Fat chance that Mounjaro will save the NHS
An exasperated Copperfield on the trials and tribulations that Mounjaro prescribing has wreaked on general practice
Well, that’s one question answered: What happens to patients post-Mounjaro? Yes, they flab up again, but who will be responsible for stopping that happening? Ah, you’re ahead of me. We GPs will be expected to ‘monitor’ them for at least a year after treatment, with regular ‘check-ins’ and action plans ‘tailored’ to their needs and, yes, waist alterations may well be required.
In other words, we’re providing the wrap-around care, except without the treatment it was being wrapped around. Hang on, though. If weight management was as easy as lifestyle advice, surely that would have worked in the first place?
The more pressing concern, though, is managing the immediate workload. Every day, I seem to be scaling the exhausting heights of Mounjaro. Or, if you prefer generic, I’m drowning in a tirzepatidal wave.
First, there’s the consultations with patients desperately wanting to tick the Tier 3 boxes by:
- A) trying to attain the threshold BMI of 40 (‘I guess I’ll have to go away and eat more pizza, doctor’) and;
- B) demanding testing for T2DM, hypertension and dyslipidaemia, trying to pass off their pizza-induced dyspepsia as possible angina and volunteering suspiciously textbook symptoms of sleep apnoea.
And second, the tedious deluge of lengthy letters from online pharmacies about patients they’ve privately jabbed. My inbox is obscenely bloated with this junk. It needs Mailbox Mounjaro.
All this correspondence requires processing, and that’s where things get trickier. On the one hand, we have MDOs warning us we should not ignore online pharmacy requests for info, we should grass up porky patients telling porky pies etc etc. And on the other, we have the BMA getting all militant and supplying us with a template TTFO letter. This is 46 inch advice in 32 inch trousers, and it’s not comfortable.
It’s only going to get worse as the criteria are relaxed and there’s the inevitable mission creep into general practice. Plus there remain some oddly unanswered questions. What are the treatment targets? When should we stop the the jabs in responders? Who’s going to do all the apronectomies? And, most of all, did anyone foresee that we’d not be saving the National Health Service, but turning it into the National Mounjaro Service?
It makes me wonder why we don’t all just eat less. Or is that fatuous?
Dr Tony Copperfield is a GP in Essex
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READERS' COMMENTS [3]
Please note, only GPs are permitted to add comments to articles
worry not now pass me a pie!
You can ease the pain by playing patients at their own game……..….
(I want Mounjaro) “Could you help me with my weight doc?”
“Certainly. Have you considered Mounjaro?”
(Yes!!) “Oh, does it work?”
“Yep”
(Play it cool)“Is it safe?”
“So far yes”
(He’s going to give it to me!!) “Any side effects?”
“Well if you can stick the nausea and constipation it’s fine”
(Go for it!) “Right, brilliant, could you write me a prescription?”
“Oh heavens no! It’s about 150 quid a month at Boots. Alternatively I could prescribe metronidazole to take with your Frosty Jack’s, same effect “
(Smart ass bar steward!) “!?!?!?!?!?”
I was going to make an angry TikTok video about how 4 minutes are being added to every consult with both a) and b) that you’ve listed above (one patient told me they ate sweets to get their HbA1c from 46 to 49) but last thing I want to do is increase publicity