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At the heart of general practice since 1960

How to solve a problem like acopia?

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I am baffled, which doesn’t happen often. I have had a great surgery this morning. A brilliant mix of good old general practice (plantar fasciitis and scabies), red flags (haemoptysis) and mystery (isolated night sweats, no other symptoms). I’ve done some good; I’ve listened and educated. I might even have got ideas, concerns and expectations in there somewhere. 

This is what I signed up for.

The money should be spent on educating everyone from new mums to pensioners about self-care and red flags

What I didn’t sign up for is the next patient. ‘I’m struggling with this cough. I can’t sleep. It’s not shifting so I thought I should come in.’

‘Have you tried anything?’ I ask.

‘Yes, I took some paracetamol last night.’ Good, I think. Has tried paracetamol; something sensible.

‘And you said it’s not shifting. How long have you had it for now?’

‘Since last night. About 10pm.’

Stony silence. It is currently 10.30am.

‘So, you were fine yesterday (yes), you went to bed (yes), started coughing (yes), took some paracetamol (yes) and less than 12 hours later rang for an urgent GP appointment (yes)’?

The problem is, this patient genuinely thinks having a cough for 12 hours requires an urgent appointment. They also were not too happy to be told that I wasn’t going to prescribe any antibiotics.

And, despite myself, I can see why they might be confused. All the packets of paracetamol and cold remedies say ‘do not use for more than three days without consulting your doctor’. All the adverts say ‘Cough? It could be cancer!!’

The rub is that I can’t tackle this in 10 minutes. I can’t address a myriad of mixed messages and confused illness behaviour. So, off goes the patient, grumbling that I am a rubbish doctor.

While this is an extreme example, it’s a recurring theme. Last week I saw a whole surgery of URTIs. All of them genuinely thought they ‘needed checking’. I don’t begrudge them the consultation, because very few are wilfully misusing the service. But equally I could have spent an extra 10 minutes with the suicidal patient, or on the admission of a patient with septic arthritis.

If all these patients disappeared, UK general practice would be a different place. We seem to be treating the symptom of busy GPs by adding new clinical staff, but missing the point that the money should be spent on educating everyone from new mums to pensioners about self-care and red flags. It’s not about getting nurses to see them, or physician associates.

The whole point is, NO ONE should be seeing you if you’ve had a cough for 12 hours. If the Department of Health spent less time fighting junior doctors and more time looking at the whole issue, instead of throwing daft initiatives at small bits of it, we might salvage primary care.

Here’s a bright idea. Maybe getting public health to actually help with the health of the public might solve a whole lot more than an outbreak of Salmonella.

I think the best solution is a regular winter sabbatical. Somewhere I can relax. I’ll come back in time for hay fever season.

Dr Zoe Norris is a GP in Hull

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Readers' comments (25)

  • Quite correct and I hope to be able to help. For 22yrs of full time practice I was in the same boat and that was enough, I left last July to set up an internet business and it's great, the best treatment for acopia I have known. I wake up early, reap the rewards of my work and have a satisfied and happy customer base!! If people abuse and mistreat my products then I can tell them they are not entitled to a refund or replacement, when they wear out through prolonged use my customers understand and order new ones rather than expecting me to keep the old wrecked ones going faultlessly for ever. This is nothing like GP, I still feel guilty that I am just 50yrs old and not using what must be a good knowledge and experience level but it was bloody awful for the last couple of years and I don't think I will be back, in a few years there won't be anything to come back to I suspect. Good luck in the future but don't expect it to improve.

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  • I'm surprised there's only a 5% fall in applicants.

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  • 12.29pm again, just had a thought.
    How marvellous to be sat having light lunch and a filter coffee whilst looking through world and GP news, I shall restart in an hour or so, just taken dogs for a walk and will do again later before dark.
    I bet very few if any GP's are doing this today, I am afraid that I now do this every day.

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  • Zoe, the NHS is beyond saving. Prolonging the inevitable is causing more damage than allowing the whole system to collapse. Too many conflicts of interest and corrupt GPs/Politicians are in the mix. Rotten to the core needs demolishing and re-building and nothing else will do.

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  • Sadly the whole world is corrupt. Even if the NHS collapses and something is rebuilt that in turn will become corrupt like everything in life. Unfortunately those most likely to corrupt try and get into positions of power where they are able to carry out their desires.

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  • Public Health budgets are being slashed and the work is being added to the CCG. !!

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  • It doesnt matter what resources are thrown at the NHS and its patients, the demand will keep on growing exponentially; patients are spoiled and will demand more.....

    face it folks its over...

    ditch the country comrades!!

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  • 12:29 why not find a website for internet entrepreneurs to gloat and post on, and leave the NHS to those of us that still want to work in it ;)

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  • 8.08pm I have left the NHS thanks and those of you who wish to continue working for it are welcome. I was not gloating, just demonstrating that there are alternative non-medical ways of dealing with 'acopia'. We are usually a fairly bright and able bunch and thinking that medicine is the only option is not correct.

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  • @11:38

    I appreciate your posts and thanks for sharing your experiences. You're a demonstration to us that the world is really our oyster and we can choose to do anything we wish. The NHS institutionalises you very quickly and you can begin to think that this is the only way if you're not careful;

    I left aged 31 over 3yrs ago and have found a wonderful life abroad after quitting a stinking partnership in the south. im done with the garbage and my life and career is about my family and myself from now on! Initially it was a big step leaving all you knew behind but time, experience and self belief see you through eventually!

    the arrogance of those that run and administer the system is staggering; People with our skills, experience and dedication should not be leaving a vocation like medicine however many are due to a myriad of reasons and no one can blame them;

    I wish you all the best in your business endeavours and hope to see further encouragement from you again in the future....ignore the troll at 8:08pm....he/she is probably bitter because they want out of the rat race but haven't got the balls like we have!!

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