Urgent services have co-opted our tactic of sending patients away with simple advice – but this is both frustrating and dangerous, argues Dr David Turner
A few years ago, I was talking to a friend who was moaning about their GP. Their complaint went along the lines of the following:
‘You always have to go to the GP twice with a problem. The first time, they just fob you off with advice to rest and take painkillers or whatever. But you go along with it, knowing full well it won’t work and you’ll have to go back again in a couple of weeks with the same problem to get blood tests, X-rays and whatever else to get it sorted out. Why can’t they just do all that when you first go?’
As GPs, we all know this is true, and we all know it is true for a very good reason: most things are mild and self-limiting and will likely get better on their own within a couple of weeks, so they won’t necessitate the return visit. And of course, for those who do come back, we will take things further.
There is a purpose to this process. It rations demand for further tests and investigations to those who really need them. It is by no means a perfect system, and we occasionally get it wrong. But for most of our patients, it usually works.
More recently, I have noticed that our local A&E department has started to use similar tactics. A patient with a swollen arm, who we suspected had a blood clot (the diagnosis later confirmed this), was bounced back to us twice from A&E with suggestions that the GP tries antibiotics and analgesia.
Several patients with a range of infections obviously needing admission, who we have sent up to hospital, have been discharged back to us with helpful advice, such as ‘GP please prescribe antibiotics’ – in what world would we not have already done that?
Why is this a problem? Well, first and foremost, despite some of the bad mouthing we get in the media, it is not such a common practice to send patients to hospital. Set against a background of dealing with 40 to 50 patients a day as a full time GP, I would probably send one or two a week to A&E at most. And if I do, it is for good reason: because I cannot provide the further investigations and care they need in the community. It needs to be provided in hospital.
You’d think that this would be reasonably evident to the doctor (who is usually junior) assessing the patient in casualty. It is incredibly frustrating and potentially dangerous for patients to be bounced back from A&E to us. Only for us to reassess them and ping them straight back to hospital where second time round they usually do get dealt with properly. It makes us all seem unprofessional, quite apart from wasting all our valuable time.
I know some of the reasons why this practice has developed, and I won’t waste words describing in detail an emergency care system stretched to breaking point. However, using the primary care tactic of sending the patient away with simple advice when they have been sent up by their GP is not going to make the workload lighter in hospitals. In fact, it will do the reverse.
Dr Turner is a GP in Hertfordshire. Read more of his blogs here