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GPs criticised for treating one condition at a time

A patient watchdog has criticised GPs for displaying signs telling patients that they will only deal with one condition at a time at routine consultations.

Aneurin Bevan Community Health Council (ABCHC), which monitors health services in South Wales, said some practices are continuing either to put up signs or to tell patients verbally that they will not deal with more than one condition at a routine appointment, despite previously being warned it was ‘clinically inappropriate and indefensible’.

However, the RCGP has argued that some practices are forced to make such rules to cope with heavy workloads.

The issue was raised at an Aneurin Bevan University Health Board meeting, where the ABCHC’s new annual report was highlighted.

The report states: ’Last year we drew the Health Board’s attention to the bluntly worded signs which we had observed in some GP surgeries indicating that only one medical issue could be dealt with in a routine GP consultation. We considered that such notices could inhibit patients from raising a number of symptoms which may be linked, and could discourage a fuller discussion which might assist an accurate diagnosis.

’The Health Board agreed with this view and the assistant medical director (general practice) communicated with all GP practices in the Gwent area to advise that a blanket policy was clinically inappropriate and indefensible.’

The board said that there has been a ‘reduction in this approach’, but that ’we are still seeing it continue in some areas’

It adds: ’While appreciating the time pressures in GP consulting rooms, we are concerned about the risk to patients if this issue is not fully resolved.’

But RCGP Wales vice-chair Dr Jane Fenton-May said: ’I can see where the CHC is coming from but this is one of the things that GPs have to do to regulate their workload. Some practices have been doing this for a long time.

’If a patient comes in with a shopping list of four or five things then sometimes you just have to tell them that you’ll look at the one that’s most important. Sometimes their problems are linked but sometimes they are not. We are limited to ten minutes per consultation, but the RCGP would like that to be longer.’

Dr David Bailey, Deputy Chair of the WGPC said: ‘GPs should treat holistically, although we understand that sometimes when providing urgent rapid access it may be important to clarify that the time slot is limited.

‘We would not support a blanket rule however, as sometimes a patients different problems are inextricably linked.’

NICE is currently working on guidelines for GPs dealing with multimorbidity, which are due next year.

Readers' comments (26)

  • I've seena few practices with prominent notices saying 'If you want to discuss more than one condition with the GP please make a double appointment' which seems a politer way of making the same point, especially if reiterated in person.

    That said, I don't think I've ever been asked by a receptionist if I need a longer appointment or not - I think they tend to be desperate to get through the hell that is 8.30am when the phones open.

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  • I think it is frankly ridiculous to expect a safe assessment of more than one problem in a measly 10 minute appointment - appointments should be longer or they should book a double appointment atleast .The sanctimonious attitudes in some of the previous comments that we should just suck it up and do it is galling - I bet these are the 'portfolio' types who spend very limited time in face to face consultations or partners with salaried mules doing all the work.Especially when you consider how different the current climate is , say compared to even 10 years ago . Patients have much higher expectations now , usually unrealistic , and they are much more likely to complain and litigate . Hence we have to keep more detailed and copious notes -this also takes time . The necessity to get chaperones for an increasing number of examinations takes time . We have to deal with more multimorbidity and there is an increased need to organise investigations .The customer culture in healthcare means people get more irate if they are kept waiting as well . This all adds upto a vicious cycle and increases stress and risk of burnout .

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  • And will the GMC or Police or Coroner support the GP if they misdiagnosed a serious illness just because the GP was in a rush to deal with with all the multiple problems in one appointment and hence was sloppy ?I thought not .

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  • As a patient, I enjoy booked appointments at doctors and dentists more if there are up to date magazines to pass the time. Happy to wait. Never has it crossed my mind to complain.

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  • Just another example of the way in which medical care is service-centred rather than patient-centred. Patients are expected to fit in with the needs of doctors rather than doctors providing a service to meet the needs of patients.

    Diseases present with more than one symptom - how is the patient supposed to know which one symptom is the most important?

    Also surgeries don't exactly advertise the fact that they have double appointments available - so why blame the patient?

    A modern approach to medicine would involve considering how patients present and what can be done to meet their needs - it would not expect patients to fit into an idealised, unrealistic, standardised model of the "perfect patient".

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  • I've tried both, dealing with everything they ask about and restricting them to 1 problem so that everyone gets seen on time. I get shouted at either way. I really hate the way I feel at the end of a days work. I work hard, I'm nice and still I get shouted at. I then see the comment 00:57 and realise it'll never get better. The reason I'm shouted at is because they think we behave to serve our own needs.
    I feel like a dog confused about why my owner keeps beating me. No matter what I do it won't please them.

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