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At the heart of general practice since 1960

Unwelcome intrusions

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We wouldn’t tolerate it if somebody with a clipboard was sat in the corner of the room, asking how much cycling the patient did. Or how much they smoked, or whether they’d been offered a contraceptive implant recently. Yet we put up with it at one remove, when the clipboards are replaced by yellow flags in the corner of the computer screen. Technology has an odd way of blunting the impact of intrusion, but the consultation can be derailed just as effectively.

Patients have to struggle to get their appointments. They fight their way through our phone systems, and are almost all polite and understanding when we keep them waiting. As a group, they also fund the appointments. All this should guarantee that they get to set the agenda once they’ve managed to get through the door. Yet they often don’t – a significant proportion of their ten minutes is taken up by us ticking boxes that the patient might not care about.

Additionally, blanket imposition of population-level medicine costs us time which we don’t have. We’re recalling patients for checks that might have no direct benefit to them, and thereby reducing the availability of appointments for others. This has a predictable effect on patient satisfaction, and it would be interesting to know how many patients end up going to A&E because all the appointments had been taken up with this kind of work.

It would take a brave politician to say that what General Practice needs is less regulation, and more freedom to react to what patients really want. After all, we are all potential Shipmans, and we need close watching. And of course without QOF to prompt us, we’d soon be telling people that smoking will do them no harm. But maybe it’s worth gambling on a radical rethink. We could see what happens if the consultation is driven by what the patient is concerned about, and what the doctor can offer as options for dealing with the problem. Patients and doctors would both be happier. General practice would be a more attractive career option. There might even be political capital to be made, if A&E queues shortened.

Readers' comments (5)

  • Absolutely correct.
    We need a 'Campaign for Real Medicine' in General practice.
    Computers are now frequently used by bureaucrats as a means of controlling the GP's actions during the consultation.
    Their use may need to be reviewed as being potentially bad for patient care.

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  • Absolutely spot on,then when they are lucky enough to get an appt on the same day they have to fight for the treatment that NICE and the BNF say they deserve,why is that?

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  • All of these activities, with flags of whatever colour, are sincerely exercised for the good of our patients. But a little bit of good here and a little bit of good there, all imposed by Big Brother, rapidly build into a tyranny. C.S.Lewis applies. I like the sound of a Campaign for Real Medicine, Paul. Count me in.

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  • I think the NICE and BNF thing is a little thing called evidence!
    I don't think we can get away from the power of our involvement in popn medicine projects. Yes QOF has become silly and a wish list for 'trialing epidemiology research areas'. But it is primary care that has and can deliver large scale improvements in certain (limited) areas of health.
    We still struggle because of the incompetence of politicians and the journalist industry to have real conversations about rationing, funding and patient behaviour

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  • As a patient, my behaviour is impeccable. As a journalist, I try to have "real conversations" with doctors, and get a few courteous replies, mixed with a lot of abuse. I was once called the "patient from hell" by a a GP, a badge I wear with pride.

    If, as the CQC has just found, 23% of practices are non-compliant, it seems to me, a poor patient. that more rather than less regulation is necessary.

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