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At the heart of general practice since 1960

Concerned about giving the facts

The health of individuals cannot simply be measured by taking a bp, says Dr Fiona Young

I qualified as a GP last year and am worried as to whether or not my chosen career is going to become obsolete. I hate all the target-chasing, which often makes it impossible to address the patient's own agenda. The new contract is dealing with populations rather than with individuals.

The Government has zero comprehension of what being a GP is all about: managing risk, uncertainty, variation in disease patterns, variation in patients' priorities and wishes, the physical/psycho/social interface and so on. The role of the generalist is vital in recognising the often overlapping and merging margins of different disease presentations and management. Who else is going to usefully consult with an individual about their diabetes, their depression, their delinquent teenage son and their occupational stress?

As far as Tony Blair is concerned, it would take three or four separate professionals to do that job. What chance would there be for a therapeutic relationship with the patient? In addition, the Government is trying to create neat statistics out of something that is essentially unquantifiable. The health of an individual cannot simply be measured by checking their cholesterol and BP.

What is more important is how individual patients feel about their health. Do they feel like a cripple because they are rattling with tablets that give them side-effects and may not give them any benefit? Do they therefore become depressed and add to their cardiovascular risk? Or do they feel frustrated because every time they come to the doctor to talk about their erectile dysfunction, there is no opening in the consultation for them to mention it because the doctor is so busy chasing quality points?

Only the other day I felt I had no time to talk to an elderly woman who lives alone about the death of her dog ­ and actually felt irritated when I couldn't hear her BP because she wouldn't stop talking about her loss. It was only afterwards that I realised what the damn computer targets do to us. This woman had lost her only companion and reason to leave her house on a regular basis. She didn't care about her BP or cholesterol level. But it might have made her feel a lot better and validated in her grief to have had her GP take her seriously and give her time to talk about her loss.

The Government wouldn't offer us brownie points for that. But I wouldn't mind betting that such a patient would be less likely to be an 'burden' on the NHS if her GP listened to her agenda, helped her to cope with her loss, monitored her for onset of depression and spent time encouraging her to get a new dog or referring her to a day centre for some social interaction. This isn't 'fluffy' medicine ­ the social stimulation would help to protect against dementia and depression, and walking a dog would protect against osteoporotic fracture and CVD.

Quality points do not allow for lateral thinking, and encourage a one-size-fits-all mentality. GPs cannot function effectively under these circumstances. The most worrying aspect is the increasing ill-health among doctors. This will lead to depletion of a resource already in short supply and, paradoxically, may lead to dangerously malfunctioning GPs.

We need a healthy working environment to do a good job. No one can work well under constant scrutiny. I thoroughly pledge my support to the Pulse manifesto.

Dr Fiona Young

Edinburgh

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