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A faulty production line

If my patient really wants to be over-investigated, she can pay for the pleasure

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‘Dear Dr Copperfield,

Thank you for referring this charming lady for a private opinion regarding her rash…I suspect this is blah blah…though of course it might be blah blah blah…I’ve suggested some emollients and I will review her in due course. In the meantime, I’d be grateful if you would arrange a full biochemical and haematological screen, a urinalysis, stool for ova, cysts and parasites and a chest X-ray.

Yours blah blah

Private consultant.’

‘Dear private consultant.

Many thanks for giving me the opportunity to be your unpaid community houseman. I’d be delighted to do this work on your behalf while you earn some fully deserved private cash. Oh no, wait, what I mean is, “sod off”.

As for “charming”: well, obviously, you’re entitled to your opinion.

Yours sincerely

Dr C

PS Emollients, eh? That’s brilliant. What made you think of that?’


Because of the demographic I work in, it’s disappointingly unusual for me to need to fire off a reply like this. But, for some reason, I’ve recently had a flurry of private referrals and letters – which presumably means either that the country really is emerging from its financial black hole, or that the NHS really is heading straight for one.

And the other thing I’ve noticed, as illustrated in this example, is that private specialists seem increasingly happy to delegate any spadework to everyone’s favourite community dogsbody, leaving them more time to meet, greet, pontificate and fleece.

Which leaves us GPs where, precisely?

There’s useful guidance on prescribing requests from the private sector – useful in the sense that it aligns with what I already do, which is to prescribe if it’s what I would have prescribed anyway, and refuse if it isn’t. Which usually means refusing.

But other donkey work?

It’s harder to make the distinction between appropriate or not, which is perhaps why this is a guidance-free zone. So it does leave me conflicted when the punter presents me with a private consultant’s wishlist when I thought no investigations were needed, or the patient arranged her private second opinion without deigning to allow me one first.

The peacemaker in me says, look, just bite the bullet and get on with it.

Whereas the contrarian in me says, if the patient really wants to be over-investigated to the point of submission, she can pay for the pleasure, and if she doesn’t, she can charmingly argue the toss with her private doc.

Trouble is, there is no peacemaker in me.

Dr Tony Copperfield is a GP in Essex

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Readers' comments (13)

  • ha ha hilarious and a good point. Many would just bend over as usual but I agree that if going private and having tests not usually done then the investigations should be private too really and it would depend on my mood that day as to what I did and whether the patient was actually there.
    After all if you do the tests they come back to you you have to follow them up etc. Even if this was an NHS consultant I think we should be saying you need to investigate your own patients and actually follow up the results. I had an OGD report asking me to please follow up the results of the gastric biopsy which is dangerous as I would usually ignore results of tests done in secondary care presuming they are followed up there.

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  • Drachula

    Hmm, I think I would say it that I wasn't in a position to do the tests as I don't have the benefit of the consultant's perspective, but I would be happy to refer to the NHS consultant for consideration of this. (And the long wait!). A GP did this to me once - I was really cross, but it was very effective!!

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  • a pt was prescribed roaccutane privately but the consultant wrote to me asking for FBC, U&E, LFTs, lipid profile and pregnancy test to be arranged at GP surgery.
    I wrote a nice later back: as pt is being seen privately there isnt a reason why he (cons) cannot arrange the bloods and urine for preg test in his clinic.
    next from the cons:
    blood tests were all normal, urine preg test negative, pt on contraceptive and roaccutane started.

    it works.

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  • Instead of obsessing about yourselves, why not try to see things from the patient's perspective for once.

    The private consultant may be trying to help the patient out (as the patient may be financially struggling) by requesting the tests to be provided by the NHS.

    Clearly patients are so desperate that they are willing to go to private consultants due to their needs being unmet by the NHS.

    What exactly is the aim of your job? To please yourselves or to help patients? And why are GPs so petty?

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  • "And why are GPs so petty?"

    Why are patients so totally unaware of the pressures that we face in trying to run a service on a shoestring?

    These are secondary care investigations requested by secondary care with the results going back to secondary care. We do not have the time or indeed the contractual obligation to undertake these tests and in fact us wasting time on these kind of things makes it harder for us to focus on OUR core activity which is seeing unwell patients.

    Some patients want us to come around and clean their houses for them (I'm not joking) - this doesn't make it our job.

    Why are patients so ignorant?

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  • Patient aren't ignorant,they are quite self absorbed(sorry for the generalisation).They have no concept of limited resource both personal and the state,probably because it is free at point of service.They have no concept of how the NHS system is continually on the knife edge and is unable to provide everything everyone wants.They have failed to grasp that over the last 5 years there has been a pay freeze in the NHS(with inflation circa a 10-12% pay cut for the front line)and that in general practice there has been a sub inflation rate rise in funding since 2004(when the last GP crisis was in the offing).They have been oblivious to the Nicholson challenge+ real term cuts in funding.They just expect to continue getting their wants with in real terms a deacreasing pie+ increasing demands.They are blissfully ignorant of the pressures on the NHS because of its free of the point of service model.THIS HAS TO CHANGE.Time to join the rest of the world with an insurnace based system.Stop being ignorant of the cost of healthcare.

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  • It's pretty basic really. You request the test, you take ownership of the result.

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  • I would also similarly refused and actually offered the patient an alternative private opinion from a consultant that I know that does not do that and understands our pressure.

    - anonymous salaried!

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  • Anonymous | 24 April 2015 1:22am I agree with most of what you say until 'unmet needs.'
    Unmet wants is what usually happens or unmet needs but in a time frame unacceptable to the patient.
    The NHS is at bursting point but will sort out most issues in a reasonable time but if you go private, stay private; if you can't stay private get back in the queue with the others.

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  • I see private consultants for any condition my GP feels the need for me to see a consultant - it's not me that instigates this - I even had major heart surgery privately - Bupa saved the NHS a ton of money. I'm never over investigated. My GP never has to do any tests that the private consultants want - what would be the point in that ? Much quicker getting tests done privately. My work pays for the Bupa insurance - I couldn't possibly afford it.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder