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CAMHS won't see you now

Never underrate ‘proper’ doctors

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My patient is 26, skinny, and female. ‘I’ve got this pain in my chest, doctor, here at the front.’

‘Costochondritis’, I tell her.

‘It hurts when I breathe in. I went to the urgent care centre last night, but they didn’t know what it was’

‘It’s costochondritis.’

‘There were two nurses, and they X-rayed my chest, but that was alright so they sent me to A&E because I had chest pain.’

‘You’ve got costochondritis.’

‘In A&E they did an ECG and blood tests, and a doctor had a look at me – she said it wasn’t my heart, and told me to come here today to find out what is was. What do you think?’

I think you’ve got bastard costochondritis!

It’s impossible to diagnose a condition if you’ve never heard of it, and this is where our underqualified colleagues in urgent care centres tend to fall on their inexperienced and uneducated arses. And, increasingly, our fellow doctors in secondary care are failing to act as a safety net, assuming (a big assumption, admittedly) she actually saw a doctor; the ‘practitioners’ in A&E don’t always tell you if they’re not.

Let‘s face facts: ‘It’s not a heart attack’ is good news (not that my patient thought for a second that it was), but it’s not a diagnosis. Our patients prefer to know what it is, not what it isn’t.

A similar scenario happened with another of my patients last week. She presented to the urgent care centre with barn-door polymyalgia rheumatica, but because it was technically chest pain she was rushed down the A&E pathway, had the ECG, blood tests (but not the relevant one), an X-ray and, for some absurd reason, an ultrasound of her gallbladder. She was discharged with a diagnosis of ‘non-cardiac chest pain’ and told to see a proper doctor urgently the next day, to get a proper diagnosis. Although the discharge letter did not say that in so many words.

I listened, made the diagnosis in 30 seconds, gave her some steroids and the pain went away. I’m not some brilliant clinician. I’m just an ordinary, experienced GP, just like you. Of course I get the odd one wrong. But if either of these patients had seen one of us first, the NHS would have been saved hundreds of pounds in investigations, time and transport costs, and the patients would have been spared an awful lot of needless pissing about.

Maligned, underfunded and undervalued as we are, it is easy to demonstrate that we are cost effective, efficient and, more to the point, usually right – something both those patients were extremely grateful for.

My next patient is a lad with pain in his knee. ‘Here, at the front. It hurts when I play football.’
‘Osgood-Schlatter’s disease.’

‘My dad took me to the walk-in centre last night but they didn’t know what it was.’

‘It’s Osgood-Schlatter’s Disease.’

‘The nurse did an X-ray, and there was nothing wrong with it, so they told me to come here to get referred to a knee specialist.’

‘You’ve got Osgoo… oh, never mind. Just take these tablets. And don’t go to the walk-in centre again. It’s not good for your health.’

Dr Phil Peverley is a GP in Sunderland.

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Readers' comments (36)

  • A comic article with a lot of truth in it. Phil poking fun at menu driven healthcare which produces lots of paperwork but does not enhance patient care. We caring GPs find it funny, and at the same time a sad indictment on the changes in healthcare which do not always make the patients happier/better. I think contributors should identify themselves-This criticism of other systems is not the same as a surgeon telling the Daily Mail that most GPs are inadequate- as I understand it Pulse is a magazine for GPs and Phil is not presenting a critical review of other's care, more helping GPs realise they can and usually do a good job in humorous fashion.
    Those who denigrate GPs will end up with a more expensive less caring and less experienced service- most of my colleagues over 50 are seriously thinking about retirement as a consequence of the endless inappropriate criticism- we cannot be specialists in everything , and if perfection is necessary, we will constantly feel we are failing- a very poor motivator for a caring profession. (same for our over pressurised managers and nurses!)

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  • In my experience from an ED perspective most of these patients have tried to see a GP first but have not got past the GP receptionist and told to go to ED.

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  • Anon@2.13
    In my experience "can't get an appt" often means "can't/won't make any of the appointments offered over the next few days" when one enquires further.

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  • we run a triage service so that all same day appointment requests get a phone call from one of our clinicians. most patients love it but some hate it. only those that hate it reply to the survey.
    I do a stint at our local walk in service. I see very few of my own patients but they tend to be the feckless ones or the antibiotic/valium seekers. they hate seeing me in the walk in service

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  • I take exception to the fact that GPs in WIC- Urgent Care are second best- most of us to my knowledge are Gps working in practices on a daily basis rather than people who do ad-hoc work only in these centres. As far as secondary care or A&E are concerned, I have to agreed that discharge summaries are too scarce- eg tests done not specified!, very vague diagnosis and back to GP. We get some triage nurses sending us acute chest pains over as they cannot possibly have an MI with a normal ECG, or with no obs. At the same time, others are more thorough. Other HCPs do a great job and are good at safetynetting, but are not necessarily trained in asking the right questions due to their training or following pathways. there are good and bad apples everywhere.

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  • why can't WE all get on. I think all HCP should support each other and stop the bashing from within... it's bad enough from the without

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