It will come as no surprise to any of you that about half the prescriptions we write for sip feeds (you know, the chocolate and/or mushroom flavoured gloop that nursing homes feed to their residents to save money on their food bills) are considered to be ‘clinically unjustifiable’. So what? You could probably argue that if half the prescriptions we wrote did any good, it would give us an improbably good Number Needed To Treat hit rate of 2:1.
Anyway, word is that the ‘Number Needed to Nourish’ ratio has to improve and, you’ve guessed it, GPs are ideally placed yada yada yada.
Except that we’re not. One of the joys of being a middle-aged GP is revelling in the amount of crap I’ve been allowed to forget that I ever learned. You could put a loaded gun against my head and I wouldn’t be able to remember word one out of any textbook I ever read on the subject of anaesthetics, obstetrics, physiology and child psychiatry.
Better yet I didn’t even need to forget anything relating to nutrition because, like many if not most of you, I didn’t turn up to the two lectures I was supposed to attend on the subject. We have dieticians, they’re supposed to know all about dietician stuff. There is no learning need to be addressed.
Where I fit into the picture, right in the corner out by the frame, is to read faxes from the community dieticians, copy them out onto FP10s and sign them. As ‘Tracing and Colouring In’ are listed on my CV under ‘Hobbies and Interests’, I can do this all day without breaking sweat. Ignorance being the blissful thing that it is, it never occurs to me that half the prescriptions are for the wrong stuff or for the right stuff but for the wrong people.
I read. I copy. I sign. I move on.
But We Are The Masters Now, so I’m told. Why not – and here’s a novel concept – employ dieticians who know enough dietician stuff to send faxes asking for the right calorie supplements for the right patients first off?
Well, it’s like this…. the NHS is very very short of dieticians. I really want all my patients to get the nutritional support that they need, don’t get me wrong. I also want them to receive great dental care, enjoy the benefit of a first rate education and to be able to walk the streets safely at night. That doesn’t require or qualify me to act as a dietician, a dentist, a head teacher or a commissioner of police.
So either give the dieticians their own prescription pads and budgets, or teach them how to use mine properly. Don’t expect me to sit poring over my old medical school textbooks to compensate for their inadequacies. It might be hard to swallow but, choking aside, I’m busy enough as it is.