‘Instructions to GP: Please monitor haemoglobin and provide top-up transfusions in the community to maintain Hb above 80 as advised by gastroenterology since the patient is not suitable for invasive interventions.’
This is verbatim from a discharge report from a patient who had been in hospital for several days with severe anaemia. An ‘Instructions to GP ’note, not a polite request.
‘Please could you refer to local stroke services for assessment of possible TIA and ophthalmic services to exclude a retinal issue.’
This particular workload dump was inscribed at the end of a letter from a cardiologist who had assessed a patient and, clearly concluding that the cause of the patient’s symptoms was not cardiological, decided to ask us to take a shotgun approach to referring onwards. I just wondered why the cardiologist hadn’t suggested a psychiatric referral to exclude a psychogenic cause and a dental review while they were at it.
In the same day a private rheumatologist asked us to perform 18 different blood tests on a patient they’d seen, as the patient couldn’t afford to pay for them privately.
I’m reporting these very specific examples of secondary care dump not merely because they all occurred in the same day and not an untypical day at that, nor do I do it to have a go at our hardworking colleagues in secondary care. I do it because when we moan about being busy, there are no film crews wandering around our corridors filming patients lying on trolleys.
We have no lines of ambulances outside our doors, the footage of which can be shown on the evening news. However, when we say that we’re barely coping, it’s a fact and it’s unnecessary work deposited on us from the hospitals that are making the problem far worse than it need be.
The first example I brought to the attention of the LMC.
The second I wrote to the consultant concerned, explaining why we’re not their junior doctors.
Third example: I sent an NHS paper blood request form to the private doctor concerned and asked them to fill in what bloods they’d like and arrange to get the form to the patient.
Non-violent and direct action – give it a try.
Dr David Turner is a GP in Hertfordshire