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GPs go forth

We need to tell the time wasters to bugger off

Dr Katie Musgrave

Legend has it that once upon a time, a GP in South Devon got so frustrated with his patients that he stormed into the waiting room bellowing ‘If you’re not seriously ill, I want you to leave my surgery immediately!'

You can imagine the response in the present day. Smartphones would be seized. Teenagers would be weeping in the corner. The footage would go viral. All over the country, we’d hear horrified commentators lambasting the doctor’s insensitivity, like ‘How could he ask the poor, innocent patients to leave him alone?’

But, don’t we, in our heart of hearts, regularly share this doctor’s frustration? I’ve been a GP trainee for a few years now. Among many presentations of unwell patients, I regularly see a plethora of totally insignificant problems, that should never get anywhere near a doctor. I’d hazard a guess that on a given day, fewer than half of my patients will have a genuine medical need. 

The others present with a range of minutiae, fairly implausible-sounding health anxieties, or social problems (which I’m ill-placed to help with).

Sorting through these patients, and establishing that they don’t actually need to see a doctor, is a tiring and complicated business, especially as amongst them will occasionally lie an unexpected cancer diagnosis, or a heart attack you didn’t see coming.

Recent examples include the patient who came in worried that her toenails were stained yellow after she removed her nail varnish, and another who asked if I could offer advice on hair dye to cover her greys.

A particular highlight was a 30-something-year-old man who asked if I would mind squeezing a spot on his back that he couldn’t reach. He didn’t know who else to ask… We all have examples of such consultations.

I fear I’ll find that little old lady dead in the corner

These stories might be amusing, if it wasn’t also true that many genuinely ill people now struggle to get a GP appointment

Waiting times are so long in many places that patients are undoubtedly coming to harm, or inappropriately using A&E services

I remember a day when, running behind in my surgery, I had a delightful older lady wander in, clutching her chest. She’d been quietly having a myocardial infarction in the waiting room, while I was busy dealing with a teenager who’d been having tantrums over his PlayStation. This isn’t a joke. Those who need our help are left suffering for our lack of action.

The founding principle of the NHS of being free at the point of access has been so abused that we desperately need to address the situation.

Too many now believe that the NHS is worthless - on hand to jump at their every whim. A very small fee, for taxpayers who could afford it, might go some way in encouraging people to think twice before consulting their doctor.

Perhaps this fee would be charged at both GP surgeries and A&E departments. It wouldn’t be the end of the world - we don’t view prescription charges as threatening Nye Bevan’s principles in founding the NHS.

Likewise, a small financial disincentive to working age adults might encourage them to appropriately value their GP’s time. If patients sought advice from a family member or read NHS Choices instead of booking an unnecessary GP appointment, we might regain the capacity to manage those patients who are in genuine need of medical care. 

After all, free at the point of use is worthless if those who need the service can’t access it.

I genuinely fear that if someone doesn’t go into the waiting room and have a stern word with the patients, before long, I’ll find that little old lady dead in the corner.

Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West

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Readers' comments (72)

  • I would imagine that this "doctor" who wants to tell time wasters to "bugger off" is probably in the wrong profession. GP trainee? So how come such an arrogant opinion, with ready-made examples? Of course she is not the only one - this shallow and ill-thought out opinion is often expressed here and elsewhere. Has she ever wondered why this might be happening? Or what could or should be done about it? But go on, blame the patients for their social inadequacies and the inadequacy of the very longstanding underfunding, under-resourcing and ill-conceived structures of general practice in particular and the NHS in general!

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  • Patients should be blamed for their social inadequacy.

    Correct patients aren't to be blamed for underfunding, but funding has nothing to do with wasting a doctor's time.

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  • The only reason you all don't like what she's saying is because the "time wasters" give you a nice break between the complex legitimate patients.

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  • Henrietta, what kind of doctor are you? You don't write like a doctor..... and I think you are missing the point this young observant trainee is making...... she is stating she can't get to the sick patients she wants to help because of people coming with metaphorical fluff in their navel..... I think she makes a very valid point......when we spend time with trivia we have less time to spend with our palliative care patients, our complex patients,...... squeezing pimples on peoples back is not why we went to medical school. Id love to know what you mean by ill-conceived structures of General practice? You contradict yourself with your use of 'shallow and ill thought out opinion' by basically taking objection to the authors observations, and calling her arrogant, intelligence shows the ability to see the world though another eyes, something you have not been able to demonstrate yourself in your entry. You surely can not be arguing that reducing the un-necessary appointments in general practice would not be beneficial/desirable when it would improve the access for those who really need us? Haven't you done critical appraisal for research? Your contribution seems more emotional than logical.........

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  • I am an old doctor...and someone who insists that 10 minutes cannot be enough.

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  • Henrietta, your use of the written English language makes no sense to me and others.

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  • https://bjgp.org/content/70/691/60.1

    You are not alone Henrietta

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  • So Henrietta and Pebble.... how do you spend longer than 10 minutes with each patient when the demand keeps going up year after year? You don't have any more hours in the day, HMG is never going to sufficiently fund General Practice to meet patient demand so what do you do? The simple logical answer is somehow to have to reduce demand..... this is why people have raised the issues of charging and trying to get the trivia out of general practice.... that is the whole point of the authors article.... just dismissing her as callous shows your inability to produce an alternative answer..... so please Pebble and Henrietta lets have YOUR workable solutions to an exponential increase in demand, as thousands of hard pressed GPs up and down the land are still waiting for an answer as they are burning out.... and NHSe obviously needs some help as at this moment in time they look completely out of their depth... they keep asking GPs to do more and more, when they are already at breaking point..... Im listening..... what are your solutions???????

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  • PS Henrietta you haven't answered what speciaity you are in, Im still trying to figure out why you dont understand the conundrums of general practice in a rapidly evolving world. The 'old style' general practice is NEVER coming back because the country simply can't afford it so with all respect 'the past' is not the solution. Read the articles here in Pulse, Morale is low, medicine much more complex, we are the general physicians in the community, the public is increasingly unforgiving, the expectations ridiculous with the resources we have...... so someone has to tackle public expectation or else no one will choose general practice as a career,.....look at the stats..... you have to train 3 GPs to get one FTE, and all our leaders have gone portfolio i.e. part time.....I left the UK as my conclusion was current General practice in the UK is unmanageable and unsafe. The 'shallow and ill thought out opinion's of which you speak represent the thoughts of many practitioners up and down the land.... I still keep in touch with my UK colleagues.... I dont know ANYONE who is happy in their General practice profession.... I would suggest it is not the contributors of whom you speak ill who are out of touch with reality on the ground. Please rather than just being nasty about someone, propose a solution if you have one.....

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  • PS Katie- Brilliant article- raising a valid issue that DOES need to be addressed.....as you can see its got the debate going... a debate society NEEDS to have- every county in the world is wondering how to fund the exponential increase in health care costs and demand. If it is to remain free at the point of use then the NHS will have to reduce what it offers.... it is as simple as that....,Im sure you've noticed that your critics have not proposed any solutions. They are emotionally attached to a past which is impractical both now and in the future due to an increasing and ageing population in a world of stagnant salaries so there is already little appetite to raise taxes. Im glad to see a trainee pop their head up over the parapet. Keep up the good work!!!!! We need more people like you.

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