New Year… a clean slate, a fresh start etcetera. Or not, if my first working day of 2012 is anything to go by.
Because it brings me the following three scenarios:
1. An elderly bloke whose opening gambit is to complain he still hasn’t heard anything about his cataracts, and that the salbutamol aerosol I had the audacity to prescribe in place of his previous shiny, sleek, turbo-charged version is: ‘Cheap rubbish – it’s all about money, isn’t it?’ Well, yes, it is. ‘Those inhalers are equally effective,’ I explain, ‘But your original version is four times as expensive. Making this switch saves the NHS cash.’
Enough cash, say, to get your cataracts sorted out. And who knows, with better vision, you might be able to see what a cantankerous old git you’re being.
2. A woman who’s returned for the results of her blood glucose test. I adopt my ‘Doctor breaks bad news, but may be able to save you,’ serious face to break the news.
‘I’m afraid the test confirms you have diabetes,’ I say, solemnly.
‘But that’s great,’ she replies. ‘Free prescriptions!’
Blimey. That sounds like irony, a rare commodity down Basildon way. But she’s deadly serious, and truly delighted.
Every cloud and all that. Who knows, depending on the state of her retinas, she might get a free dog, too.
3. A letter which makes me want to head-butt a wall. A few weeks ago, I saw a patient who’d suffered a couple of episodes of haematemesis. But, just to make life awkward, he’d waited a fortnight before letting me know.
I write a referral, like we used to, back in the day – when we used words and grammar rather than boxes and ticks – explaining that he didn’t fit the criteria for direct-access OGD, so could the gastropods see him, or scope him directly, whichever they’d prefer?
But the referral management centre bounced it, advising direct-access endoscopy, so I wrote to endoscopy and they bounced it, too, because I didn’t use the correct proforma, but I couldn’t because it’s a prerequisite that he has dyspepsia, which he hasn’t, and... oh, bollocks, the patient’s just bled to death.
It’s dark, now. That may be because it’s late, or it could be because I’ve gone round in so many circles that I’ve disappeared up my own arse.
That’s the first day of the new year. A grumpy bloke who can’t see reason, a woman who can’t see how bizarre her response is and a GP who can’t see a way forward.
Oddly, I find all this reassuring. Coping with disgruntlement, dysfunction and despair is what we GPs do so well.
It proves that, while it’s indisputably 2012, normal service has been resumed, and it’s a service only you and I can provide effectively and efficiently. I’d suggest we make the most of it, though.
After all, come 2013, things are going to look very different.
Then, as well as the usual blood, sweat and tears, we can also anticipate commissioning, revalidation, CQC registration and any other bright ideas the great, the good and the frankly ga-ga come up with.
Which means that, on 1 January 2013, I’m not sure I’ll want to see the way ahead – because it’ll be a vision of hell.
Dr Tony Copperfield is a GP in Essex
