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The ten mistakes that consultants make – even the good ones

I’m sure that many of you would have read and enjoyed this two page spread in the Daily Mail devoted to the twelve mistakes that GPs make, even the good ones. Purely in the interests of balance and good journalism I offer this companion piece, ‘The Ten Mistakes that Consultants Make – even the good ones.’

  1. Stumbling mindlessly beyond their field of expertise
    He may be a great surgeon, she may be one of the country’s leading haematologists and they just can’t resist the temptation to stick their oar in where it’s not wanted. ‘By the way,’ they write, ‘I thought Mrs J. looked a bit fed up today so I gave her a prescription for Prozac. Be a good chap and carry on prescribing it.’
  2. The surgical one trick pony
    Joke – This bloke goes in to the hairdressers and says that he wants his hair cut like Robbie Williams. Before he has a chance to argue, the barber shaves his head. ‘Robbie Williams doesn’t have a haircut like this!!’ ‘He will if he comes in here…’ Most surgeons have their favourite procedures, the ones they’re good at. If a patient’s got a bunion, that’s the operation they’ll get, even if an alternative that the surgeon isn’t as familiar with, or as skilled at performing, might be a better choice.
  3. Blurring the lines between the NHS and the private sector
    ‘I saw this delightful lady in my private rooms today, could you refer her urgently in to my NHS clinic so I can arrange some further investigations that I’m afraid her budget won’t stretch to here at St. Matilda’s…’
  4. Blowing 93% of the NHS budget on 7% of the work…
    Without acknowledging that GPs do 93% of the work with 7% of the budget.
  5. Prescribing the newest drug in the book and dumping the cost onto the GP
    You can always spot these… a patient turns up with a hospital prescription for a newly licensed drug that’s almost certainly no better than the standard treatment and that hasn’t yet made it past the prescribing boffins on to the hospital’s formulary. It’s always a branded product, it always costs ten times the price of the usual stuff and you can easily visualise our white coated colleague trying the spell the generic name – that could win a game of Scrabble straight off – a couple of times, before giving up in frustration and copying the brand name off a nearby coffee mug.
  6. Ignoring their own guidelines
    Dr Bloggs sets out in no uncertain terms in her recent lecture that, for example, bath additives are the nearest thing Big Pharma has to Toilet Duck – a product expressly designed to go straight from the bottle to the sewer. However, she hasn’t passed the message on to her band of GPSIs, who continue to send every child they see home with three litres of watered down yellow soft paraffin that will do little except beautifully moisturise every rat between here and the Essex coast.
  7. Implying that GPs are stupid (and contributing to newspaper articles that perpetuate the myth… )
    Once upon a time, in a hospital not very far away, a patient of mine was receiving his fourth (count ‘em! ) opinion. He had been seen by me, referred urgently, seen by an SpR or similar, who asked his consultant what to do, who apparently didn’t know either. The patient eventually found his way in to an Ivory Tower by the Thames to meet Dr Big Bollocks, the country’s leading expert in diseases as rare as unicorns, who made the definitive diagnosis. And then told the patient that, honestly, the diagnosis was so obvious from the outset that he simply couldn’t understand how the GP missed it. Top Man, there, Top Man. By the time we GPs have filtered out the dross (remember the 93% thing… ) it’s no surprise that consultants see cases every month that some GPs will never encounter.
  8. Treating GPs as their unpaid junior staff
    We’ve all had this one… though to be fair it’s usually in a letter sent by the lower hospital orders. ‘Test ordered. GP to chase result…’ ‘I’ll tell you what pal, as you’re probably younger and fitter than I am, you can chase the bastard result.’ There’s an unwritten law in medicine, ‘He who orders the test gets the result and does the needful…’ There. I’ve just written it down.
  9. Making us sit through their sodding home movies
    I am not averse to continuing GP education. I have strong views about appraisals, but vis a vis education, I’m right on message. I’ll even toddle along to meetings where we let the CWBTs* drone on about the new ways they’ve devised to treat piles, if it makes them happy and scores me a brownie point. But why do they think I actually want to watch a fifteen minute video of them performing the procedure while I’m eating a lukewarm curry? I don’t make them sit through our registrars’ videotaped consultations, if only on humanitarian grounds.

    *CWBT = Chap Wearing Bow Tie. The ‘C’ may be redefined in line with my prevailing attitude toward them…

  10. Addressing out-patient letters to ‘The Practice’ and leaving my staff to redirect the mail to the appropriate recipient.
    Why do they continue to write to GPs who retired years ago? Is it simply that they can’t be arsed to read the name at the bottom of the referral letter? If I refer a patient for a second opinion I’d quite like to be told what that opinion was, person to person. I don’t want to find a letter in the patient’s file, addressed to ‘The Referring Doctor’ with the information I needed several weeks earlier. Spell my name wrong if you must, but at least make an effort.