Posted by: Jobbing Doctor21 January 2013
It is always very busy in the winter, and this winter at Jobbing House Surgery is no different. A plethora of minor infections that people want checked out 'just to be on the safe side'.
I hate the expression 'just to be on the safe side'. In parents and patients it means that they don’t want to take responsibility for making judgements about their children or themselves where there is a free service available to them to tap into.
'Just to be on the safe side' is closely related to its first cousin,'you can’t be too careful', which is the phrase beloved of the underqualified who aspire to the roles that they really aren’t good enough/experienced enough/able enough to do. 'You can’t be too careful' demonstrates a mindset that says 'I am going to play at being a GP' but ultimately shirks any difficult decision.
In the world of 'you can’t be too careful', diagnoses are frequently made that are plainly nonsensical and absurdly grandiose. I review ‘acute tonsillitis’ that almost always turns out to be a snuffly cold. If that is allied to someone having being prescribing rights (on the basis of a GCSE in woodwork and a two-day course sponsored by Kelloggs) then the prescribing of powerful antibiotics like co-amoxiclav or clarithromycin seems like good medicine to the Trip Advisor brigade, but it is not.
Jobbing House Surgery covers a mixed urban area, outside of London, but it is mostly deprived. We do get a lot of illness in our patients, and that contributes to the workload that we face. We are struggling to stay afloat with the demand, and are doing our best to cope.
The increased workload engendered by the 'you can’t be too careful' brigade is actively encouraged by a culture that simply refuses to understand that general practice is about risk assessment. They appear to be caring and conscientious as they increase somebody else’s workload.
Assessment of illness in primary care is not easy, and those who say it is are clearly not experienced enough to know what they are talking about: that is why it should not be left to an inexperienced person (with an algorithm) to decide what to do.
This is one of the reasons why the service NHS Direct didn’t work, and only seemed to generate more work for GPs and A&E departments. If I had a pound for every from every re-directed case from this service that was pointless I could probably buy a Lexus.
NHS Direct is predicated on the 'just to be on the safe side' mentality, and not only directs a constant stream of rubbish cases into other services, but often does it in ludicrous time frames. Any skin rash must be seen ‘immediately’, and minor problems are often told that they must be seen by a doctor in four hours (NHS Re-Direct).
It is one of those phrases that I have learnt to hate - 'I’ve rung NHS Direct and…'. It invariably means more work for me, almost always unnecessarily. This phrase wins the silver medal in the Irritating Phrases game, only just behind 'I’ve looked it up on the Internet…'.
I was cheered to read recently that NHS Direct was going to be phased out. I thought that someone had done an analysis and found it expensive and not at all helpful, and it was to be given a decent funeral as an idea that never worked and just generated more activity.
Not so: it is to be superseded by NHS111. Aaaarrrggghhh!
The Jobbing Doctor is a GP in a deprived urban area of England. You can follow him on Twitter @jobbingdoctor.