Doctors: Diagnosis By Phone

[jollybaby]

Not sure about this idea. Am a doctor (but not a GP) and have to take phone calls from patients when on call. I find it a nightmare to assess them over the phone and more often than not direct them to somewhere they can be seen. You can also spend 10 minutes on the phone to gather the same information that you'll get in 10 seconds face to face - ie is this patient sick or not. But then again GPs deal with a totally different range of problems to me and maybe this is more workable in their practice.

[jollybaby]

Ultraconsultancy Wrote:

-------------------------------------------------------

> I was always told that trainee doctors learn four

> diagnoses;

>

> 1. There's a lot of it about

> 2. Leave it alone , it'll go away

> 3. Take two of these

> 4. I'm going to send you to see a colleague of

> mine

>

> I ran this past a chum recently, who happens to be

> a consultant dermatologist. Oh no he said, the

> fifth diagnosis is by far the most useful.

>

> 5. Sit back, put fingers in pyramid, "there's

> really nothing I can do for you..."

For hospital doctors there's a 6th option too. 'Not sure what it is but if it hasn't settled in a couple of weeks I'd see your GP about it' (if you can get an appointment that is!)

[LostThePlot]

Well, a clinical nurse called me back, and booked in tomorrow for ECG and then blood tests and possible X-Ray for knackered ankle. Yes, it was prompt, and yes i will be seen, but still can't help thinking this is not a step in the right direction to be honest.

[????]

The NHS is largely a fucking joke nowadays - based on its employers' needs (especially GPs and 'the odious management consultants involved) rather than any sort of patient service. And it's not like its 'free'to taxpayers, it costs us a fortune. It's a sacred cow - and the politicians are afraid to tackle its huge problems.I resent having to go private (sadly no longer on principle but as a taxpayer) but if my family needs it I'm paying

[Marmora Man]

???? Wrote:

-------------------------------------------------------

> The NHS is largely a @#$%& joke nowadays - based

> on its employers' needs (especially GPs and 'the

> odious management consultants involved) rather

> than any sort of patient service. And it's not

> like its 'free'to taxpayers, it costs us a

> fortune. It's a sacred cow - and the politicians

> are afraid to tackle its huge problems.I resent

> having to go private (sadly no longer on principle

> but as a taxpayer) but if my family needs it I'm

> paying

Agree, agree agree.

The NHS could be run for 70% (quite probably less) of current cost at 100% improved effectiveness if it were managed properly.

For info - last time I tried to use NHS GP for an urgent problem with eldest son(on a Sunday evening)I ended up going private - The private GP cost about ?70.00 and was with me, at home, within 40 minutes.

A GP friend once proposed charging 100 families ?1,000 a year for a 24/7 GP service with guaranteed home visits and support. It's a model I could see working well if the cost to an individual could be tax deductible.

[SeanMacGabhann]

Can we have some more of our NHS employees input on this one?

Not sure how your GP friend's suggestion would work in reality MM. How can they guarantee those home visits and 24/7 report - unless they know those 100 families are generally healthy anyway. What if 50 of them were badly injured in a coach crash (extreme example maybe but you can extrapolate your own scenarios)?

It's still a case of limited resources dealing with an unknowable amount of demand

I'm not arguing that the NHS is perfect or unimprovable - far from it. But as an aspiration "free at point of service to all" is both achievable and behoves us

No-one has ever argued it's "free" - I've been paying tax and NI for 21 years and have barely ever used it - so someone else has got all my money! Good luck to them... maybe they needed it more than me (and that applies just as much when I earned ?3000 a year as it does now)

[annaj]

Can we have some more of our NHS employees input on this one?

That would include me, I suppose.

The subject telephone consultations in primary care is quite complex and impacts very directly on my workload as a front line hospital doctor. So, I do have opnions on it, but there are a couple of reasons I haven't got involved in this one.

This thread has a slight anti-doctor feel that I really don't have the energy to get into and I'm definitely not up to locking horns with ???? over the NHS.

More importantly, I just don't have time this morning. My working day started just before 8am with a debrief with one of the junior doctors about problems during the night shift. I've now got a teching session to write and present for the juniors and a huge backlog of audit data to enter before my 10 hour clinical shift starts at 1pm.

It's an easy life here in the NHS.

Sorry if this sounds a little jaded, but I am this morning.

[Brendan]

Anna please don?t take this personally it is not meant as an attack on doctors, but as someone who has had direct experience of another medical system as well as the NHS I can honestly say that the quality of care received from GPs on the NHS is piss poor. I have luckily never had to visit an NHS hospital so I cannot comment on that. GPs however don?t seem to be able or willing to diagnose or treat anything. I don?t know whether this is down to inability, administrative constraints or institutionalised jadedness but as a patient you are almost forced to go private in many circumstances.

I use private health care, even though I can barely afford it, because it is often the only way of getting decent treatment. This irks me because in principle I think all private health care should be illegal as a country like Britain should be able to deliver the best care possible through a national health system funded by proportionate taxation.

