GPs are partly to blame for their crippling workload, says columnist Dr Tony Copperfield
It’s a fact that we’re all working our gonads off. But it’s not quite a fact that this is all down to feckless, self-serving politicians and insatiable patients. There’s a bit more to it than that.
Look in the mirror first thing on Monday morning: that dead-eyed automaton staring back is actually part of the problem. Because the inconvenient truth is that much of the crippling workload is self-generated
by the medical profession.
Yes, really. We have become collaborators in our own demise. For example, we increasingly medicalise risk factors, shades of normality and borderline abnormality – see hypertension thresholds, prediabetes
and, coming soon, adult separation anxiety.
Also, for obvious reasons, we’ve defaulted to fronting primary care with the inexperienced, the risk averse and the uncertainty intolerant, who use a random test generator to end every consultation. But we are the ones who then spend hours poring over the results of investigations we would never have ordered in the first place, which is about as rewarding as doing a crossword with no clues.
Even with genuine pathology, we double down to compound the problem. Hence, chronic disease management becomes a relentless grind of target chasing and a follow-up regime that is unnecessary,
unfeasible and unwanted by patients.
And if the punters get as far as the local DGH, gawd help us, and them. After acute admission, we can look forward to what used to be known as a discharge letter but is now officially a dumping list, with ‘GP kindly to’ repeat bloods, chase scan results, refer incidentalomas and, to give two recent examples, ‘assess fitness to drive’ and ‘refer to a dentist’. Sure, shall I kindly do that before or after I’ve cleaned their windows?
Whoever said ‘treat the patient and not the test’ was so right, and is so forgotten. The reverse is the norm. Patients are now just repositories for so much biochemical, physiological and anatomical data for us to sift and rectify. It’s a literal measure of the insanity of this process that we are incentivised and rewarded for it.
And that is a significant part of the problem: much of this brainless workload generation is a direct result of the need to jump through hoops – QOF, IIF et al – set by clinical drum bangers working with a medically illiterate NHS England. This has ground us down to the point where we’ve ended up colluding with target obsession and fetishising ‘checks’ because a) we fear stepping out of guideline and b) we’re too knackered to think straight. This ritualistic medicalisation drains patients, too, making them ‘depressed’, which creates one more thing to ‘treat’.
Please, someone, put the brakes on this treadmill of nonsense. There is simply too much medicine, and too much of it is self-perpetuating. We need to take a calm and common-sense look at the self-imposed quantity and the target-driven ‘quality’, and dial back on both.
Such a culture shift would mean fewer protocols and more pragmatism, fewer investigations and more considered consulting, and less box ticking and more time to think.
It would make us all far better doctors. Looking in the mirror in the morning, we might even recognise a fulfilled and functioning GP peering back at us. Oh hang on, that’s the locum.
Dr Copperfield is a GP in Essex. Read more of his blogs here