Those of you who were teenagers in the 1980s will be familiar with the ‘Just Say No’ drugs campaign, hijacked from Nancy Reagan and the Republicans in the USA.
Maybe we should all be encouraging the RCGP and our leaders to rebrand this catchphrase in order to manage the relentless and unsustainable demands of our patients. There has been much lip service given to self-care but most of it is skirting around the edges, focussing on patient education rather than negative reinforcement of attendances.
Let us start with the most basic reinforcer of attendance; the prescription. Despite the massive publicity campaign to reduce our prescribing of antibiotics, I still see significant numbers of prescriptions justified on the basis of sputem colour or sticky eyes. But at least there is still an element of rationing of these as they are prescription-only medications. The enormous prescribing of cheap, over-the-counter medications, often with limited evidence base, is surely not what the NHS was set up for? Many GPs feel uncomfortable with dishing out bottles of Calpol, pholcodeine and enough emollients to survive the English Channel, but are too fearful of the NHS complaints system to behave any differently. It’s a lot easier to point to a policy than to stand up as a lone GP and explain to a patient why you are the only doctor who is not prescribing the Forceval they have received for the last 20 years.
Another issue is the medicalization of any manner of human emotion and processes – from exam stress to relationship breakdown and even TV appearances, all of which are legitimised by the obligatory GNFYD (Get a note from your doctor) We are more concerned about jeopardising the doctor-patient relationship than preserving our role and this results in us conceding to all these requests.
Finally, we have silently accepted the insidious shift in our role from family doctor to public health physician, which will no doubt worsen with the move of public health to local authorities. Obesity, smoking, vitamin D and most recently aspirin in pregnancy are just a few of the public health issues that need to be tackled on a population level rather than GPs continually attempting to add the rope and saddle to Buckaroo.
Our leaders should be furnishing us with the tools to improve our collectively low self-esteem and regain our self-respect and professionalism. Rather than trying to persuade us to federate, open 12/7 or tell us we are better off salaried, why are we not being encouraged to be more assertive so we can reclaim our agenda – both with patients and the government.
We need to remember our youth and…Just Say No.
Dr Shaba Nabi is a GP trainer in Bristol