I am not saying that NHS staff are not dedicated and don?t work hard. I am friends with a number of nurses and midwives who are very dedicated. The problem is that the service the public should be getting is not being delivered. I think this is an issue that NHS staff should be just as upset about as the rest of us.

[Ladygooner]

LostThePlot Wrote:

-------------------------------------------------------

> Well, a clinical nurse called me back, and booked

> in tomorrow for ECG and then blood tests and

> possible X-Ray for knackered ankle. Yes, it was

> prompt, and yes i will be seen, but still can't

> help thinking this is not a step in the right

> direction to be honest.

Well thats good I suppose but I think it would have been nicer to speak to someone face to face to allay your worries.

[SeanMacGabhann]

on the subject - and please don't anyone get defensive - I know that people do have ailments and need treatment. I'm not calling anyone specifically a hypochondriac

But have I been lucky? Apart from a couple of accidents when I was younger involving appendages I have never needed to go to a doctor. I often get cold-type symptoms, sometimes migraines and a few times some eye infections - but all I ever do is take myself off to bed for a few days until I feel better

Approaching 40 I thought that I should at least see if there was anything deeper and registered on Crystal palace Rd and had a check up - which went fine and everyone I dealt with was great

But I got the impression that as well as the sick and needy there was a lot of... people who didn't need to be there. That could be just tucked up in bed. But they LIKE spending time and resources down at the clinic. And if the NHS took a different line with them that would free up plenty more resources for the genuinely needy

[Brendan]

I am anything but a hypochondriac and I have gone to the GP with a real compliant, being in constant pain to a point where I couldn?t do my job, and then been faced with a blank-faced, grunting, GP who pushes a button on their computer and then stares at you with a ?and so what should I do about it? expression.

The service the NHS offer is inadequate, simple as that. As the people who pay for it we have every right to say so. In fact I would say that we have a duty to say so.

[Cassius]

Sean - I get what you are saying, but for every person who is at the clinic who does not need to be, there will be someone who does need to be and who could be put off by this telephone system. What about people who can only talk on the phone at times of their choice (ie if you work in a call centre or if you drive for a living)? What about people who clam up on the phone? Surely the NHS which is paid for by us all should be available to us all.

[spadetownboy]

personally i dont see what the problem as by ltp,s admission ,they have had some "fainting of late". that suggests to me that its not the first time it has happened and reading between the lines ltp appears to have held off seeking treatment and advice until it has suited them and then when they are unable to be seen and dealt with pronto suddenly its a big problem, and if thats not the case then i certainly apologise.

however,im an ex a&e nurse and manys the day i spent on my triage desk dealing with similar scenarios, persons presenting with various ailments and injuries which have been going on for various periods of time and when they eventually get off their backsides to see someone about it and are told or made to wait for assessment/treatment its a big issue for them. imho the telephone consultation is by far the appropriate way to approach these situations its otherwise known as clinical assessment and prioritisation, and more or less sorts the wheat from the chaff. i suspect that if ltp had sought advice/treatment the first time it had happened they would have been dealt with very promptly.

[missd]

i'm sorry spadetwown boy but i am a little lost. why would it have been dealt with "very promptly" then and not now??

[SeanMacGabhann]

hmmmm - seems that despite me saying I know that people have ailment and Im not accusing anyone here of not needing treatment, people appear to be getting defensive

I'm not even hinting that Brendan or LostThePlot don't need treatment - mine was a more general question on overall volume of people hitting the NHS. I agree with Cassius completely that "Surely the NHS which is paid for by us all should be available to us all."

Brendan's point about the NHS being inadequate I can't really say - I just haven't had enough exposure to it myself. But I do listen to other's experience and I have heard many people echo Brendan's point. I have also heard many people say how wonderfully they were treated. I believe both sides to be true

To take the grumpy (doctor?) in Brendan's example - I can imagine dealing with a huuuge workload, many of them possibly time-wasters and when Brendan walks in, his view of humanity is less than jaunty. Does that make him/her a bad doctor? A person in the wrong job? And under-resourced doctor? A doctor who just needs a holiday? Or is it more fundamentally a flawed system?

If the doctor in question had half the workload and was in better shape to treat Brendan with more care and attention, would it matter if it was private or NHS?

If the NHS is offering an inadequate service then what are people's suggestions? Comparing it with private health doesn't really work because no private company could or would want to offer the same global service. I get offered private cover through work but I always tick the box that says "no" - I still retain belief in the NHS

So whereas I would retain the concept but change the way it's run (how? I haven't the answer but I can see internal markets et al not being part ofthe solotion) some people fundamentally disagree with even the concept - so perhaps people should state that off the bat to avoid cross-purposes in any argument?

Oh - and I wish LtP and anyone else who is unwell a quick recovery

[spadetownboy]

because its not natural for people,esp young fit people(which i assume ltp is) to suddenly faint for no particular reason and it could be caused by any number of things eg, cardiac,neurological issues,and i would expect that if someone fainted and sought immediate treatment then they would get it. however if as i assume in ltp,s case it has happened previously, then yes while it may be indicitive of something going on, it is not an immediate problem, it needs to be looked in to, to try an establish a cause,but its not an emergency situation at that time, therefore tests would be arranged but they dont need to be immediate,and judging from ltp,s response this appears to be the case. i would also strongly suspect that ltp would have been advised that if a similar episode occurred again prior to attending for the test then they should either contact the surgery or attend a&e immediately.

