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Gold, incentives and meh

All this help is making me feel a bit ‘hypo’

Copperfield

copperfield duo 1500x1000px

Yes, it was only a trivial and innocuous electronic Task, one which would normally warrant just the usual eye-roll/delete routine. Then again, I do see it as my vocation to call out nonsense, plus there’s a bigger point here.

So that’s why I responded when I received a message about a patient that one of the various paramilitary wings of the community nursing service had just visited. In the course of sorting out a non-diabetic patient’s leg ulcer, the nurse had for some reason checked his blood sugar. Despite any relevant symptoms, ‘Because it was only 3.1,’ she made him tea and biscuits, checked that his glucose had risen, patted herself on the back and messaged me about it.

To which I replied that this made no sense at all, that significant hypoglycaemia is only realistically an issue in diabetics on treatment, and that if she really had time to brew up and crack open the Hob Nobs, maybe she could pop over when we’re next signing repeat scripts?

And that’s when the chill of the bigger issue ran down my spine. While completely misunderstanding everything about hypoglycaemia is a fairly tiny demonstration of illogicality, it does demonstrate a profound misunderstanding of, well, medicine. I could give many other examples, almost always related to non-GPs doing a GP’s job, or part of it, and doing it not-quite-right, with the resulting dysfunction inevitably ending up in our lap.

Now we have so many non-doctors, all ‘helping us out’, the problem is spiralling out of control

Now that we have HCAs, nurse practitioners, pharmacists, paramedics, physician associates, nurse specialists etc etc, all ‘helping us out’, each with their own mistakes, misunderstandings, and misinterpretations, this problem is spiralling out of control.

Someone wise and articulate recently pointed out that the current funding arrangements for general practice are like trying to paint your house using multiple tiny sample pots. Spot on. I’d argue that maintenance of that house now suffers the same problem: the keys have been handed over to multiple agencies who come in, who mean well, but who leave it in a worse state than it was in the first place, with the result that we have to clear up the mess.

It’s enough to make us feel dizzy, sweaty and trembly. And we all know what that isn’t, don’t we?

Dr Tony Copperfield is a GP in Essex

 

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Readers' comments (22)

  • BAP doesn't look that hard to do?I wonder how long the training is?

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  • Wouldn’t it be great if noctors were not being encouraged to do stuff above their pay grade and hence make silly mistakes like this that cause work and waste everyone’s time including their own.

    Then we wouldn’t have to complain and upset people.

    The uk is the only country trying this noctor experiment. In my view it’s an expensive way of getting really poor quality care and it needs scrapping as soon as we can.

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  • Keitflyer - its what you get with socialised healthcare provision and state intervention. In the free market, pple who want and pay for noctors would get noctors, and pple who want and pay for doctors would get doctors. and everyone would be responsible for themselves :)

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  • Bullying? Or drawing attention to a genuine problem of asking people to do a job who haven't been trained. I abhor bullying, having been on the end of it, but this is simply pointing out the incredibly risk averse nature of "Noctor" interactions, which causes its own problems of overinvestigation and overadmission (as mentioned above admitting nursing home patients to hospital is a very bad thing if it can be avoided)

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  • Bravo Copperfield and James Wallace.
    Ms Welch's views are a reason to retire early.

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  • Are the nocters the driving force behind employing them? I suspect not, so is it fair to belittle them when they are pitching in the help our crisis? When people are taught the rudimentaries of a foreign language to help in a situation that needs communication with a lot of monoglot people, do the fluent speakers of the same language laugh at those less fluent that are helping out? If we're not careful the nocters will vote with their feet and one raised middle finger.

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  • I wonder if the hapless patient with the leg ulcer and hypoglycaemia has secondary amyloidosis causing adrenal insufficiency.

    In a way I am joking but all symptoms should be thought about carefully before reflexively being dismissive.

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  • Excuse me Hot Felon, I’m not in the least bit bothered by titles, unless it is clearly being used to belittle someone- yet another clear example of bullying behaviour. I am a Dr, with GMC registration just like everyone else here, unless you falsified a number to get a sign on to post here. Plus a license to practice on the GP register, which I suspect some of you are not. The only one that looks like a numpty is you if you think you can get away with hiding your insulting bully tactics behind clever denigrating sarcasm.
    So, Mr. ‘I don’t have the balls to put my own name to my insulting comments’ Hot Felon, do you feel big now?

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  • Just Your Average Joe

    https://youtu.be/JgzjnQMs_uY

    Thanks BAP - enjoyed that video as learnt something new.

    Wish I knew what to connect the dressing to! The video ended on a cliff edge!

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  • Joe good point -I think it's a four parter. I think I could quite get into these vacuum dressings. Well not literally. I reckon the training will cost about £2000 require 4 hours of reflection and the ENB2018 on how to plug in a Dyson.

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