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CAMHS won't see you now

Dr Emma Nash: Why my plea to patients on Facebook hit home

Last Tuesday, for whatever reason, I decided to bite.

I can’t tell you why - nothing particular had happened and I had heard it all before. Facebook’s newsfeed threw up comments from a few about waiting too long to see a doctor, with their ‘just as well it isn’t urgent, otherwise I’d be dead’ digs, thinly veiled as a humorous jibe.

I think the public is beginning to see that this isn’t a choice of ours, that there simply aren’t enough GPs to provide the service any of us want, and the fact this is a national problem has granted us some sort of reprieve from individual, personal responsibility.

However, one comment made it uncomfortably clear that many of our patients have little idea about what their GPs are actually doing. Someone complained that they had to wait 17 minutes for their appointment because the GP was running late. They suggested that they might charge us for their time. Admittedly I think this comment was tongue in cheek, but the sentiment clearly reflects the expectations of us and the entitlement of the ‘consumers’.

Countless times, during duty, I have had patients express their disgruntlement, and occasionally downright disgust, at waiting for 45 minutes to be seen. Even when the green jumpsuits wander in to the surgery, a few minutes later trotting out through the packed waiting room with a pale and rather waxy-looking crumbly, the individual frustrations cannot be suppressed.

Usually I empathise, sympathise, or acknowledge with a mirroring groan, but more recently I have started to challenge. I don’t like keeping anyone waiting, I certainly don’t do it for fun, but sometimes it feels like patients think I do.

Hypocritically, I have sat in a GP waiting room, with three young children playing with the single CQC-compliant toy, grumbling at the fact that the last patient came out ages ago and I’ve still not been called in. Sometimes fellow patients quietly tut and shake their heads, look at their watches and make poorly muted comments questioning what on Earth the GP is doing ‘in there’.

Actually, what do our patients think we are doing? Are we negotiating with our stockbrokers, having yet another cuppa and a cake, doing a spot of online shopping, checking Facebook or simply playing Solitaire?

The thing is, they don’t know. And without knowing, they guess. I would suggest it’s fair to say that the British press has largely not done us any favours in reporting our reality, and the only other source of information comes from the television. Others may differ, but my practice doesn’t have a lot of resemblance to any lunch time TV soaps.

We know what we do, but largely our patients do not. Therefore it is hard to justifiably criticise their ignorance, if they haven’t been told any different. I decided to tell. Surprisingly, amazingly and brilliantly, so many others have decided to tell too.

Dr Emma Nash is a GP in Portchester, Hampshire.

I really do understand the frustrations of the general public - but we are working flat out

Unhappy with your GP?

Write to your MP. 

There is absolutely nothing we can do about this at a practice level. 

We cannot recruit any more GPs. 

We cannot fund any additional staff.

We cannot work any longer hours and be safe (bet you didn’t know that I often leave work around 11pm and have left at 2am before). My ‘part time’ 5 session (ie 20h) is approaching three times that in reality. 

Why do you think we’re running late? (Genuine question - I’m interested to know what people think we’re doing.

It’s because people come with lists. It’s because 10 minutes isn’t enough. 

It’s because people use appointments that they don’t need when actually self-care and time and patience will do the job perfectly well. The human body is designed to cure a lot of things itself, especially infections. 

It’s because we’re interrupted, quite legitimately, by phone calls from palliative care nurses wanting to discuss medication urgently for the dying patient; by ambulance crews called inappropriately who are asking us to take responsibility for patients not being taken to hospital; by the coroner asking us for information to try to prevent a bereaved family having to wait for a postmortem before they can arrange a funeral; by nurses who need us to give a second opinion on something that they’re already gallantly managing beyond their duty; by urgent prescriptions that need signing because the patient didn’t plan properly (we all make mistakes). I could go on. 

We get brought tea because otherwise we wouldn’t drink anything for 5h at a time - morning surgery typically is 4.5-5h, with patients every 10 minutes. 

Each patient is not just a symptom. They are people with problems, with lives and responsibilities, and we try to treat them holistically. In 10 minutes. 

It takes the frail old lady 2 minutes to undress so we can examine her, another minute to get up onto the couch, another couple to put herself back together again. That’s half the appointment gone. 

We could do longer appointments, but would have fewer.

I really do understand the frustrations of the general public - remember I have a family too, who occasionally need to see a doctor.

But. We are working flat out. There is a reason that there is a shortage of GPs. There is a reason that no one wants to train as a GP.

If we were genuinely working 9-5 on >£100k then why would there be a recruitment problem?

No one wants to do it because it’s a draining job, very heavy on workload, and we are demoralised and constantly berated by the press and portrayed as lazy and money grabbing.

If you have ideas on how it could be done better then please share. Genuinely. We are all out.

Read Dr Nash’s post on Facebook and share with your own friends

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Readers' comments (21)

  • beautifully written..well said

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  • Fantastic to hear from a like minded gp! Keep up the good work :-)

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  • Dr Nash I suggest you join a Balint group run by Dr Martin Brunet rather than posting this Facebook rant.

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  • Well said. I agree whole heartedly with your every word and am sure you are an excellent GP.
    Can anyone see a way out of the mess we find ourselves in?

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  • I felt the pressure to do everything and work hours +++as a consultant. hated the politics so became a GP. your post is excellent but you are letting people walk on you . Become a locum / sessional / portfolio doc like me - meet lots of people - work in a selection of places etc and enjoy it.
    While you slog to do all the work the powers that be will let you carry on.
    Who is Balint?

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  • 8:49am - there are plans afoot to force locum and sessional docttors into land of permanent employment by making it very unattractive. I'd suggest exploring the emigration route now for the coming toxicity.

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  • Comments on here make me feel like I live in Nazi Germany. Are the powers that be really going to make locum work unattractive? Why make a shit job even worse. Locumming has no security and most cant handle that anyway. If Im salaried I still wont do all the tick boxing bollox. I see patients and deal with their problems read lettr bloods now as a locum and the same as a salaried. Even when I cover for 3 months for an abscent partner that's what I do. Only when I actually was a partner was I mega stressed seeing 60 patients per day and going to meetings all the time. If they make me go salaried I would demand good money or just spend more of my time working in Canada than I currently do. Anyway they will always need locums. We have a shortage of doctors we have the power if there weren't so many who think they don't even deserve what they have or are too worried about everything we could unite and say no to a contract not in our favour. Were the professionals with a service to offer we should make the rules not them.
    If they make my life harder I will probably just charge more money to compensate.

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  • After all competition laws and the free market forces are what the tories always say make services better so interfering with locums is surely against their ethos and competition law

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  • Dear doctor 1:16pm
    I am planning to do locums in Canada
    Would you mind terribly if I picked your brains about how to do it?
    I am completely whacked. Got my practice notes down from 83 to 64 today
    Have been doing 1-2 hours of apollo daily
    The locums are great when we can get them but can't clear the stuff off my desk

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  • Absolutely on the nail article and I'm not even a GP but a practice nurse struggling with very similar problems.

    I may not be a partner in the practice but I certainly go out on a limb trying to both help GPs and and bottle washer as well.

    There is an ambiguity here though e the salaried issue. As much as there are many caring and overworked GPs and nurses, something does need to be done about quite a number of GPs abusing their "independent" status as employers and some are very poor managers with little recognition of skill mix and good communication and collaborative working.

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