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Gold, incentives and meh

Losing my auriscope... and my moral compass


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I think I’ve lost my moral compass.

Recently, my rechargeable auriscope went on the blink. I say recently. A few weeks ago. Maybe a month or two. I keep meaning to do something about it, but inertia has taken over, so I’ve learned to live with the situation.

That means I’ve just carried on using it. You know, without the light thing. Patients can’t tell, can they, especially if I make the right ‘Hmmm…’ or ‘Ahhh…’ noises as I examine their ears, pretending that my dead auriscope has somehow illuminated the path to their true otological diagnosis when I can actually see sod all.

But I rationalise my behaviour on the basis that: a) Even if their EAMs were illuminated by Wembley stadium-power floodlights, I quite possibly wouldn’t have a clue what I’m looking at anyway; and b) The examination is in itself therapeutic. Even if it is a sham.

My use of the pulse oximeter to reassure is both kind and cost effective, if not entirely based on science

Still, I am wondering if it says something about me. After all, it’s not the first example of such behaviour. For example, I always use the CCF (Copperfield Correction factor) when taking blood pressures. This involves routinely subtracting 10 from the systolic and 5 from the diastolic. Trickier now we use automated cuffs, but still possible if you angle the screen readings away from the patient. This is not entirely for QOF purposes – it also very thoughtfully takes account of the inevitable white-coat-effect. But mainly it’s for QOF purposes.

Is that bad? Maybe. But I’m not completely morally bankrupt. I ditched the idea of nobbling the waiting room blood pressure machine to read 120/80 in everybody. Ditched in the sense of, I lost the vote at a practice meeting. 

But I must admit, I really am worried about my use of the pulse oximeter. The thing is, I’ve discovered that patients are really very impressed by this gizmo, are delighted to see their percentage creeping towards 100%, and seem to feel better as a result. So my use of it to reassure and rapidly dismiss patients with dizziness, headache, fatigue, muscle aches and a whole host of complaints not normally associated with a need to measure oxygen sats is both kind and cost effective, even if my claims that the figure represents some accurate and objective gauge of overall wellness isn’t entirely based on science.

It’s the auriscope thing that’s really bothering me, though. It seems to be loaded with symbolism: the light has gone out, I am in a dark place and I have lost my way. So it may be time for a new auriscope. Or it may be time for me to go.

Some better news, though. I’ve found my moral compass. It was in my bottom drawer, where I keep my pulse oximeter. And it seems to be working fine. Honest.

Dr Tony Copperfield is a jobbing GP in Essex

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Readers' comments (15)

  • Fix your auriscope and carry a spare stethoscope assuming you are not joking ?!
    All it needs is a whistle blower and you will treated to a 4 or 5 month NHSENGLAND and CCG investigation as well as intense CQC ‘inspections’ !

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  • Healthy Cynic

    I feel better for this refreshing blast of honesty! It just illustrates how much of what we do is solely to meet expectation. It's not only the proctologists who spend their days 'going through the motions'. Hands up who reaches their diagnosis before the patient makes it to the chair?

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  • AlanAlmond

    I ditched the auto sphyg a while ago and now use a manual one. That way I’m in control of what the blood pressure reading is, not the plastic box. Does require a little more effort but it’s worth it, the only down side is the slight rub with all those folk who casually add ‘can you just check my blood pressure please?’ ..usually for no obvious clinical reason, and after a length discussion about all the most stressful aspects of their lives..baaaa. .

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  • So face to face consultations are basically useless. Doctor-as-drug can be easily done via skype

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  • Wow, I hope you are joking. I have a friend attending a 3 week GMC hearing following a medication issue ( OTC medication). It doesn't take much for things to spiral out of control with the GMC.
    An ear problem is generally a gift for a GP, a 5 minute consult. However being able to see the EAC is surely vital? Is there a perforation, bulging TM, possible cholesteatoma, vesicles, impacted wax, blood, malignancy, fluid behind TM etc. No doubt the vast majority of examinations are pretty normal but isn't that what we have to suck up as GPs and use our skills to diagnose treatable conditions? If we don't know how to examine something then advise the patient to see somebody who does, do some training or leave the profession before somebody dies.

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