in on the day of exposure, since the vaccine virus works if given immediately; and make the product available on an emergency basis. Also, parents have to be aware that it's only unimmunized children that are getting the disease. Can't the vaccine be made compulsory for school or day care admission (even though this is a bit late)?
Why only GPs? Shouldn't GP's be able to negatively evaluate other types of physicians, ie consultants? and shouldn't patients themselves be the ones to complain about GPs?
I recall doing a locum for a few weeks in a rural practice, where the doctor had a shelf of large glass bottles of different coloured water. Patients would ask for a particular colour, and take a small container of it away with them. I never saw any of them come back, except for a refill.
I must say I do think it makes very good sense to schedule elderly persons, and in fact everyone for that matter, for a regular health maintenance visit, with increasing frequency as they get older, as envisaged by Breslow and Somers in the 1970s (N Engl J Med. 1977 Mar 17;296(11):601-8). These visits are not really time-consuming and can be largely managed by support staff.
I get rather upset when a professional person whom I have come to for help supplies me with a list of practitioners to go to and invites me to chose. How am I supposed to know? There are all sorts of very good reasons why this should be part of the services doctors offer. Some pharmacists might provide a very good explanation of side effects or drug interactions etc. Others might provide a comfortable area to wait (important if patients are handicapped), or to park my care without getting a ticket. Others might be inclined to pressure clients to buy other, non-prescription items at inflated prices, or be downright rude. A doctor is in a good position to know about all these things, and patients expect this kind of advice.
DH 'vetted severance payments' and more calls for NHS chief exec to leave, but HIV can probably be cured
It looks as if it might be possible to cure babies infected perinatally, but these are not inclined to get themselves reinfected. It would be an entirely different picture in adults, who would have a false sense of security.