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All hands on deck

Dr David Turner

‘Well if nobody else will, I’ll go and get the ******* patient myself!’

As a medical student, I witnessed this outburst from a slightly grumpy but very hardworking consultant surgeon.

He had a busy morning operating list and after having just called the porter’s lodge to ask for his next patient to be brought down to theatre and being told the porter was on his tea break, he decided to go up to the ward and wheel the patient down himself. This struck me at the time as the perfect example of a doctor not afraid to get his hands dirty.

I have spent my career trying to be first and foremost a hands-on doctor. I’m afraid my respect for trained doctors who spend the majority of their time sitting on committees, sending emails and generally telling those of us at the coal face how to do our jobs from the comfort of their ivory towers, is on a par with my opinion of Trump voters.

Sadly, even before Covid, there seemed to be a developing trend for some newly qualified GPs to prefer to avoid direct patient contact by opting for telephone triage work over actual face-to-face work. Covid has made it much easier for doctors who dislike seeing real patients to hide behind a computer screen.

When I teach undergraduates, I make it very clear that in my opinion medicine is a face to face, bloods and guts profession that frequently makes use of four of your five senses. Remote consulting can, at best, make use of two.

If we wish to maintain the high level of regard patients have for us, we need to continue to show we are willing to engage physically with patients during and after Covid. Whether that is physically helping out giving flu vaccines in a flu clinic, or just going out into the waiting room to call a patient in personally. Patients really do appreciate the personal touch. Not one of them will give a damn about your CQC rating or how many CCG committee meetings you have sat on, but they will remember the times you sit and listened to them face to face.

Yes, there is a risk of catching Covid from patients, but when has there not been a risk of us catching something from our patients? Our job is dealing with illness, for goodness sake! Whether it’s TB, MRSA, meningitis or norovirus, we have always been at risk of contracting something infectious from those we treat. Frankly, if you don’t like flames, don’t become a firefighter.

There is another potential sinister side to the increase in remote consulting. In a few years, with the country racked with debt from Covid, whoever is health secretary then may be tempted to do general practice on the cheap, by franchising our remote consulting to call centres full of doctors overseas.

‘It couldn’t happen in the NHS!’ you cry. Really?

Dr David Turner is a GP in west London


David jenkins 1 December, 2020 12:34 am

well said !

if you see and examine the patient AND RECORD IT, and you get it wrong, then you can say in court “this is what i was told, this is what i did (and why), and this is what i thought” – you might have a fighting chance.

if you say in court “i didn’t see it, wasn’t told half of it, and didn’t examine any of it – very sorry your honour, the patient didn’t tell me she had lung cancer/tb – she told me she had a chest infection. i’m very sorry the patient is dead/relatives have now all got tb etc etc etc”………….

no prizes for seeing where this will end up !

Cameron Wilson 1 December, 2020 8:13 pm

Yep, totally agree with the sentiments of this article, and also David’s comments which are a lot of the problem! The litigation culture not to mention their lapdogs at the GMC, then by default the RCGP have managed to stifle common sense/ the nuances of GP and reduced it to the very real danger that a call centre mentality/service will form as a result, and don’t expect it to be delivered locally!!

David Mummery 1 December, 2020 9:39 pm

Absolutely excellent article David – couldn’t agree more! As to your last observation I think it’s more than likely..

Concerned GP 3 December, 2020 8:10 am

I’m afraid that this does rather add fuel to the fire of the GP bashing lobby which portrays GPs as “lazy” and wanting to avoid face to face work. It’s rather disappointing to say the least.
If you hadn’t forgotten we are still in the middle of a global pandemic. Yes it’s true that we do catch things from our patients. But are you seriously suggesting that we ought to just carry on as normal with all the risks that entails just because patients like it? Ask yourself about those healthcare workers who have literally lost their lives whilst doing their jobs? Not to forget those suffering with long covid. I don’t know of any GP that is actively trying to shun patient contact. In fact I know several who are at significant risk of complications from covid but who have still been doing significant F2F work in spite of the risks.
It’s frankly insulting to imply that younger generations of GPs just want to sit on committees and avoid clinical work. Also policy making and sitting on committees is work that needs to be done. Why are you seeking to divide us? May I remind you that there were no halcyon days of the past? Most of us remember the long brutal on calls whether in hospital or in the community and they were not healthy for anyone. There has to be a balance.
Having said that I do agree with the last paragraph and it’s going to be up to us to ensure that we do get back to safe and significant levels of F2F work.
But people have legitimate concerns over covid and I don’t think that the fact that we have had to adjust our ways of working for the time being should be used as something to beat us with. We all want to see a return to safe F2F working but until we are in a position to do this please don’t keep bashing us. We have enough to deal with already.

