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How to solve a problem like acopia?



I am baffled, which doesn’t happen often. I have had a great surgery this morning. A brilliant mix of good old general practice (plantar fasciitis and scabies), red flags (haemoptysis) and mystery (isolated night sweats, no other symptoms). I’ve done some good; I’ve listened and educated. I might even have got ideas, concerns and expectations in there somewhere. 

This is what I signed up for.

The money should be spent on educating everyone from new mums to pensioners about self-care and red flags

What I didn’t sign up for is the next patient. ‘I’m struggling with this cough. I can’t sleep. It’s not shifting so I thought I should come in.’

‘Have you tried anything?’ I ask.

‘Yes, I took some paracetamol last night.’ Good, I think. Has tried paracetamol; something sensible.

‘And you said it’s not shifting. How long have you had it for now?’

‘Since last night. About 10pm.’

Stony silence. It is currently 10.30am.

‘So, you were fine yesterday (yes), you went to bed (yes), started coughing (yes), took some paracetamol (yes) and less than 12 hours later rang for an urgent GP appointment (yes)’?

The problem is, this patient genuinely thinks having a cough for 12 hours requires an urgent appointment. They also were not too happy to be told that I wasn’t going to prescribe any antibiotics.

And, despite myself, I can see why they might be confused. All the packets of paracetamol and cold remedies say ‘do not use for more than three days without consulting your doctor’. All the adverts say ‘Cough? It could be cancer!!’

The rub is that I can’t tackle this in 10 minutes. I can’t address a myriad of mixed messages and confused illness behaviour. So, off goes the patient, grumbling that I am a rubbish doctor.

While this is an extreme example, it’s a recurring theme. Last week I saw a whole surgery of URTIs. All of them genuinely thought they ‘needed checking’. I don’t begrudge them the consultation, because very few are wilfully misusing the service. But equally I could have spent an extra 10 minutes with the suicidal patient, or on the admission of a patient with septic arthritis.

If all these patients disappeared, UK general practice would be a different place. We seem to be treating the symptom of busy GPs by adding new clinical staff, but missing the point that the money should be spent on educating everyone from new mums to pensioners about self-care and red flags. It’s not about getting nurses to see them, or physician associates.

The whole point is, NO ONE should be seeing you if you’ve had a cough for 12 hours. If the Department of Health spent less time fighting junior doctors and more time looking at the whole issue, instead of throwing daft initiatives at small bits of it, we might salvage primary care.

Here’s a bright idea. Maybe getting public health to actually help with the health of the public might solve a whole lot more than an outbreak of Salmonella.

I think the best solution is a regular winter sabbatical. Somewhere I can relax. I’ll come back in time for hay fever season.

Dr Zoe Norris is a GP in Hull