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