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Falling on deaf ears

Copperfield

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OK, yes, I realise I write about ear wax with a regularity that borders on the fetishistic. And true, I do intend to collect all cerumen-based columns and blogs in book form one day (‘Copperfield: The Wax Works’).

But really. I mean, REALLY. Word on the GP street is that ear syringing should be defined as non-core and therefore provided only as an enhanced service, or directed to the ENT department.

I do want to steer clear of any laboured jokes here, but I have to say that I really don’t hear what the problem is. Ear syringing was literally the first thing I learned to do as a GP trainee. And because that was in the Mesozoic era, it has to be about as core as the solid ball of alloy at the Earth’s centre.

Besides – and I know I’ve said this before, but it’s fallen on deaf ears – in our gloomy primary care world of viruses, soft psychiatry, chronic disease drudgery and dull-as-dishwater primary prevention, ear syringing is a rare shard of glorious therapeutic sunlight. Armed with nothing more than water, a syringe and a pinny, you restore the gift of hearing. It’s a sodding miracle.

Ear syringing has to be about as core as the solid ball of alloy at the Earth’s centre

This came to me, today, as I was about to perform a rectal examination, the common thread being, presumably, the colour brown. I was standing there, with digit poised in the traditional manner when, to ease the tension, I rather randomly asked my middle aged, prostatically anxious patient what he did for a living.

At that moment, it occurred to me that, if we’re going to deconstruct general practice ad absurdum into its constituent parts, where will it all end? Could, for example, the time-honoured rectal examination be next as we down gloves and work-to-rule? And if we continue on this process of screaming and shouting that various GP tasks are not actually our job, then won’t we a) Appear ridiculous b) Justifiably be viewed as money-grubbing, workshy or both? c) Lose moments like this?

Moments like this, in this case, being the reply from the other end of the couch, which was, ‘I regret to say, at this precise moment, that I am an estate agent’. A sentence I heard perfectly, on account of wax-free ears, and which prompted me to pull that glove up to my elbow.

Dr Tony Copperfield is a GP in Essex 

 

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Readers' comments (8)

  • Watch the you tube Videos on microsuction, they kept me occupied for hours-- does that make me weird? Oh no is that the GMC knocking at the door?

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  • Vinci Ho

    You will make far more money by publishing your book(s), mate.

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  • The sad thing is that everything has become more and more subspecialised. Forty years ago I worked for a year in a rural Practice in Canada. In the mornings the GPs performed hospital work, GA, cold case surgery (hernia repair, open cholecystectomy, excision of large cysts, varicose vein stripping, caesarian sections..) and ward work on adult male, female and paediatric wards. In the afternoon we did Office (Surgery) work, like a normal NHS GP surgery where I never saw more than 10 patients and didn’t perform a single home visit. All patients were brought to us. Much of that has now changed. Of course it is understandable why this has occurred (minimum numbers needed to be seen/surgically performed per year etc). Apart from working on a farm (the pay was terrible), it was the most enjoyable job of my life. Those days are long gone and things have become more subspecialised. However this appears to be more of the case near large conurbations. The government and NHSE now realise that subspecialisation is very expensive and is trying to push much of the more routine hospital work back to general practice.There is a problem. I believe NHSE thinks that by creating very rigid protocols it will be possible to safely move much of this work back to the community, with less funding than it had when performed in hospital. Even if this is doable, which is debatable, where is the enjoyment factor? It will not be like the rural practice in Canada, where we were an autonomous practice of only four GPs. Despite this we had very good outcomes.

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  • Disagree Tony. This move to define core and non-core is entirely due to the slow death of goodwill in the profession. In the old days we were treated reasonably and mopped up lots of demand because that’s our job. Now we are ttreated so poorly by our paymasters, and we are so surrounded by organisations constantly defining what they dont do, that this becomes contagious. “Not a contracted service” is the new mantra. You can forget ECGs and dental problems, too.

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  • Disagree Tony. This move to define core and non-core is entirely due to the slow death of goodwill in the profession. In the old days we were treated reasonably and mopped up lots of demand because that’s our job. Now we are ttreated so poorly by our paymasters, and we are so surrounded by organisations constantly defining what they dont do, that this becomes contagious. “Not a contracted service” is the new mantra. You can forget ECGs and dental problems, too.

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  • Like orthopaedics that will only see fingers, one day we might have GP PR specialists, entry requirements by the size of their fingers.

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  • brilliant !!! and so right.

    let’s stop pointless ‘soft core psychiatry’ though. Now that would save time and stop us poisoning the uk population.

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  • Before I retired I rarely went a day without reaching for Dr Noot's tank (Does anybody know who he was?) I would always tell the patient that an instant cure was very rare in medicine but ear syringing was close and they were probably the only patient I would make completely better that day. Oh and in 30 years of "instant cures" I never perforated an eardrum. Do you thiunk I can hire myself back to the NHS as an unlicensed "Consultant Cerumologist"?

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