As a medical SHO in the 80s, life was hectic. I felt I needed to know about every disease and every drug and GPs knew nothing. When patients were admitted, we stopped half the drugs the GPs prescribed. Patients got better, went home, job done. Polypharmacy, that was usually the problem.
Then I became a GP and life changed. Days became manageable. I was less tired. Patients became people and I realised how little real medicine I actually knew.
The tablets the hospital doctors stopped got started again. Why? Because people were taking them for a reason. Symptoms recurred when life returned to normal. Ankles swelled when they weren’t spending all day in bed with their feet up.
Thirty years later my days are long again and I am tired. Hospital doctors are all specialists focused on one organ or symptom and aren’t allowed to follow people up in clinic. I am juggling patients with multiple severe problems and need to know more about greater numbers of diseases and drugs than ever before. I am also battling nationalised polypharmacy. Each specialist adds something new but stops nothing. ’Why is this person with end stage cancer/heart/lung/liver disease on primary prevention therapy?’ is almost a weekly question. Common sense has evaporated in the face of guidance-driven flow charts.
Making patient-centred decisions is the ideal, but not encouraged by said flow charts. Most of them leave out the question: ‘What does the patient want?’ Exploring patient wants and expectations and helping them to make informed decisions about their care takes time which is not exactly funded and certainly not measured. Nor does it always have the preferred medical outcome, which can seriously dent practice income.
Like an increasing number of GPs, I am a locum now, by choice. I have eschewed counting and measuring to spend the few years I have left talking and listening. Patients like that and, against the national trend, I haven’t had a complaint in over fifteen years.
A middle-aged man recently told another doctor he would see me about exactly why he needed to restart his antidepressants. When he did, I picked up my coffee, (the one the CQC is so down on), sat back in my chair and we talked solidly for twenty minutes. We didn’t solve his problem, but we shared it. I think he left with some hope for the future, something positive to think about anyway. It may have saved a referral to psychological therapies. Time will tell.
There is no clinical measure for that. The consultation will not show up in performance data, other than it left me running late. Again.
Nor will there will be a practice payment. But for him I like to think it was a priceless moment.
For the practice and the NHS, however, no extra charge.
Dr Sue Martin is a GP in Edinburgh
Letters to the PM: Pulse’s writing competition
- 1st place – Dr Samuel Finnikin: When you are dying, I hope you can rely on the NHS
- 2nd place – Dr Dominic Hennessy: I love my job but it’s making me sick
- 3rd place – Dr Mabel Aghadiuno: Going beyond the call of duty
- 4th place – Dr Nishma Manek: We help shape lives
- 5th place – Dr Antonio Manno: Two lives overlapping
- Under 35s winner – Let’s make general practice great again
- Read all the other entries