A patient upends a bag of medication on my desk to reveal penicillin, co-codamol and benzydamine spray.
Another patient later upends another bag of medication on my desk to reveal oral rehydration sachets, metoclopramide and loperamide.
Yet another patient even later upends yet another bag of medication on my desk to reveal an antihistamine, a nasal decongestant and ibuprofen.
The diagnoses are, respectively, viral pharyngitis, gastroenteritis and a cold. I know what you’re thinking. The common thread here is that each patient has just returned for a post-holiday-illness review, the clues being the tan and the hilarious foreign polypharmacy. Wrong, though they have recently been to a far-flung place – Planet Advanced Nurse Practitioner, which I’m realising really is a very alien environment.
We all know that continuity is Cheyne-Stoking its way to oblivion, especially for acute and sub-acute illness. But something else is dying on its feet, too – rational treatment of minor illness.
Welcome to the trenches, pharmacists. Bring some bags, will you?
Unlike the ANP approach, I was trained to manage the illness, not the symptoms. Minor, self-limiting ailments are just that, and, most of the time, require nothing more than reassurance (that it’s not meningitis, sepsis, necrotising fasciitis etc), explanation (of how to self-manage) and redirection (so we don’t waste each other’s time with this stuff in future, OK?).
That sore throat, gastroenteritis and a cold would have got precisely nothing from me, because that’s precisely what it needs. I’ve worked 30+ years convincing patients that I don’t have a pill for every ill; I certainly don’t have one for every symptom. The way not to manage minor illness is to inflate its importance and confuse its resolution by seeking-and-destroying each individual symptom with a pharmaceutical goody-bag, unless, that is, you’re trying to undermine the NHS by creating work and destroying the drugs budget.
And as GP workload and recruitment dictate that acute care is delegated further down the road, things are not going to get any better. Who worse to introduce to the frontline than health professionals whose very existence has traditionally depended on monetising symptoms? Welcome to the trenches, pharmacists. Bring some bags, will you?
Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield