Tuesday, April 15, 2008

Moan grone droan....

Soul searching is a wretched occupation to be sure, and yet sadly there are times when it becomes unavoidable. For me the past few months have been just such a time, and the truth is I'm far from happy with the conclusions I am reluctantly drawn to make.

You see folks, before you stands a creature as obsolete as the diplodocus, the marsupial lion, the dodo. It appears the job I spent almost half my life training for, and the remainder practicing, is no longer relevant. Family Practice, at least the sort of practice I understood as such, is dead.

The thing that hurts most about this is the knowledge that I and my colleagues have been at least complicit in, if not active proponents of its demise. Never has it been more true that good intentions make for the poorest choice of paving. It matters little how we got here, except perhaps to historians who in years to come may pore over the all too brief social experiment that was the post war Labour administration's establishment of the welfare and national health systems that now lie in tatters. It's what we do next that really matters. So for what it's worth, and for as long as I am able, I shall continue to ply my trade the best way I know how to any who wish to avail themselves of my services.

But with an uncaring, pettyfogging, beureaucratic civil service under a runaway political class on the one side, and an increasingly litigious, narcissistic, solipsistic populace on the other, I'm starting to feel more than a little like Han Solo in a trash compactor.

And the walls keep on closing in.


Jobbing Doctor said...

Dear Dr Jest,

Your latest post is far from jestful. I read and reconise all of what you say: indeed some of this is in my blog that you might care to glance at.

I blow hot and cold about the future. Like you I have spent my entire adult career in the service of others, and it makes me weep to see what the Tories and New Labour have done, with their attacks dogs in the media (who should be ashamed of themselves). We are being dragged down like a stag by a bunch of hyenas.

But what matters is the day to day support of my patients who are lovely. They keep me going.

The Jobbing Doctor

Anonymous said...

My doctor's practice have dedicated a full notice board to informing patients of the recent changes and asking them to lobby the local MP. My GP was delighted when I provided him with a copy of the response received (whether you can put much faith in the words is, of course, another matter)

If huge numbers of patients lobby MPs (essentially saying "We get good service, so lay off GPs") then the message MAY eventually get through.


Elaine said...

As a patient with a GP practice, I would be horrified and terrified if this service were to be withdrawn in favour of so-called drop-in clinics. No doubt the latter could have their place with young-ish people wanting, say, an antibiotic for a cold.

I do hope that quacktitioners would be taught about the perils of over-prescribiing.

Good to see you back, Dr Jest.

orchidea said...

I don't know what to say, Dr J. As you know, I'm far away and not influenced by the policies you mention. I am very sceptical about the efficacy and wisdom of so-called drop-in clinics for all but the most trivial or immediate medical needs, because the doctor/patient relationship is of crucial importance in healthcare. One example: the country I live in has one of the lowest teen pregnancy rates in the developed world (on a par with Holland, behind Japan). This isn't because Swiss teens are less sexually active, but rather because the majority of Swiss women have a longstanding relationship with their personal gynaecologist and take their daughters along too when they reach a certain age. I know women who are prepared to travel over an hour to visit their gynae, and I feel lucky to live in a country that awards its citizens the freedom to choose which doctor they wish to consult, from the GP to the specialist. This is important - it shouldn't be a luxury reserved for the monied few.

I hope I'm not sounding trite, but I am sure you make and will continue to make a huge difference to many people's lives. Please try not to become too discouraged.

o xxx


Doctor Jest said...

jobbing doctor-- welcome. As you rightly say, it's the punters we are here for and they absolutely make the job worthwhile. I'm just very sad that it looks as though we shan't be free to continue to practice it as we would wish for very much longer. Still perhaps when Mr Branson is in charge we can all get staff discounts on flights and CDs.... (the round shiny spinny things that is, not the vials in the double locked cupboard). And I'm massively impressed by the blog BTW. Very John Crippinesque.

NC-- thanks for your support I'm sure your GP is very appreciative as we all our of our patients efforts on our behalf. The sad thing is I really get the impression nobody in the corridors of power gives a monkey's. I know for a fact that ministers have been briefed to ignore anything we send them.

elaine-- thank you too for your support. It's not so much that the service will be withdrawn, more that it will become progressively uneconomic to run in the way we all have for so long. Good news for the holders of the public purse, so long as the rise of the quacktitioners doesnt blow the budget on the massive increase in cost of diagnostics and referrals, (yeah, right), but very bad news for old fashioned corner shop GPs. Still, as of tomorrow I'm another whole year closer to my pension....

orchidea-- merci vilmal.after a bit of a re-read I can't help thinking I need to "get over myself" as our transatlantic cousins might have it. GP land has been under threat from our political paymasters repeatedly this past umpteen years, it's just that this time it seems to be a whole lot nastier, and it really feels like our masters have been sold on the idea of US style HMOs and attach no value at all to family practice. Still as the good Jobbing Doctor has pointed out, it's the patients we all do this for, not the suits, so perhaps the best thing really is just to get on with the job.

Thanks also for the brief insight into the mores of Swiss teens. I had always assumed it was Lutheran propriety that kept them pure and chaste. I stand corrected ;-)

Nutty said...

I don't' want to be treated by whoever's on duty in a polyclinic; I want to be treated by my usual GP. He has known me for many years and in particular is used to my erratic prescription requests. He knows that I like to keep about a month in hand, but sometimes leave it until the last minute to reorder, so that I ask for two prescriptions one shortly after another. I doubt if a doctor who didn't know me would agree to this without a time-consuming appointment to explain it all.

I know of fellow mental health service users who are disengaging from the mental health services because (a) reorganisations mean that they cannot remain with the psychiatrist they know and trust or (b) they see a new junior doctor every time they go. It will be the same with polyclinics. Wait for the redtops to find out how many mentally ill people disengage because they can't see a GP they know and trust.