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Independents' Day

Alert: have you remembered how incompetent you are today?


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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

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Readers' comments (9)

  • Spot on, as always!

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  • Well said. It is part of the culture of needing to be " seen to do something" . A simple system of occasional significant event bulletins would be good enough without disrupting our daily lives .

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  • Any epileptic should be locked up in solitary isolation then?
    Should we throw away the key too?
    And why is the NHS recommending an antibiotic for simple UTIS that also causes pulmonary fibrosis as first choice?

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  • Re Hyperkalemia-standard GP response is fully in keeping with Copperfields modus operandi eg repeat until normal.And this is why Copperfield DOES need the circular so he can put his "Obviously" response aside and do what one would expect a clinician who knows his ass from his elbow to do eg THINK is this spurious? Is patient on medications which could cause this? Is the eGFR ok?Etc etc.

    And GPs get peeved when their clinical acumen is commented on negatively....

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  • NHSE has to have something to do.

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  • @the cavalry
    I think we could all give NHSE something to do.
    Two words.

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  • David Banner

    There is a chilling subtext to these irritating warnings. When GPs strays from the guidelines they can no longer claim to have been acting in the patient’s best interest. Those annoying flashing catastrophising pop ups and messages that we increasingly ignore will one day be the damning evidence used to hang us out to dry.

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  • @David Banner; so true

    @IDGAF; he’s obviously joking

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  • Not to mention 'warning fatigue' after so many warning boxes that you close them down without even looking and miss the one in a thousand that was actually important...

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