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Let’s start with a crack down on noctor prescribing


This week the Government is mainly cracking down on GP prescribing

And that’s really very convenient. Because, only this morning, a mum tips over my desk the contents of a brown paper bag containing the treatment for her child’s D&V - specifically, a fluid replacement solution, paracetamol, an anti-emetic and an anti-diarrhoeal. And your job is to decide where she has just come from with this glorious example of pointless polypharmacy. Turkey? Spain? The shattered shopfront window of a ram-raided chemist?

Nope. She’s fresh from the local out-of-hours service, where the noctor who saw her upchucking and downsquitting progeny last night not only prescribed this pharmacopoeial goody bag but also delighted in recording the fact in notes so lengthy that I have developed scroller’s finger.

Needless to say, the child is absolutely fine. You know what I’d have put in the notes, don’t you? ‘D&V, child manifestly well, advice.’ Job done, no script, next please.

What strikes me as I deal, increasingly, with the aftermath of consultations outsourced to the prescription-happy protocolariat is that many years of GP work and public education is systematically being destroyed.

It has taken a huge amount of time and effort to get the message across to patients and parents that the important thing with illness is to carefully establish cause rather than brainlessly treat symptoms. You don’t have to fight fever, you work out what’s behind it, you don’t mask bellyache with painkillers, you ensure it’s not appendicitis, you don’t exacerbate tension headache with more pill-popping, you reassure it’s not a tumour and so on ad nauseam (which, by the way, does not require an anti-emetic).

Not anymore. As the front line is evolving into a GP-free zone, sensible management is being replaced by reflex superficiality. As if a pill for every ill wasn’t bad enough, it’s now a prescription for every symptom.

Bit late in the day, maybe, to finally realise why the prescription pad was always seen as sacrosanct. But if the Government wants to crack down on prescribing errors, why not start with this one?

Dr Tony Copperfield is a jobbing GP in Essex 


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Readers' comments (8)

  • "prescription-happy protocolariat"... love it..

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  • Absolutely on the money. Loving the term protocolariat.

    We've missed you Coppers.

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  • David Banner

    Another vote for "Protocolariat" new word ever!

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  • We must be sure to all use "Protocolariat" every day until we can get it into the dictionary. This would be a worthy legacy to TC.

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  • we've got a nice theme going here!
    can I share my own little contribution to modern English? its a verb.
    "To cameron" or "to do a cameron"- means to make a bold and ambitious statement or proposal, but without full knowledge or understanding of facts or circumstances, that leads to great calamity or to loosing one's cause. A synonymous phrase is "to stick your neck out (and loose)"

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  • t seems pretty typical of current NHS leadership thinking that at the same time as clamping down hard on what GPs are able to prescribe, it is also creating lots of other prescribing roles to replace the functions of GPs - whose training, protocols and reflexes will be to prescribe, prescribe, prescribe.

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  • Symptom medicine rather than diagnostic medicine is alive and well in Canada with polypharmacy the norm.

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  • In psychiatry they have thrown away diagnoses and replaced with "clusters'. It sets psychiatrists up to be done away too. Perfect self destruction. Psychiatrists are brilliant at it but perhaps this is now spreading outwards?

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