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At the heart of general practice since 1960

Here's a catchphrase we can all get behind

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Those of you who were teenagers in the 1980s will be familiar with the ‘Just Say No’ drugs campaign, hijacked from Nancy Reagan and the Republicans in the USA.

Maybe we should all be encouraging the RCGP and our leaders to rebrand this catchphrase in order to manage the relentless and unsustainable demands of our patients. There has been much lip service given to self-care but most of it is skirting around the edges, focussing on patient education rather than negative reinforcement of attendances.

Let us start with the most basic reinforcer of attendance; the prescription. Despite the massive publicity campaign to reduce our prescribing of antibiotics, I still see significant numbers of prescriptions justified on the basis of sputem colour or sticky eyes. But at least there is still an element of rationing of these as they are prescription-only medications. The enormous prescribing of cheap, over-the-counter medications, often with limited evidence base, is surely not what the NHS was set up for? Many GPs feel uncomfortable with dishing out bottles of Calpol, pholcodeine and enough emollients to survive the English Channel, but are too fearful of the NHS complaints system to behave any differently. It’s a lot easier to point to a policy than to stand up as a lone GP and explain to a patient why you are the only doctor who is not prescribing the Forceval they have received for the last 20 years.

Another issue is the medicalization of any manner of human emotion and processes - from exam stress to relationship breakdown and even TV appearances, all of which are legitimised by the obligatory GNFYD (Get a note from your doctor) We are more concerned about jeopardising the doctor-patient relationship than preserving our role and this results in us conceding to all these requests.

Finally, we have silently accepted the insidious shift in our role from family doctor to public health physician, which will no doubt worsen with the move of public health to local authorities. Obesity, smoking, vitamin D and most recently aspirin in pregnancy are just a few of the public health issues that need to be tackled on a population level rather than GPs continually attempting to add the rope and saddle to Buckaroo.

Our leaders should be furnishing us with the tools to improve our collectively low self-esteem and regain our self-respect and professionalism. Rather than trying to persuade us to federate, open 12/7 or tell us we are better off salaried, why are we not being encouraged to be more assertive so we can reclaim our agenda – both with patients and the government.

We need to remember our youth and…Just Say No.

 Dr Shaba Nabi is a GP trainer in Bristol

Readers' comments (17)

  • Una Coales

    I quite agree Shaba! Well said and well written. Just say NO! We need our GP leaders to have our backs, not persuade GPs to give up their autonomy and independence to become salaried state workers. Time for GP leaders to support and empower our GPs, not collude with those who seek the demise of general practice by layering on more work for less pay.

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  • Great article. But this isnt about leaders making these suggestions its about all GPs having the balls to say no en-masse.

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  • Anonymous @10.30.
    It's not about us having balls..The phrase 'too fearful of the NHS complaints system@ says it all.Remove this fear and the uncertainty of where complaints may lead then behaviour will change.Until then it is insulting to imply doctors are failing in some way by not risking their livelihood and their family's wellbeing for the sake of an antibiotic prescription.When the government provide support and indemnity for sayng no that will be the time to change.It is about the DOH having the balls to say no and telling the public that is what to expect from us and defend our actions.Then and only then will I say no to everybody.

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  • More power to your elbow, Dr Nabi!

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  • Bob Hodges

    How about 'No' and then the right to deliver a slap to the forehead of the person askingwithin 5 seconds?

    That'll be more fun.

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  • Great stuff ,Shaba -we as GPs are all too eager to "please"-to accede to every whim presented to us by our patients.
    Can we hear your views on gender selected abortions next!!

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  • Una Coales

    @11:13 agreed. GPs need government/DoH protection from consumer retribution (lawsuits+GMC referral threats) if they dare say No to a patient with a questionable request.

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  • "Protection from Consumer retribution?" Immunity from the consequences of our actions? Never having your judgement open to question? Where would that lead, I wonder......

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  • Well said Shaba. We have become mere slaves to the general public`s incessant demands and we have been ` ordered` to obey them unquestioningly. We have become like Pavlov`s dogs where the patient rings the bell and we start salivating . The last few batches of doctors who have qualified and are working, will become so used to this kind of working, such that when the current generation of colleagues who have known better days as they should have been disappear from the scene, they will be the seniors and no one would know what being a proper doctor in general or a GP in partiicular means, and would carry on as though that was the norm. Rather than just blame the punters and the DoH, the GPs should learn to unite and say a collective NO , but unfortunately, with many vested interest$$ amongst GPs , that will be impossible.

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  • It is very disappointing that Dr Nabi feels that the most important public health initiatives which will improve long term health and reduce health inequalities are nothing to do with GPs.

    Surely the GP has a crucial role in raising these issues with patients and referring them to appropriate services - a few words from a GP are far more likely to have an impact than a poster, leaflet or government information film

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