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CAMHS won't see you now

It's all the GP's fault

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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 

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Readers' comments (28)

  • In a totalitarian state it is important for everyone to have broken the law in order to have the option to prosecute the free thinkers.

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  • according to my MDO the key thing is to make 'reasonable attempt' at contacting the patient for test results.

    not sure what their stance on ordering tests that the patient never goes to.

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  • In our CQC inspection, the office wanted to know - how did I make sure patients attended an investigation or carried on taking a new medication?
    My response of - patient responsibility did not go down well 😕

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  • Peter Swinyard

    I was told by the MPS lawyers that a letter to a perfectly intelligent hypertensive woman saying "I think it would be a good idea for you to come in to see me soon about this" is not adequate medicolegally unless I spell out all the gloom and disaster that may follow her ignoring my advice - which I believe she has a total right to do. This is becoming such a litigious no-win environment in which to practice and the concept of patients taking responsibility for their own health seems to have evaporated. Along with a lot of GPs.

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  • And many GPs do a lot of impossibles but not good enough for the powers that be. All in the name of "protecting" Patients. Protecting them from their GPs!

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  • If you do not follow your hairdresser advice - you look stupid.
    If you don't take your lawyers advice - you lose your case.
    If you do not follow your mechanics advice - you lose your life/licence/car or kill someone else.
    If you do not follow your doctors advice- it's ok you can sue them.
    What other job if you do not follow the advice is it the professional's fault.

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  • I don't get it, - why would Dr Cooperfield "buck the trend" of your own practices standard operating protocols, apart from testing the waters and seeing what happens to your GMS registration?

    Dr Kenyon, - you probably have processes in place that would satisfy the CQC officer:

    1. your practice probably does supply all the necessary documentation for the patient to know where when and how to attend their appointment.

    If your referral bounces from the provider, they will send you a letter, stating they could not book the patient in and you would make an individual decision when reading that letter on whether this is something that needs following up, or if the patient feels better.

    2. On medications, - you agree with the patient that they will book a follow up appointment (reflected in your notes) to review the effect of taking, or not taking this new medication you decided to start them on.

    Fobbing off the CQC inspector with a generic "patient responsibility" answer will just give our practice manager unnecessary headache in following up and demonstrating the processes.

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  • Thank you for the timely reminder to send off that C.V , good luck.

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  • As the adage goes, you can lead a horse to water, but you can't make it drink. People, like horses, will only do what they have a mind to do. So why in hell’s name is it the GPs fault if the patient, being mentally capable, do not follow the GPs advice??

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  • Practice manager 7:02 am - we are doctors, we provide medical care, we do not enforce it. Usual compliments!

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From: Copperfield

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