Adrian Hamilton: I'd rather see my own doctor, please
If a GP won't take responsibility for you, who in the whole system will?
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Independent Minds
It has been six months since my doctor retired from the inner London surgery where I am registered. So I asked to whom I was being re-assigned. "I'm afraid we haven't got round to it yet, I think," he said, before adding: "Anyhow, we're rather moving away from that now."
Precisely so. Ministers cheerfully talk about choice and how the new front line of the health service is to be the doctor's surgery. The modernised NHS, they declare, is going to be a world of efficiency and immediacy, a land of super-surgeries, immediate appointments, rapid testing and consumer control.
What they don't say is that it is also becoming a world where no one is finally responsible for you, where the GP you see is no longer "your" doctor, but the one that is available, a processor of your symptoms by quick reference to your file on the screen.
That may suit some patients. When you are young it doesn't really matter who you see at the surgery: you've fallen off your bike, got kicked in a rugby match, gone down with a fever, feel pain in your stomach. Your past, your health profile, is not important. What you want is instant attention and a ready cure.
But once you start developing a history and once you start to get older, the value – indeed, the need – of seeing a doctor who knows your case increases by the visit. At the very least, it saves you having to go through once again all the details of your past record, the fact you had rheumatism as a child, or a miscarriage or the delicacies of mental problems. And, at best, it improves the chance of getting a diagnosis that takes into account your peculiar condition.
It is easy enough to see what the health bodies are up to. In a political climate obsessed with targets, the name of the game in the NHS is "outcomes". Conversations with a doctor have become dominated by talk of averages and statistics. Symptoms, pills and diagnosis are all reduced to a statistical norm of side-effects for this pill, normal readings for your age, the likelihood of symptoms arising from this condition or that. Numbers are what matter, not people, as much as to funnel them through the system in minimum time as to meet their individual need.
This suits not just the system but the doctors too. Leaving aside the question of whether the remuneration package for doctors has been over-generous (it probably has but envy is a corrosive emotion) the effect has been a noticeable tightening of doctor's hours. The more the doctor is paid for readily achievable outcomes, the less incentive there is to put in extra hours. That is particularly so where there are married couples in a practice – as in mine – where the partners can now organise their working hours to suit their parental needs. Even if you are assigned a doctor, an appointments system that prevents you booking slots more than a fortnight ahead makes it extremely difficult to arrange time for reviews.
It is fine for the providers. It might even help improve the outcome statistics. But it is not fine for the patients. The old doctor-patient relationship may have been cumbersome, inefficient in managerial terms. But it did answer to the needs of the patient in what, for many, is the most specific and personal part of their lives. If a doctor doesn't take responsibility for you, who in the whole system is responsible?
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Comments
The NHS now resemble a subdivision of the National Lottery.
Another part of Bliar's legacy.
its not all grim oop north!
They have a NHS walk-in centre staffed by nurses masquerading as doctors, who diagnose you with a computer programme, tell you there's nothing wrong and to take a painkiller and see your doctor after the weekend. By that time the condition which you had and which your doctor knows about has reared its head and you are bedridden for a week.
Big issue, very important, read here:
http://www.guardian.co.uk/politics/2
Beyond financial charades, corporate abuses, ministers expenses and many other issues that have become public knowledge in recent times,
"the people" are denied proper and open debate on our basic freedoms.
We must stop this.
The Executive Branch of Westminster must warrant the closest scrutiny and investigation on all of the events of recent times immediately.
Write to your MPs, form action groups, contact anyone that may assist in putting a stop to this crime against the people.
Oooh it may be good face to face at times but I think it is back to the hospitals at times
The cop dragged him unconscious into the garage, yanked his trousers down and committed what was described as ' an act of barbarity'.
The Gendarme appeared before a judge and was remanded in custody. He was said to be on suicide watch last night and faces 30 years behind bars.
His victim suffered what was described as ' irreparable damage'.
No I mean I agree to all I say .this story pooped in the net as was writing and trying to defend your doctor. The police come and the doctor has to look at the bottom not face to face here at least .shame is it not. It just doesn?t work at times I feel sad and bad but why do you say face to face?
http://www.thesun.co.uk/sol/homepage/ne
I thank you
Firozali A. Mulla
Thus it is now doubly urgent that patients become learned about their maladies, available treatments, prognosis (if you can get one), and risks and benefits. Take some responsibility. Your resource is now Dr. Google, plus a goodly measure of nous. Acquaint yourself with the science; learn about how studies work, what they can prove, and the empirical method. Read Ben Goldacre. Know your drugs.
Contrast Germany, where many doctors still perform house calls. The NHS has taken a wrong turn. Good practice, tested by time, has been abandoned in favour of soul-crushing, sausage factory outcomes. It's your health at stake. Work with the many good people in the NHS to improve your quality of life by being a grown-up and understanding how medicine works and its limits. Understand that many available treatments (that you're told about) are a quotient of what the bean counters will tolerate. Push harder. Don't be a credulous baby. Your doctor means the best for you, but they are now working under intolerable conditions. Work with them.
My guess is you live in one of these wealthy areas where GP provision seems to be somewhat better than elsewhere - I experienced this when I was fortunate enough for a short period of time to live in Henley upon Thames - an empty surgery mostly with grandmas popping in for a chat, so different to my rundown corner of reading full of sick poor people and screaming children.
To a system which cannot get worse any changes I hope will be for the better.
Losing personal lists is a bad one.
And not one pressed by the profession.
This is a result of a Government (and possibly a media) campaign to denegrate GPs and make them look greedy and uncaring. The ongoing 24 hour responsibility that we had which was one of the cornerstones of ongoing care was taken away from us as the Government thought we were not doing well. They have since realised we were doing it very efficiently, cheaply and professionally.
Unfortunatley, it is now too late and Adrian will probably never get such a relationship with one doctor again, unless he finds a private GP who is in his early 40s. Anyone older and the GP will retire (as I am going to) within the next 5 to 10 years. Anyone younger will not understand the point of the above article.
Dr Trefor Roscoe
I thank you
Firozali A.Mulla