[Brendan]

I wasn?t getting defensive Sean just pointing out that even when you have a very clearly identifiable problem there is an inability/unwillingness on the part of GPs to do anything about it. It has happened to me a few times. You have to actually fight the NHS for treatment. They seem to put as much as possible in the way of you getting treatment as they possibly can.

I also don?t see why just because it is a public service there should be any excuse for it not delivering anything other than the best care possible.

[SeanMacGabhann]

I pretty much agree Brendan, but itis a public service like no other. I can't think of anything else that has the same scale, criticality, unpredictable demand

What has changed is that "in the modern world" successive governments have tried to scale it back - ok huge amounts of money have gone into the pot marked "NHS" but a lot of that has gone to consultants to look at "modernising" it - which means scale it back and get it to the stage where it is no longer a universal public service. If that means effectively breaking it and thus turn public opinion against it then I doubt any government would be duly upset

But it should retain it's original goals - and if the world has changed since then (transient populations, medicines, whatever else) the fact remains: if a country broke after 2 world wars can implement something onthis scale then modern, more prosperous Britain can certainly, with the will, have a decent service in the 21st century. But I'm not convinced the will is there

[Brendan]

And as the tax burden gets larger the delivery of public services gets worse.

So where the fuck is all our money going?

[ratty]

Have to say that the GPs at Melbourne Grove have never struck me as being disinterested, in fact I am extremely impressed by them!

As to people being in the surgery when not ill, well, there could be a thousand reasons for this - some of them stipulated by bullying employers who demand staff get sicknotes for every day they are ill. If these can de dealt with over the phone then excellent!!!

[SeanMacGabhann]

when you say the tax burden gets larger - based on what and compared to what?

although rising in the UK it remains lower than most European countries. I disagree with the 10p band abolition but generally I have always thought the UK to be pretty cheap (tax-wise) compared with other countries

I haven't (amazingly!) got the time to go and source the data now so I'm open to being corrected on this of course. But

[david_carnell]

As an aside can I recommend the following website for anyone wishing to learn more about a GP's lot in life:

NHS Blog Doctor

Edit: There's even one about the Forum!

Read the day to day stuff from the link posted or go to the homepage for a more varied content. I think GPs get given pretty short shrift from Joe Public in general and media-quoted salaries are often highly optimistic for all but the very few.

I can't think of a bad experience I've had with a GP either in ED or where I used to live in Surrey. With the right system in place you could nearly always get a same day booking for urgent appointments and I was always treated professionally. Even the giant medical practise in Leeds Uni was successful. Oh, and I've also been twice to the drop-in centre in Victoria due to work commitments and was pretty impressed there too.

A&E Depts at night on the other hand........

[bignumber5]

Can we have some more of our NHS employees input on this one?

Honestly, my humble opinion: the NHS is on its arse. Budget buggered, patients dissatisfied, staff getting increasingly frustrated but unable to affect any significant change due to budget buggered, population expanding, SICK population expanding due to medical advances (save a life in a heart attack situation with clever new medicine, 30 years more life with high blood pressure, cholesterol, angina, associated congestive heart failure etc... costs costs costs...). buggered. If the NHS were a business, it'd have been shut down years ago. And it is a business, attempting to provide a specific service on a specific budget.

Phone consultations and extended nursing roles are all short-term measures to cope with the enormous strain that services are under. And that's great, until someone phones their gp or sees an inexperienced nurse pratitioner with a non-descript feeling that sounds a lot like indigestion and dies of a heart attack later that day at home, with a bottle of gaviscon for comfort.

The cash injection over recent years looks like a lot of money but is nowhere near sufficient - an audit a few years back determined that to run just the diabetic services to an optimal level would cost more than the entire nhs budget. I see the cash injection as the swan song of the nhs, so that in a few years, when arguing for the scrapping of it, whichever political party has the stones to make the case will be able to point out that even the financial investments of 2006-8 did nothing. Whichever party that is will be making a true act of martyrdom: they'll lose power for doing it, but revolutionise the healthcare of a nation.

What mamoraman alludes to in an earlier post, a GP being able to provide a round the clock service of top-notch care if they were well funded on a per patient, by-the-patient basis is, I suspect, the future of UK healthcare. Shame, but pretty much inevitable, I reckon.

[Brendan]

That sounds like a very similar view to other people I know who work for them.

[bignumber5]

The sad thing is that I truely believe in a free-at-the-point-of-contact health service, I just can't see a way of making it work for much longer without either a lot more money or a lot less service use.

That's the saddest thing, really: I've never been in anything other than front line health care, never been in management and never want to, and I still end up talking about funding, because that's what it all boils down to. How disillusioning.

And just to stop this getting lounged, ED ED ED ;-)