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GPs buried under trusts' workload dump

The inbox can wait

Dr Kate Harding

Every time I open the monthly magazine thoughtfully sent to me by my medical defence organisation, I feel a distinct tremor of anxiety. I usually skim-read it, to minimise any further rises in blood pressure, and then put it in the recycling with a degree of relief.

The case histories, while often eyebrow-raising (’The doctor/dentist did WHAT?! Why?!’) are just as often frighteningly ordinary everyday tales of a system overloaded by demand and doing what it can to get through the day. Corners are cut; sometimes they have to be. Mostly, that works out okay. Sometimes it doesn’t, and lives are ruined, including the healthcare workers’.

When I was working full-time in New Zealand’s primary care system two years ago, my life was dominated by my clinical test results inbox, which, because I had remote access from home, began to rule my life outside work, as well as in the surgery.

I distinctly recall once travelling on a bullet train between Tokyo and Kyoto on holiday, diligently checking my inbox on my laptop, worrying about the usual tsunami of deranged liver function tests contained therein (is there anyone left in the Western world with a normally-functioning, non-fatty liver?) Meanwhile all around me, my tiny, neat, self-contained fellow travellers read manga comics, snacked, chatted and gazed out the window in apparently carefree reverie, almost certainly possessors of perfect livers, one and all.

If ever I have the good fortune to go to Japan again, I will relish the sights, sounds and food unperturbed by LFT-induced stress

How I longed to be like them – neat, self-contained (a perfect liver would be good too; mine is nearly 50, after all) but, most of all, free from the Inbox of Doom. That inbox was a millstone around my neck, and one of the main reasons for me giving up regular general practice again a few months later (something I have done several times over the years, and never with the slightest subsequent regret).

We all know the medico-legal pitfalls of the mismanagement of results, which is partly why I was (absurdly, I know) checking my own inbox while on holiday.

At the time, it felt like a logical thing to do, and the best way to manage my work-related stress. When I gave my eight sessions up, and the inbox with it, I felt like dancing a dance of pure glee on the pavement outside the surgery, on my final exit from the building.

And if ever I have the good fortune to go to Japan again, I will leave my laptop behind, and relish the sights and the sounds (and the food! Oh my God, the FOOD) unperturbed by LFT-induced stress.

Dr Kate Harding is a locum GP and hospice doctor in Herefordshire

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Readers' comments (4)

  • I wonder what proportion of blood tests leads to a genuine diagnosis of actionable pathology

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  • @WhoamI

    I think the problem is more subtle: what proportion leads to action that is almost certainly pointless?

    (Vitamin D, I'm looking at you... marginally raised TSH, I'm looking at you... eGFR of 54, I'm looking at you... hba1c of 42...)

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  • Whoaml @8.20m- almost none, because blood tests are ancillary to history/exam, and support the evaluation of the case.

    Dylan @5.26pm-that really depends on the action you choose. And that means thinking around the whole case to get some context for the abnormal result before you to determine the correct course.

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  • I'm with Dylan!

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