I know I’ve banged on about this before. But, really, if only for the sake of catharting some pent-up rage, I need to share this with you. This being yesterday’s star discharge letter about an elderly lady admitted with falls. What follows, I swear, is pretty much verbatim, redacted only to remove the linking narrative:
- Patient has unexplained hypocalcaemia, kindly refer for endocrine opinion.
- LFTs abnormal, kindly arrange hepatology follow-up.
- Patient has thyroid swelling, kindly arrange surgical opinion.
- Kindly refer to falls clinic.
- Arthritis causing difficulties with ADL, kindly contact OT for domiciliary assessment.
- Ongoing memory problems, kindly refer to local memory clinic.
- Lung nodules found on scan, kindly arrange repeat scan and refer if necessary.
The killer, of course, is that word ‘kindly’. There’s nothing like some mock humility as you smirkingly lob a grenade into the GP’s day. While this discharge letter is extreme, you and I know it’s not atypical. Given the context of the GP Forward View, the ‘GP to do’ fiasco has reached utter piss-take levels. And the recently reported fact that CCGs couldn’t give a toss really shouldn’t surprise anyone because, after all, why would they?
We either suck this up, accepting it as just another nail being slowly hammered in the coffin of general practice. Or we thwack it back from whence it came, using the BMA template letters. Problems is, sooner or later, this is going to result in a patient having something important overlooked or delayed. Now, I’m not known for being patient centred, but even I recognise this isn’t good. Besides, it’s not good for GPs, either, at least until we’re 100% clear where the medicolegal liability lies.
In the meantime, I suggest we have a competition to see if anyone can top my list of seven ‘GP to-do’s’. Prize is a holiday in a five star resort. Kindly arrange and fund yourself.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield