For the last 18 or so months, I’ve been doing regular ‘hot clinics’ in Stockport as part of our local GP federation. The clinics are based in the local out-of-hours hub, but take place between 10am and 6.30pm, Monday to Friday.
Patients first contact their own GP who then refers to us if they meet the criteria. We see anyone with confirmed or suspected Covid (whether Covid is the cause of their symptoms or not). And because there’s no age cut-off for the clinic, we inevitably end up seeing a lot of feverish children. And that’s fine with me – children smile, play and do funny things which brightens up my day. Plus, most of them are quite well and don’t need much to be done.
But recently, at the end of the clinic, I sat for a moment and took stock of what had happened. Out of a clinic filled with children, I hadn’t written a single prescription or even made a referral. They all had minor, self-limiting seasonal viral upper respiratory tract infections.
I think the reason I was feeling in such a reflective mood after that clinic was that our 13-month-old had only just recovered from a nasty viral illness which had lasted for the best part of two weeks. For a stretch of four days, he ate nothing at all, surviving on milk, cuddles and Calpol, and at its peak he was far worse than any of the children I saw in the clinic that day.
Of course, I understand that we’re in a privileged position: my wife is also a GP, and our work is (reasonably) flexible, so between us we were able to keep him at home, monitor his symptoms, check some simple observations, and reassure ourselves that he would be ok.
Being new to Twitter, I had a sense that this is the kind of experience that people Tweet about, hence why I wrote:
Really, I just wanted to express my concern that parents seem to lack confidence in the management of minor illnesses in their children, but something about the wording I’d chosen seemed to fire up the Twitter algorithm and within hours it had received hundreds of replies and thousands of likes.
Generally, people were supportive of the idea of parental education and the only thing they really seemed to take issue with was the idea of mandating it. I understand the difficulties of making something like that mandatory. But does that mean we shouldn’t even consider it? After all, the idea of mandating things is well established in every modern democracy.
I want to be clear that I’m not blaming parents in any of this – the roots of these problems run deep in our society. And while there is no single cause, I think that the lack of any useful health education in schools, Google, and a risk averse health service are the three most important reasons why a highly trained medical professional is the one telling parents that their child’s ‘very runny nose’ is normal for a 3-year-old in winter.
Certainly, when I first started medical school, I barely knew where my liver was, and I’d never even heard of a spleen. Few of my patients have a good understanding of how their bodies are put together and how they work, so it’s not surprising that they often get confused by their symptoms.
And, these days, if you’re not sure about something, you turn to Google. But Google wasn’t designed to give medical advice – its job is to rank websites in order of ‘relevance’, which isn’t the same as ‘trustworthiness’ or ‘appropriateness’, however similar they might sound.
Without an understanding of epidemiology and training in source analysis, it can be hard to determine how worried to be when presented with such overwhelming amounts of unfiltered information.
Parents often say that they ‘just wanted some reassurance’. Now, as a GP, I have no problem with giving reassurance – it’s an important part of my job – but some of the things I see in the clinic are so minor that a GP probably isn’t the best person to seek reassurance from. As insignificant as some of these problems seem, I can never give complete reassurance – there’s always a part of my medical brain that imagines how a runny nose might lead to severe illness and death. And if I don’t warn them of the rare but serious risks, I worry that I’ll be considered negligent. If you just want reassurance, perhaps a doctor isn’t the best person to speak to?
I don’t expect that parenting lessons of any kind will become a legal requirement anytime soon, but we should do what we can to empower as many people as possible to confidently manage minor illnesses by themselves at home. Some of the replies to my tweet pointed out that there are already lots of resources available to provide to patients – and that’s fine – but the scale of the problem means that the onus shouldn’t be on individual GPs to do this sort of health promotion work.
Of course, all of this is only a concern in a publicly funded health service which must balance competing demands on limited resources. In a private system, these sorts of minor presentations would be welcomed with open arms as a very lucrative source of income.
Dr Paul Jepson is a portfolio GP in Manchester