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Kindly do your own bloody work

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I know I’ve banged on about this before. But, really, if only for the sake of catharting some pent-up rage, I need to share this with you. This being yesterday’s star discharge letter about an elderly lady admitted with falls. What follows, I swear, is pretty much verbatim, redacted only to remove the linking narrative:

  1. Patient has unexplained hypocalcaemia, kindly refer for endocrine opinion.
  2. LFTs abnormal, kindly arrange hepatology follow-up.
  3. Patient has thyroid swelling, kindly arrange surgical opinion.
  4. Kindly refer to falls clinic.
  5. Arthritis causing difficulties with ADL, kindly contact OT for domiciliary assessment.
  6. Ongoing memory problems, kindly refer to local memory clinic.
  7. Lung nodules found on scan, kindly arrange repeat scan and refer if necessary.

The killer, of course, is that word ‘kindly’. There’s nothing like some mock humility as you smirkingly lob a grenade into the GP’s day. While this discharge letter is extreme, you and I know it’s not atypical. Given the context of the GP Forward View, the ‘GP to do’ fiasco has reached utter piss-take levels. And the recently reported fact that CCGs couldn’t give a toss really shouldn’t surprise anyone because, after all, why would they?

We either suck this up, accepting it as just another nail being slowly hammered in the coffin of general practice. Or we thwack it back from whence it came, using the BMA template letters. Problems is, sooner or later, this is going to result in a patient having something important overlooked or delayed. Now, I’m not known for being patient centred, but even I recognise this isn’t good. Besides, it’s not good for GPs, either, at least until we’re 100% clear where the medicolegal liability lies.

In the meantime, I suggest we have a competition to see if anyone can top my list of seven ‘GP to-do’s’. Prize is a holiday in a five star resort. Kindly arrange and fund yourself.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

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Readers' comments (13)

  • Astonishing. As a developmental psychiatrist I refer my own patients to wherever they need to go and liaise with hospital Paeds if needed to help with this. I do ask GPs to do bloods as our clinic no longer has paediatric phlebotomy.

    I thought we moved on from the C2C ban years ago!

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  • Emma- what makes you think GP has Paediatric phlebotomy?

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  • Alan Ferris

    Phone call yesterday from a consultant: "I've just endoscoped your patient, she has a carcinoma. Please can you refer her to me via the 2 week rule."

    I despair

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  • I had a BUPA "health screen" sent in recently with 7 "GP action points" on it. Needless to say it went into my "routine appt" (i.e. 4 week wait) pile. The terrible thing was that point 4 ("likely BCC on back") looked very much like 2 x malignant melanomas to me (and the dermatologist I referred to via the 2WR agreed). This sort of dumping is exceedingly dangerous!

    I have considered changing my letter sign-off to "community house officer" but don't feel that accurately reflects the level of non-esteem I'm held in by certain hospital staff.

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  • Vinci Ho

    You see
    Simon really thought he was the saviour and the most pro-GP politician ever. As I wrote in the other longer comment today , he is facing one serious dichotomy of his life where his big aspirations are confronted by a dangerously fraud hypocrisy. May be the so called integration of care was supposed to address these issues of referrals going around the system. But without the nodding of the PM and Chancellor and providing the funding he needed , the 'one-stop' shop in general practice will turn into a one stop dumping ground instead. Oh , PS , with a bit of 'help' from a specialist on Skype.........

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  • *

    I don't think work dumping represents non-esteem. It's basic passing of the buck and its engaged in by the lazy, 'can't be arssed' and 'don't give a shite' brigade because they think they can get away with it without come back. Not everyone does it...but there are definite repeat offenders in every hospital and they need to be identified and told where to get off. There are the occasional folk who genuinely seem to believe large parts of their job are below them best done 'in the community' - bounce it back that's what I say.

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  • As regular readers here know, I have some rather deep and troubling psychological issues; receiving such a letter would perversely act as a tonic to my warped mind and I would respond by phoning the discharging consultants secretary and demand that the consultant get back to me ASAP because I needed to discuss with them their chaotic and incoherent management. Never underestimate the mood-elevating power of smug self-righteousness when high-lighting the inadequacies of those who by default deem their capabilities as being superior to those possessed by oneself.

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  • Why did you not just email or phone the consultant and tell him to do it? I have been doing this for several years now and NOT ONCE have I had any come back from it. They always do it once it has been challenged.

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  • Confidentiality appreciated but I hope they ruled out a thyroid cancer with mets before deciding the above list of abnormalities were all separate issues for scattergun referrals elsewhere..... Think this represents what the late Douglas Adams describes in his Hitchhiker 's Guide to the Galaxy as erecting an SEP field - 'someone else's problem ' field -around something which renders it invisible...

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  • Sally at 2.43 - my diagnostic thoughts exactly!!

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From: Copperfield

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