Columnist Dr David Turner says secondary care should rethink its approach of telling GPs what patients do not have wrong with them as it leaves them searching for answers
Have you noticed how secondary care seems to increasingly tell us what patients do not have, rather than what they do have? I reflected on this recently while reading letters sent to me from secondary care.
The gastroenterology team frequently ends colonoscopy reports with ‘no signs of bowel cancer’, and nothing more. Fine, we needed that excluded. But the patient still has undiagnosed gastrointestinal symptoms, which are going to bring them back to me and potentially lead me to refer them back to secondary care. Why not arrange to see the patient and discuss the next steps? We will usually have done as much as we can in primary care already.
The out-of-hours NHS 111 reports are no better. The list of what the patient does not have usually runs to a whole page. It seems everything the patient has not experienced – from a postpartum haemorrhage to an ostrich bite in rural Zimbabwe – is listed, with what is actually their presenting complaint buried in the text as a one liner. Or more often than not, after a comprehensive list of negatives, the phrase ‘advised to see their own GP within four hours’ is printed at the bottom of the page.
Outpatient referrals often feel like headbutting a brick wall (not a RAAC one, though). Patients referred to ENT with prolonged vertigo tend to have an MRI to rule out inner ear tumours and are then sent back to the GP. Super! So they do a scan to rule out a rare cause, then dump the patient back on primary care to vent their spleens about nobody actually making a diagnosis or doing anything about their symptoms.
The NHS has always predominantly been an ‘illness’ rather than a ‘wellness’ service, but recently it seems to be becoming a ‘rule-out-cancer-and-dump-everything-else-back-on-the-GP service’. Now, this is not necessarily a problem. In fact, if we were given sufficient time and resources, we could probably deal with a lot of the non-cancer-but-nonetheless-significant symptoms better in the community.
For instance, we could employ more counsellors to treat our IBS patients with CBT and biofeedback, as well as more physiotherapists specifically to treat labyrinthine disorders. Diverting funds from NHS 111 to primary care might mean we could up the pay rates for out-of-hours work and perhaps encourage more doctors to work in primary care. At least that way, patients could talk to an individual who has spent a decade training in medicine, rather than a call-centre operative following a flow chart.
Fanciful suggestions? Maybe, but I am certain I do not have a mono-delusional disorder.
Dr David Turner is a GP in Hertfordshire. Read more of his blogs here