Posted by: Tony Copperfield3 December 2015
The sign reads, ‘Do Not Step On The Live Rail’.
‘Your Mastermind specialist topic is ‘The Bleeding Obvious’ and your questions start, now…’
One thing that’s for certain is that if anybody did decide to jump down from the platform and step on the live rail, somehow, some way, the GMC would rule that it was their GP’s fault.
Why shouldn’t it be? Everything else is.
Coffee room chat today is what to do about patients who either don’t go for tests that we order or who can’t be arsed to find out what the result was after the event.
The GMC, for once, is quite clear about this situation and, as so often, is completely wrong.
The impossible is what GPs these days are expected to do
When I order a test I tell the patient that checking that the result has arrived and picking up any message that I might have left for them is their responsibility. It’s right there, printed at the bottom right hand corner of the request form. There aren’t enough hours in the day to chase up every abnormal result that flashes across my computer screen. If it’s an iffy shadow on a CXR, then OK, I’ll be looking for the victim, but a borderline low vitamin D level? Click on ‘Tell patient to collect prescription’. Issue prescription. Staple to Vitamin D booklet. Place in out tray. Job done. Next. ‘Mild to moderate degenerative changes are visualised in the knee joint’. Click on ‘Ask patient to telephone me to discuss.’ Bish, bash, bosh. Next.
Here’s the catch.
Suppose one day that you decide to buck the trend and decide that you aren’t going to ignore a patient who presents with potentially serious symptoms, no matter what the Daily Mail thinks. And, in the new spirit of openness and patient empowerment, you decide to be up front with the punter and let him do the worrying instead of worrying on his behalf.
Summoning up all you learned in your CQC-sanctioned ‘breaking bad news’ training day you tell it like it is, ‘Welcome to Deep Shit Creek, Arizona. This is something we need to look into. Here’s an ultrasound scan request form. Go to it.’
Except, scared senseless by your candour, he panics and shreds the form. Denial is a wonderful thing.
Six months later he reappears, inoperable. The cookie has crumbled, and crumbs, if it wasn’t your fault all along.
Ask your defence body, refer to GMC guidance, they’ll both tell you the same. It doesn’t matter that you were on the beach at the time, it doesn’t matter that the patient appeared to have capacity to make decisions and a perfect right to make the wrong choice, it’s your responsibility to make sure that every test you ask for is actually done, as well as to act on the result.
Short of frog-marching the patient to the lab and/or imaging department that is, of course, impossible.
And the impossible is what GPs these days are expected to do.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield