Some readers criticise this column for being doctor-centric. They claim I’m uncaring and act as though patients exist to provide me with an income rather than a vocation. Which is unfair. It’s no act.
But even my doctor-centredness draws the line at the ‘one problem per consultation’ rule many of you seem to favour – and strongly enough to put up a finger-wagging poster to that effect in your waiting rooms, too.
I think it’s unrealistic and unfair. It’s not that difficult dealing with multiple problems in one slot, and being able to spin plates without the consultation crashing is one of our USPs. Besides, illnesses often present as multiple problems. Under draconian ‘one problem per consultation’ legislation, a woman complaining of infertility, hirsutism, acne, amenorrhoea and obesity would have to make five different appointments before being diagnosed with PCOS – by which time she’s also developed the unfortunate complication of endometrial carcinoma. (‘And irregular bleeding, you say? You’ll need another appointment for that.’)
So that’s where I stand on the one problem per consultation controversy.
Okay, stood: I’m having a change of heart. I’ve just finished what is laughably known as ‘morning surgery’ – but what is, in reality, a parallel universe in which everyone has chronic pathology, which I’m meant to a) be interested in, and b) sort out. I spent three hours on recalls of patients with IHD, hypertension, asthma and COPD – each appointment prompted by the QOF, prescription reviews or some other misguided notion that requires us to see patients with chronic disease every year to remind them they’re ill.
This is what the typical surgery has become, and it’s as much fun as punching myself in the face every 10 minutes. In trying to improve the quality and quantity of patients’ lives, I’m ruining mine.
Worse, it generates work from thin air. Think about it – if you were an asthmatic with any kind of life, would you take time out of your schedule for the pleasure of blowing in a peak flow meter while your GP ticks a box? No. So you justify the hassle by making sure you deal with all those annoyances you wouldn’t otherwise have bothered the doctor with: your itchy bottom, tiredness and anything else you can think of to destroy your GP’s soul.
Maybe that’s what has prompted the ‘one problem per consultation’ clampdown. But, frankly, rather than scrap the average punter’s traditional right to ‘while I’m here…’, I’d rather scrap chronic disease management, which is the chief forum for them. With a bit of imagination – home blood pressure monitoring, an information leaflet stapled to an annual cholesterol blood form, a group lobotomy of those in charge of the QOF – the whole thing could be ditched.
For us GPs, it would generate spare appointments and the excitement that we might sometimes see people who are acutely sick rather than chronically ill. And for patients, it would free them from the manacles of their long-term disease. Not that I give a monkey’s about that, of course.
Dr Tony Copperfield is a GP in Essex
