Thursday, October 01, 2009

"This is the end.....

.... beautiful friend."

It's dark. Insects chirrup in the underbrush. Muffled explosions, miles off, punctuate their fretful murmurings. The night belongs to Charley.

Somewhere a jangling guitar picks out a sparse twanging tune, a handful of notes at a time. Drum and organ whisper underneath a plaintive vocal that speaks of loss, despair and dark dark urges.

Yes, beautiful friends, we are in a far from happy place, and the sense of foreboding if anything is building out here in the boonies. And I know I'm flogging the metaphor to death here, but I can't help it. Somehow Jim just speaks to me right now.

Anyhow, now that I've got your attention, I'm not really talking about a war a generation ago and half a planet away. I'm bemoaning my plight here in Ambridge as usual.

And why?

Permit me to explain.

Exhibit A; A policy statement from a health minister, repeated I believe at party conference that patients will be free to register with a GP anywhere they damn well please and bu**er the geography. Now much as I would welcome the chance to care for patients of all origins and ethnicities, registering patients domiciled on Orkney would seem a bit stupid. Yes I know busy commuters and politicians have a hard time of it prioritizing their health above their oh so important trough snouting... er, working activities, but freedom to register anywhere, I mean really have they no common sense? Anyone who has any experience of front line primary care will tell you this notion is a junkies charter. Any addict has just been told he/she is free to roam the country at will registering here, there and everywhere, and demanding that all important codeine / methadone / valium script. Even if they only manage a week's worth everywhere they register, in just one day on an average inner city bus route, they should be able to score enough gear for a month of Sundays. Bloody brilliant. Sorted! (Or so I believe the vernacular has it).

Exhibit B; Choose and Book. An IT based appointment booking system that will allow a patient to book their own appointment with a specialist they choose at a time and in a hospital of their choice. Sounds fantastic. And when it works, is fantastic. When it works. But how do you know which specialist to choose. Or which hospital to go to. If only there was somebody you could ask...

Exhibit C; Two Week Wait. Patients suspected of having a cancer diagnosis should have to wait no more than two weeks to see a specialist. Quite right too. And again, to be fair, when it works it works well. But witness a call I had today. Two days ago I made such a referral, on the same day I saw the patient concerned. Today the "Two Week Wait" clerk is on the phone declining to accept my referral. They've offered the patient an appointment but she's going to be away for a week starting 13 days from now and won't be able to take it, so please would I not refer her until she's back, in three weeks time. Only the cancer czar has told them they've got to book the appointment within 14 days and they can't..... "Now just supposing I do this, and then in three weeks when I am permitted to re-refer, you still can't give her a slot inside 14 days, what would happen?" I ask politely. "Well then we'd have to refuse your referral again." So no, sorry I'm not taking my referral back, it needs sorting.

Believe it or not there are plenty more exhibits. And that's before Gordon, or Dave, or even (should pigs take wing) Nick start wielding the axe we all know is coming.

If I'm sounding a tad cynical today I apologize, but that last little circus act has really got to me and reading the runes things are looking pretty bleak.

Still, maybe they'll look better after a cup of tea eh?

What do you think?


ageing student said...

I do understand what you are saying about addicts, but for the man in the street (or student at University) not having to re-register with a local doctor during the long summer vacation makes sense. Of course, if everyone's medical records were centralised (what do you mean - a hot potato?) then it would make it more difficult for patients to obtain multiple prescriptions, wouldn't it? Or am I being naive?

Z said...

A It all depends on whether such things are ironed out at the start and whether a doctor can refuse to take on a patient - and if a new patient who lived nowhere near the practice asked for methadone, wouldn't that raise a slight suspicion anyway?

B And if you don't feel too ill or anxious to do all the research.

C Well yes, like Tony Blair was really surprised to find that if a surgery hadn't got a space for an appointment within the designated time, the patient was told to phone the next day instead, because he thought he'd sorted the problem with a stroke of the pen.
Mind you, if I thought I had cancer it would have to be an extremely important trip not to cancel it.

I've just had such a helpful consultation that I wrote and thanked my doctor for his advice and the referral. Never feel unappreciated, dear Dr J.

alhi said...

I have to say while I agree with a lot of what you say, if I was suspected of having cancer and referred under the 2 week rule, I would cancel all plans of going away: a patient also has to take responsibility for their health.

As regards being able to register with a GP anywhere: is there no way a person could opt out of being able to have home calls. My GP is wonderful, knows me, knows my records and if I was to move outside of the practice area I would very much wish to remain within it and forego things such as home visits. Admittedly, I can see scenario that you raise coming to fruition. Safeguards perhaps such as no prescriptions till medical records come through? Or perhaps more reason to extend the availability of patient records to patients so Drs can ask patients to log on and show their records to them?

ageing student said...
This comment has been removed by the author.
Doctor Jest said...

A.S.-- Hot potato indeed. You're right of course and *if* we had a model where the patient controlled the access to the record that would be fine, but even with the NHS Spine I'm hearing anecdotes from a well connected IT savvy GP of NHS staff using their computer access to stalk patients and track down ex-partners, and it's not hard to imagine any number of scenarios where unauthorized people can access our existing records, which is why, for now, I and many of my colleagues are opted out of having our data held on the spine.

Z-- A: You'd think requests for Methadone would cause antennae to twitch, but a desperate patient in front of an inexperienced Doc can exert all kinds of pressures, that aren't always that easy to resist. Even us old hands struggle with some of the most troubled and troublesome.

B: Indeed. And have the time and the tools to do said research with. A good consultant is likely to be busier, but often well worth the extra wait to see.

C: Well yes. To a point I agree, and this particular case raises some questions about the contract between patient and the state, BUT my fundamental objection is to the idea that a non-clinician is asking to to pretend I haven't seen something I have for a couple of weeks so a Trust can continue to meet its targets. That cannot be allowed to happen, and especilally not when a cancer diagnosis is probable.

Alhi-- I'd agree about responsibility, but the monolith that is the Acute Trust is very poor at coping with normal humans who may have child care issues, partners with dementia who will need day care and any of a zillion other examples that can confound a nice orderly appointment system. I'm afraid that all of these can mess with their targets, but I object to being told by and administrator when and how I am to be permitted to refer.

And to both yourself and Z above, your GPs are lucky to have you as patients. So seldom do we get any positive feedback, so a thousand thankyous on their behalf.

Doctor Jest said...

Ooops. Just realized I didn't touch on the remote registration thing. Since 2004 we've not been "onbliged" to offer home visits as part of the service. But if you're taken ill in office hours and need someone to see you then really they need to be within a sensible radius to do so, or you will end up having either to call for paramedics, or to wait it out till the out of hours provider kicks in. You might feel this is a risk you're ready to take-- right up to the point you get renal colic, or pacreatitis, or gallstones. Trust me it makes more sense to find a new Doc closer to home.

alhi said...

I consider myself lucky to have found my GP! In a recent survey by the surgery I was asked what was the best thing about my health care. I named her:)

Given the last few years, however, I suspect she may very well wish not have ever met me!