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Merging into the detritus



I don’t mean to be unkind about the fine people of the Thames estuary – after all, my two children are Essex boys (sorry chaps). But the truth is this. There are still times when, after a home visit – having beaten off patients seeking antibiotics and dogs seeking a chunk of my buttock, negotiated my way round empty pizza boxes and desiccated lumps of organic canine matter, and finally peeled my feet from the carpet to escape into the cool, fresh air outside – I have an overwhelming urge to take a shower and irradiate my clothes.

I know it sounds snobbish, but I just don’t see the attraction of living in a landfill site. How does that happen, then? Presumably, if you live among squalor long enough, there comes a time when you merge into the detritus and stop noticing.

And that’s exactly what’s happening to our profession. This occurred to me recently, when I attended a lecture about the new QOF depression requirements – specifically, the (takes deep breath) biopsychosocial assessment, known to its mates as DEP001.

This is fleshed out with an 11-step consultation plan, which includes current symptoms, relationships, support, employment, alcohol, suicidal ideas and treatment options. Sound familiar? Of course it does. It’s what any half decent, self-respecting doctor does already.

The end-of-lecture debate centred on how we should record this assessment. To me, the answer’s obvious. Write up the consultation in the normal way, highlighting the important areas – just as we do now – tick the DEP001 box and win a banana. But the audience was filled with a collective probity neurosis. Would this satisfy the QOF SWAT teams? Shouldn’t we record the consultation in the QOF 11-bullet-pointed way, perhaps using a proforma to prompt us and act as the requisite ‘proof’?

That’s when I had my epiphany, my breath of cool, fresh air. Not only are the forces of QOF, DES et al invading the sanctity of the consultation and defining what we do. Now they are dictating how we do it and even how we write up our notes.

How much further might this insane and insulting deconstruction go?  A TATT001 QOF criterion in which I’m obliged to record that the patient is tired all the time, is not depressed, diabetic, anaemic, hypothyroid, sleep apnoeic or alcoholic, is stressed with poor sleep hygiene, doesn’t take enough exercise, wrongly believes himself to have CFS and is clutching an ominous bundle of internet printouts and, yes, views me as beneath contempt because I can’t/won’t prescribe a tonic/write a sick note? Which, pre-tick box era, I’d have recorded as TATT, usual bollocks, advice.

We debate these things as though they actually merit discussion. But they don’t; they’re demeaning, demoralising and dehumanising. How have we sunk so low? The answer is that we’re having so much crap forced on us that we’re now used to living in it. We’re not noticing the squalor of our de-professionalised surroundings. And if The Only Way Is Essex, I’m getting out.

Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com and follow him on Twitter @DocCopperfield.