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Try working for NHS Direct first before you criticise

Anyone who wishes to complain about the performance of NHS Direct should, in the first instance, work a short session as adviser in order to comprehend the complexities involved in history taking and assessment over the telephone.

The highly trained and knowledgeable staff are expected to deal with problems ranging from possibly trivial to potentially dangerous and including telephone CPR. Assessment would depend entirely on telephone presentation of symptoms and the manner in which the patient/carer verbally delivers the message. Not all clinical decisions are straightforward even with the advantage of visual and physical examination, let alone by telephone. Mistakes are bound to occur, considering that the service deals with thousands of calls each week.

Dr Steve Hugh, medical manager of Shropshire Doctors on Call, mentions failure to diagnose a hip fracture (February 3). Well I recently saw a patient who was being treated by his GP for musculoskeletal lower limb pain while in fact he had been suffering from symptoms of peripheral vascular disease. I could give several more such examples. 'People in glass houses' springs to mind!

Dr Ian Trimble, co-author of the Carson report on the future of out-of-hours care, seems to be of the view that the problem lies with the software (February 3). NHS Direct software is strictly controlled and examined by senior medical officers. Whatever the software, the final decision is determined by one's informed judgment. They are trained staff, not robots!

NHS Direct deals with many emergency cases, but without the advantage of being able to physically examine a patient. Occasionally mistakes will occur. Come to think of it, we GPs really have a 'cushy' job, being able to pass the buck, when in doubt!

Let us stop moaning and work in unison with all concerned for the benefit of the patient in particular and the profession in general. If NHS Direct is unable to meet the demands, blame the politicians.

Dr Jay Nathan

Sunderland

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