This month, by way of a little variation, I am kicking off the column with a quiz. Would you:
1 Discharge a patient found to have liver metastases from an unknown primary, and a normal oesophago-gastro duodenoscopy/colonoscopy, back to his GP, because you only do gastroenterology?
2 Decide not to follow up a 23-year-old with a diagnosis of a TIA in your stroke clinic, on the basis that preliminary investigations in A&E proved negative?
3 Return a patient with a one-off BP of 160/90mmHg in the pre-op assessment clinic to the GP to ‘establish his fitness for surgery’?
4 Ask a patient’s GP to follow up a thyroid function test you’ve arranged and which you will forget to send him a copy of?
5 Fail to arrange anticoagulation follow-up for a patient warfarinised after an admission with atrial fibrillation, and instead bury something vague in the discharge letter, such as, ‘For follow-up in the anticoagulation clinic’?
6 Diagnose sleep apnoea in an inpatient via sleep studies and a specialist opinion, then, on the discharge note, ask the GP to refer the patient to the sleep clinic to see the very specialist who saw him in hospital?
The answers, obviously, are no, no, no, no, no and no. Which is precisely the sequence of words I use while repeatedly banging my head on the desk as I work my way through this catalogue of cock-ups.
I’ve stopped at six, not because I’m short of material but because I’m worried I won’t have enough column wordage left to convey how pissed off I am.
The common thread, of course, is secondary care. Or rather, secondary couldn’t-care-friggin’-less. Imagine this: that little collection of cases was, genuinely, this morning’s contribution. I could easily double that by close of play. So could my partners. So that’s 6 x 6 x 2 = 72 episodes of hospital f*ckwittery to manage each day in my practice. Per week, that’s 360. And as your practice is no different to mine in terms of the torture inflicted by its local centre of excrement, that’s 360 x 10,000 = 3.6 million discrete examples of dumb-assedness dumped weekly in our laps, and 3.6 million uses of words such as ‘GP to chase/follow up/sort’.
And I’ve only accounted for hospital dysfunction arising from written correspondence. There are also phonecalls, emails, requests via secretaries, messages via patients and so on. However it arrives, it inevitably comprises half-assed communication from hospital half-wits doing half a job. And it leaves patients up in the air and GPs in the crap.
It simply isn’t good enough. True, it isn’t new, surprising or easy to correct. But it is getting much, much worse – to the point that I spend as much time being an unfunded hospital lackey as I do being a GP.
I’ve tried writing to consultants and the CCG and I’ve tried the GP/hospital interface thing, but it’s as much use as a tissue in a tsunami. I’ve reached the point where I have a standard, ‘Would love to help but, actually, why don’t you get stuffed?’ letter. GP to sort? Sorted.
Dr Tony Copperfield is a GP in Essex. You follow him on Twitter @DocCopperfield