Alert: have you remembered how incompetent you are today?
I realise I regularly find things to get fed up about. This might just be age-related, like my tendency to doze off during consultations. On the other hand, it could be that there really are more things to get fed up about than there used to be. And I see it as my duty to bring them to your attention so you can say, yes, I’m fed up about them too, which, if sufficient momentum builds, might actually prompt us into uncompromising action, such as putting the kettle on.
So, this month, I have mostly been fed up about a constant stream of alerts warning me that I am about to do something wrong. Some of which I’m used to, such as the irritating habit of the computer to set off sirens and a flashing neon sepsis warning every time I enter the word ‘fever’, even if preceded by the word ‘hay’.
But this tendency to a) catastrophise and b) assume GPs are incompetent, now seems to be developing into a mini industry. Here are some recent examples:
• A new medicines management system, introduced by our CCG as part of its prescribing incentive scheme, which takes a very Chicken Licken approach to therapeutics, with regular alerts of increasing degrees of neurosis. You haven’t checked this patient’s U&Es for six months! This person’s on a drug that can affect thyroid function!! Failing to monitor this medication at half-hourly intervals may result in the sky falling on this patient’s head!!!
Must GPs now appear in person to admonish women on valproate when they have sex?
• An MHRA warning advising that, such are the perils of valproate in pregnancy, we must proactively recall women of childbearing age on this drug and undertake various actions, including getting them to sign up to a Pregnancy Prevention Programme and (I think I’ve got this right) appearing in person whenever they are having sex, to wave an admonishing finger.
• An increasing number of unsolicited circulars warning me about bad things that might happen and would be my fault. Such as, to give just this week’s examples, some sort of critical incident bulletin questioning whether we know what to do about hyperkalaemia (obviously: repeat the potassium until it’s normal) and a ‘Quality team’ update explaining that mesalazine can cause renal failure and nitrofurantoin can cause pulmonary fibrosis. Such warnings are invariably signed off with helpful suggestions: familiarise yourselves with local guidance, do an audit, appoint a practice lead – which does at least give us something to do in those empty hours between patients.
Doubtless it’s all well intentioned. And I have no objection to being educated and updated from time to time. But, frankly, I can no longer see the signal for the noise. Plus, it’s offensive and demoralising constantly to receive messages implying I have f***ed up, am f***ing up or am about to f*** up.
Given the complexity and intensity of general practice, it’s a minor miracle that the number of actual cock-ups is tiny. And that’s a testament to GPs’ judgement, diligence and professionalism. So, if you don’t mind, please jiggle your worry beads elsewhere, and let us get on with our jobs. Tea, anyone?
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield