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CAMHS won't see you now

Hospital doctors – don’t you just love them?

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‘Foreskin problem, Betnovate, Cephalexin (dose according to weight)’

This is all that was scribbled on a discharge report from paediatrics that ended up on my desk this week.

Now as a rule I try not to bitch about our hospital colleagues too much, after all we were all hospital doctors once, but this scrawled offering raised my hackles.

Let’s just analyse this report bit by bit.

‘Foreskin problem’ - what does that mean? Too long? Too short? Wrong colour?

Did six years of medical school and (one would imagine) a not inconsiderable postgraduate education, not equip the author of this with enough knowledge to have at least a vague stab at a diagnosis?

I now know how low the bar has been set in communication between the hospital and general practice

Was that too much effort? Were they thinking: ‘This trivial crap is so beneath me I can’t even be bothered to label it properly’?

‘Betnovate’ - apart from the schoolboy error that the drug should be generic, what about dosing instructions? After all, I assume the arrogant git was expecting me to prescribe it, although of course this was not stated explicitly in the report.

The last bit really took the whole packet of digestives though - ‘Cefalexin (dose according to weight)’. So, this doctor is expecting us to get the child in to weigh them to work out the dose of antibiotic. Now I know the cuts to the NHS have been savage, but I didn’t realise hospitals could no longer afford weighing scales.

Now my best guess (in absence of any proper information) is this child was taken to A&E with dysuria then referred to the paediatrics. They hedged their bets between a UTI and balanitis and decided to treat for both.

The only problem is, they didn’t. If I am to prescribe, then I take legal responsibility for the treatment so I need to have made a diagnosis - I need to get the kid in to the surgery and take up one of our appointments, which are currently as sought after as a golden ticket to the Willy Wonka chocolate factory.

This was extreme but not an isolated case. I see many examples of poor communication from the hospital every week.

In this case I wrote back to the hospital explaining why, without a proper diagnosis, I was unable to finish doing their job for them and invited them to complete their own work.

On the plus side, now I know how low the bar has been set in communication between the hospital and general practice I can save a lot of time writing referral letters:

‘Dear paediatrician, please see little Johnny as his willy hurts.’

Dr David Turner is a GP in west London 

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Readers' comments (7)

  • Initial discharge letters are useless and rarely readable.

    Hospitals are contracted to provide a legible discharge letter + 2 weeks'supply of med.

    We stuck to our guns on this (patient education/ccg alets/safeguarding alerts).

    It did make us "popular", but at the end of the day unnecessary clinical workload has been reduced.

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  • David, your suggested referral letter is too detailed. I'd advise refer to same level of info you get returned:
    'Dear Doctor. "willy prob" Many thanks' should suffice.

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  • We should have joint presentations to develop closer seamless working

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  • Retired GP. This is not a new problem. Relative discharged from overnight stay post Lapaoscopic Cholecystectomy...3 pages of computerised print out. Drugs only half readable (? ink low?) And 1 line.. Lap Cholecystectomy. No mention of Insulin and Fentanyl infusions.
    On the other side...have received referrals from GPs on Mars Bar wrappers/toilet paper/back of shopping list when HO in 70s.."please see and advise"

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  • My favourite was as a Junior gastro HO in the late 90s when I got a classic one-liner from primary care with "please see and do the needful" on someone with polypharmacy and extensive history. I duly asked my consultant if I could reply in kind, so long as I followed up a few days later with a proper discharge letter. The first letter read "Saw and treated". Point made.

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  • Much easier to put up a sign saying:
    "Broken down. Please go straight to A/E" It is what Hunt intends anyway and the juniors are much better at fighting for their rights than we sad (adjective of choice) GPs.

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  • "Gone abroad"
    "popped out- back in 5"

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