Apparently, the proposed HS2 rail-link could lead to the RCGP being evicted from its new HQ. And that’s a sad thing. No, really, it is. OK, sure, we’ve all had fantasies about driving an express train straight through RCGP HQ, of course we have. But not now that Clare Gerada’s there, because she’s good, isn’t she? She’s not someone I’d want hit by a train.
Unlike the entire organisation that is NICE. The proposed indicators for QOF 2013/14 are out. I haven’t the time, inclination or energy to go through them all – they’re as mind-numbingly awful as you’d expect. But one really leapt out at me: ‘Diabetes 5, the percentage of male patients with diabetes with a record of being asked about erectile dysfunction in the preceding 15 months.’
Look, NICE people, enough is enough. I remember the time – when QOF was first born – that I thought it was quite a neat way of encouraging good, evidence-based medicine, and rewarding us for practising it. Now it has become a bloated monster that threatens to eat general practice, driven by those with pet obsessions or drums to bang who seem to have a very elastic view of the concept of time. As a result, my consultations are being deconstructed and prompted to the point that the reminder box that pops up when a diabetic patient walks in is now actually bigger than my computer screen.
The only way we’ve been able to cope thus far is by cheating. Do I really screen them for depression? Are you insane? Hang on, that’s the psychosis screening question. OK, no, I don’t. Yes, it’s just two questions. But it’s almost inevitably a consulting non-sequitur that I don’t need given that I have so much else to plough through, plus their presenting complaint, assuming I remember to address that. So long as I detect a flicker of a smile, or maybe a lip curl, then I’m happy that a) I’ve screened for depression and b) They’re not depressed. Box ticked. Take me to the GMC if you must, but it’s the only way to cope.
But I can’t do this face value shortcut for erectile dysfunction, not unless they walk in with a giveaway bulge in their pants. And, frankly, I simply don’t want to open up this Pandora’s boxer-shorts, just because some diabeto-evangelist has twigged that we’ve already asked our diabetics every other question under the sun. Life, and the consultation, is too short.
Dr Tony Copperfield is a GP in Essex
