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Gold, incentives and meh

We are everyone’s house dogs

Dr Shaba Nabi

Red was a significant colour for me as a junior house officer (F1 if you qualified after 2005).

It was the colour of the pen I used to diligently transcribe abnormal results from bits of yellow and pink paper into a patient’s medical notes, beautifully tabulated and ready for the consultant ward round.

It was also the colour of my lipstick, which I purposefully re-applied before heading down to the dungeons of the radiology department to beg for my patient’s ultrasound to happen this side of Christmas.

As I passed through both psychiatric and medical specialist training programmes, I was able to delegate some of my work to more eager puppies, all trying to outdo each other with their tricks.

But once I joined the world of general practice, I realised consultants still viewed me as their community house officer, existing only to support their very important work.

A patient who comes in to the surgery because ‘the consultant said to see you for my results’ is not only irritating, but is also in downright danger, when said results happen to be abnormal tumour markers.

In the world of primary care networks and multiprofessional working, it seems my emasculation is only getting worse.

My inbox is now filled with demands from a spectrum of healthcare professionals including podiatrists, physiotherapists, paramedics and specialist nurses.

The majority of the time, often through no fault of their own, they are unable to complete the patient pathway, so requests for X-rays, fit notes and blood tests inevitably find their way back to us.

Unlike my consultant colleagues, I still have a full day of patients and telephone callbacks

This would be less of an issue if I were swanning around my network with an entourage of my own faithful dogsbodies behind me, barking out orders for all the tests that are needed.

But, unlike my consultant colleagues, I am still seeing at least 30 face-to-face patients each day and managing a mushrooming list of telephone callbacks solo, so all this extra work is squeezed into an already bulging day.

Setting aside my personal gripes, this situation also results in a poor experience for patients. They are navigating their way around a Monopoly board, often landing on a chance card that sends them back to ‘Go’.

This isn’t too much of a problem if it’s just waiting for medication that should have been issued by the hospital, but if mismanagement means they go back to the bottom of a waiting list, they may feel as though they have been sent to jail. We are all patients and we deserve holistic, joined-up care.

I’m cautiously optimistic that these pathway glitches will be ironed out in time. After all, we’re still in the early days of having first-contact musculoskeletal specialists and paramedics relieving us of some of our work.

But what I am not optimistic about is the level of medical risk and uncertainty that will still be passed to us. In spite of the NHS’s new general practice indemnity scheme, we will still potentially face the emotional turmoil of being sued. And no amount of red lipstick is going to help me get through that.

Dr Shaba Nabi is a GP trainer in Bristol. Read more of Dr Nabi’s blogs online at pulsetoday.co.uk/nabi

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