Legend has it that once upon a time, a GP in South Devon got so frustrated with his patients that he stormed into the waiting room bellowing ‘If you’re not seriously ill, I want you to leave my surgery immediately!’
You can imagine the response in the present day. Smartphones would be seized. Teenagers would be weeping in the corner. The footage would go viral. All over the country, we’d hear horrified commentators lambasting the doctor’s insensitivity, like ‘How could he ask the poor, innocent patients to leave him alone?’
But, don’t we, in our heart of hearts, regularly share this doctor’s frustration? I’ve been a GP trainee for a few years now. Among many presentations of unwell patients, I regularly see a plethora of totally insignificant problems, that should never get anywhere near a doctor. I’d hazard a guess that on a given day, fewer than half of my patients will have a genuine medical need.
The others present with a range of minutiae, fairly implausible-sounding health anxieties, or social problems (which I’m ill-placed to help with).
Sorting through these patients, and establishing that they don’t actually need to see a doctor, is a tiring and complicated business, especially as amongst them will occasionally lie an unexpected cancer diagnosis, or a heart attack you didn’t see coming.
Recent examples include the patient who came in worried that her toenails were stained yellow after she removed her nail varnish, and another who asked if I could offer advice on hair dye to cover her greys.
A particular highlight was a 30-something-year-old man who asked if I would mind squeezing a spot on his back that he couldn’t reach. He didn’t know who else to ask… We all have examples of such consultations.
I fear I’ll find that little old lady dead in the corner
These stories might be amusing, if it wasn’t also true that many genuinely ill people now struggle to get a GP appointment.
Waiting times are so long in many places that patients are undoubtedly coming to harm, or inappropriately using A&E services.
I remember a day when, running behind in my surgery, I had a delightful older lady wander in, clutching her chest. She’d been quietly having a myocardial infarction in the waiting room, while I was busy dealing with a teenager who’d been having tantrums over his PlayStation. This isn’t a joke. Those who need our help are left suffering for our lack of action.
The founding principle of the NHS of being free at the point of access has been so abused that we desperately need to address the situation.
Too many now believe that the NHS is worthless – on hand to jump at their every whim. A very small fee, for taxpayers who could afford it, might go some way in encouraging people to think twice before consulting their doctor.
Perhaps this fee would be charged at both GP surgeries and A&E departments. It wouldn’t be the end of the world – we don’t view prescription charges as threatening Nye Bevan’s principles in founding the NHS.
Likewise, a small financial disincentive to working age adults might encourage them to appropriately value their GP’s time. If patients sought advice from a family member or read NHS Choices instead of booking an unnecessary GP appointment, we might regain the capacity to manage those patients who are in genuine need of medical care.
After all, free at the point of use is worthless if those who need the service can’t access it.
I genuinely fear that if someone doesn’t go into the waiting room and have a stern word with the patients, before long, I’ll find that little old lady dead in the corner.
Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West