Kevlar Cardie 3 December, 2020 10:04 am

Shroud etiquette; Does one pin the medal on the left or right breast ?

Hello My name is 3 December, 2020 2:06 pm

The issue is that the day job has been allowed to descend to such a point where everyone is desperate to be on a committee or do some non-clinical work to escape (he’s right – we are). Sort out the workload and GPs will magically reappear! I think we should see more FTF – relationships and continuity in medicine matter, as well as examination.

terry sullivan 3 December, 2020 8:03 pm

wheres the bma?

Christopher Ho 4 December, 2020 12:17 pm

Talk about cognitive dissonance – “I’m afraid my respect for trained doctors who spend the majority of their time sitting on committees, sending emails and generally telling those of us at the coal face how to do our jobs from the comfort of their ivory towers, is on a par with my opinion of Trump voters.”

Trump voters are the conservative minded, working/middle class who ARE getting their hands dirty, wanting to keep their businesses open, it is the other side that are the super rich globalists/multi-nationals, and open border, identity groups and socialists who want to live off the welfare of the taxpayers.

I have no love lost on ivory tower “clinicians”, or have a need to feel “loved” by patients. If you want to offer yourself as a sacrifice on the altar of “virtue”, to take all the risks, work all the hours and receive nothing more than “patient appreciation”, by all means, you are free to do so. Everyone else is free to decide our priorities and the level of risk we are prepared to accept. Castigating new GPs for avoiding the sh*te frontline work is surely going to work well, isn’t it? Or is this simply virtue-signalling? As per Concerned GP, your assumption that “new” GPs are avoiding f2f contact is not evidenced, and hence, probably unjustified. But “virtue-signalling” is a clearly observable tactic, used by many.

Dylan Summers 4 December, 2020 2:06 pm

I’m unsure about this. I dislike remote consulting, and I consider myself personally unlikely to suffer any grave complications if I caught Covid.

But I’m anxious about the potential consequences of surgeries having a significant Covid outbreak amongst staff. And reducing footfall to avoid that seems to me a price worth paying.

Asgher Minhas 4 December, 2020 2:35 pm


Dominic Hennessy 5 December, 2020 7:28 am

I feel this is a complex issue, and no right answers. I am trying to see people less face to face, not through self preservation or laziness, but through altruism. Each contact I have, increases risk to our staff (some of whom have identified as extremely vulnerable), and more importantly any patient downstream whom I also feel needs face to face review.
Remote consulting is infinitely harder, and certainly more time consuming. Often I am relying on the social capital gained from spending time getting to know my patients well from many personalised interactions over the years I have taken the time to get to know them, to recognise when someone needs to be seen versus wants to be seen. It makes me far more anxious dealing with patients I don’t know well remotely; is the mother ‘sensible’, is the ‘just a bit of indigestion, Doctor’ actually impending litigation?
Not easy.
I believe David is nearly right, at best we can use four senses remote consulting – sight, sound, the spidey-sense (for want of a better term) we all start to gain from working at the coal face, and our patient’s common sense.
Castigating people for trying to do what they believe is the right thing isn’t helpful and is divisive. We are all trying hard to do what we believe is best, despite at times incredibly poor working conditions made worse by tight timelines for underfunded services accompanied by a handful of minimum 18 page documents to read in our spare time.
I believe as a wise nurse once told me, few people go to work wanting to do a bad job, and if we can’t do anything else in a situation, be kind. Lets start with ourselves, shall we?