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At the heart of general practice since 1960

Not waving but drowning

Copperfield's surgery is surrounded and under siege from anxious patients. But are any of them actually sick?

Copperfield's surgery is surrounded and under siege from anxious patients. But are any of them actually sick?

Mornings are usually hectic but it's been plain silly since the floodgates opened at eight o'clock.

Naturally one of our nurses has taken the day off sick, which hasn't helped, and one of the new wet-behind-the-pinnas got lost on the way to the office so he arrived an hour late. But it's been crazy.

So, time for Plan B – triage time. Not just the routine receptionist – nurse – duty doctor triage but proper triage, senior partners manning the phones and sorting the wheat from the chaff.

Remember the furore about out-of-hours care the other week, when one of the providers was vilified for only visiting one 'urgent' call out of a hundred or so? The media jumped to the conclusion that the docs on call were work-shy money grabbers who preferred to sit in their luxuriously well appointed office suites drinking coffee rather than providing the service their patients needed.

I can't have been the only GP who came to the other, equally valid conclusion – out of every hundred calls we get that patients label 'urgent', only one or two actually are.

We took seventy-nine calls today, all of whom had got past the 'is it really urgent, we're short-staffed and having real problems' spiel from the receptionists.

Forty-three conditions that could and should have been dealt with by high street pharmacists and/or the nurses on call at NHS Direct. Common colds, earache, chicken pox (there's a lot of it about…) and gastroenteritis being the most frequent reasons to call.

Of the rest, the majority were simple stuff that could be sorted out without an appointment - new medicines prescribed by an outpatient clinic that we were expected to supply stat, routine repeat prescriptions that had run out two or three months ago but Princess needed her moisturiser and she needed it now, requests from District Nurses to pop in and see Mrs Jones' leg ulcer for the umpteenth time. You know the drill.

Of the seventy-nine contestants, three were invited in to consult in person. That included two kids that I had asked to be brought over because their parents were frankly too dim to give anything approaching a history beyond 'He's really ill doc..', and unable to answer even the simplest question. I mean, how hard can it be to tell if your kid's lips are going blue?

One common cold, one chicken-pox. There's a lot of it about.

So, the official result of this unrepresentative non-peer reviewed uncontrolled non-blinded study is that the chance of an 'urgent call' actually being 'urgent' is 1:79. Or less - I didn't have time to find out whether the other call that resulted in a face-to-face contact was worthwhile or not.

The worried well may be happy for me to earn my £100K per annum repeating the mantras, 'A cough is generally a self-defence reflex...', 'D&V is rarely the first sign of a serious illness…' and 'The fascinating thing about chicken pox is…' to them ad infinitum.

If and when they make the transition from ‘worried well' to ‘worried sick' and depend on me to help manage a long-term or potentially serious medical condition, they may feel different, as they jostle their way through the crowd in an effort to secure ten minutes of my time.


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