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At the heart of general practice since 1960

Time for a spot of self-abuse

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I’m sometimes criticised for just being an angry old man on the sidelines, hurling abusive blame at everyone else – government, media, CQC, punters etcetera – for general practice being the complete plate of cack that it is. That’s like criticising a dog for barking, but for balance, though, this week I’ll admit that perhaps we doctors really should take a look at ourselves. Maybe we are partly to blame for some of the ‘cack quotient’.

We’re particularly brilliant at generating work for ourselves

Because, while we’re excellent at lots of things, we’re particularly brilliant at generating work for ourselves. Here, off the top of my head, are three totally unrelated examples.

1. Chronic disease reviews. Look, I’m asthmatic, and if my GP really believes I’m going to take time out just so he can ask me three asthmaticy questions, check I know which end of an inhaler’s which and confirm I don’t have a nicotine habit, he needs his head examined. And so do I, I’ll tell him, because, to make my journey worthwhile, I’ll want reassurance that my recurring headaches really are down to tension. Plus he can sort out my verruca. And I might as well discuss my IBS, too. Because that’s what patients do, don’t they, to celebrate the fact they’ve got an appointment? And it’s our fault for putting ‘while I’m here’ opportunities on a plate via pointless chronic disease reviews.

2. Scans. Once, the only obligatory casualty investigation was a urinalysis, just so a spurious ‘UTI’ could be used to explain away the patient’s symptoms. No longer. The go-to hospital test now appears to be a whole-body scan. And these are so sensitive that somewhere in every 1,000 word report will be mention of lung nodules, renal and hepatic cysts and an adrenal adenoma. Which means a confused and anxious patient, multiple referrals that are apparently my responsibility and something called ‘The Adrenal Protocol’, which should star Daniel Craig, but doesn’t. All that for a frigging sore throat.

3. Vitamin D. A few years ago Vitamin D didn’t exist. Now, it’s everywhere. Or, rather, nowhere, because no one seems to have any. And so what? Can a ‘deficiency’ with a prevalence of up to 50% actually be abnormal? If so, how come no one on Vitamin D ever feels better? So, to break the cycle of  test/‘diagnosis’/Vitamin D treatment/no improvement/what now?/repeat above, can I suggest just we tell everyone to go out in the sun and eat a rollmop herring?

True, ditching unnecessary chronic disease reviews, scanning sensibly and sorting out our deficiencies around Vitamin D aren’t going to save our profession. But there are 42,999 of you out there who probably also have three examples of how we make life difficult for ourselves. And accepting that at least some of our stress is self-induced is a significant step towards regaining control and shaping our work into something rational and manageable.

So now I’m an angry old man on the sidelines hurling abuse at myself. That’s either welcome self-awareness or a first psychotic episode. You decide.

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

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Readers' comments (16)

  • So true

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  • When I was a GP in Canada many years ago every different problem carried a fee for service.

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  • Critical reflection is what we need indeed. Brilliant!

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  • "Can a ‘deficiency’ with a prevalence of up to 50% actually be abnormal?"

    So glad to see this point in print; it really is the elephant in the room.

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  • How about annual tft for hypothyroidism? When I qualified, you tested to titrate the dose then only re-tested if new symptoms developed.

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  • Litigation....these days everyone knows better than the doctor actually treating the patient. NICE, prescribing advisors, patients, nurse consultants and of course our friendly lawyers."explain why you did not put the patient on vitamin D and now so and so has suffered....

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  • A really really really great article - I've been tittering for 20 minutes and came back for a quick re-read!!!

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  • excellent ,but does everyone know which end of an inhaler is which
    See house asthma https://www.youtube.com/watch?v=zG2DVoRP86g

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  • I thought Youtube was my inhaler until I discivered Smirnoff...

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  • There are three types of patients:
    1.Those who just need a padlock on their fridge or a few more hankies and paracetomol.
    2.Those who enjoy ill health because they are fat,idle boozers and smokers, or have "chronic Lyme disease,doctor".
    3.The small number who have a treatable illness who need our expert help and concentration.
    The epitaph of the NHS will record its failure to help the last group because it lacked the courage to turn away the other two.

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From: Copperfield

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