Posted by: Nicholas Ramscar17 December 2012
I had a couple of uplifting stories to write about this week, and this blog was genuinely intended to be a happy one, but sadly I’ve made the mistake of reading the news. And so, with a sigh, I’ve found myself sitting down to hammer out something despondent about the ‘Friends and Family Test’.
This, for the six of you blessed enough not to know, is the superb plan to reduce assessment of medical care to a binary formula. All the life-and-death stuff that goes on in A&E units, the two-in-the-morning ethics and the tough calls made with little time and less information – from this April it will all come down to a yes-or-no question.
Would the patient or their relatives recommend you, when planning their next heart attack? Or would the gentleman with the track-marks deny you his drug-seeking custom, and take it to a more acquiescent unit with better ratings?
This is part of the ongoing trend to impose the view that medicine and nursing are just a job like any other (and then to react with indignant horror when its browbeaten practitioners begin to treat it as such).
So here goes - the painfully obvious, from the top. Let’s begin with the staggering irony of starting this scheme in A&E units, inherently an area where patients who need the service don’t have a lot of choice. If you’ve been scraped off the road or you’re in asystole, you probably have a slim chance of making a shrewd consumer decision based on the local unit’s scorecard.
You’re likely to be too preoccupied with screaming, bleeding, or working on your hypoxic brain injury to check the scores on the doors. Conversely, I predict a tidal wave of poor ratings from the least sick A&E patients, miffed because they’ve had to sit and stew in the waiting room whilst the staff sort out a major trauma.
Secondly, this ‘test’ makes no allowance for the fact that good medicine may not always mean giving the patient exactly what they want. We have the responsibility of being able to prescribe drugs that are otherwise difficult to come by, and it might shock the designers of the ‘test’ to know that patients are aware of this fact, and some of them may even try to exploit it.
Astonishingly, these few sometimes resent our role in blocking their access, and would prefer to be allowed to gambol unhindered into sunny Benzo Meadows. Dealing with drug-seeking behavior is hard enough without the added headache of being rewarded with a drop in ratings if you do it properly. A similar problem will bedevil requests for sick notes, antibiotics, X-rays, referrals, operations, over-the-counter meds such as Calpol, and so on.
But most galling from the general practice perspective is the way this will punish frontline staff for failing to deliver on impossible promises made by politicians. The other ingenious idea of the moment, screening the entire world for dementia, is going to lead to a lot of hopelessly raised expectations.
Combining the two schemes, it seems the plan is to tell thousands of people that they might be at risk for a feared and emotive illness - but the memory clinics are booked solid until the next appearance of Halley’s Comet, and the drug budget’s gone. And then to ask this frightened and furious horde what they think of the poor sod who’s been forced to do this to them.
Doctors and nurses are absolutely not above scrutiny. But every bit of whimsical window-dressing that takes money and time away from frontline care will drive a few more of us into retirement or emigration. And if seemingly calculated to generate bad medicine and bad headlines, this will happen all the quicker.
Dr Nick Ramscar is a GP in Bracknell, Berkshire.