GPs are partly to blame for their crippling workload, says columnist Dr Tony Copperfield
It’s a fact that we’re all working our gonads off. But it’s not quite a fact that this is all down to feckless, self-serving politicians and insatiable patients. There’s a bit more to it than that.
Look in the mirror first thing on Monday morning: that dead-eyed automaton staring back is actually part of the problem. Because the inconvenient truth is that much of the crippling workload is self-generated
by the medical profession.
Yes, really. We have become collaborators in our own demise. For example, we increasingly medicalise risk factors, shades of normality and borderline abnormality – see hypertension thresholds, prediabetes
and, coming soon, adult separation anxiety.
Also, for obvious reasons, we’ve defaulted to fronting primary care with the inexperienced, the risk averse and the uncertainty intolerant, who use a random test generator to end every consultation. But we are the ones who then spend hours poring over the results of investigations we would never have ordered in the first place, which is about as rewarding as doing a crossword with no clues.
Even with genuine pathology, we double down to compound the problem. Hence, chronic disease management becomes a relentless grind of target chasing and a follow-up regime that is unnecessary,
unfeasible and unwanted by patients.
And if the punters get as far as the local DGH, gawd help us, and them. After acute admission, we can look forward to what used to be known as a discharge letter but is now officially a dumping list, with ‘GP kindly to’ repeat bloods, chase scan results, refer incidentalomas and, to give two recent examples, ‘assess fitness to drive’ and ‘refer to a dentist’. Sure, shall I kindly do that before or after I’ve cleaned their windows?
Whoever said ‘treat the patient and not the test’ was so right, and is so forgotten. The reverse is the norm. Patients are now just repositories for so much biochemical, physiological and anatomical data for us to sift and rectify. It’s a literal measure of the insanity of this process that we are incentivised and rewarded for it.
And that is a significant part of the problem: much of this brainless workload generation is a direct result of the need to jump through hoops – QOF, IIF et al – set by clinical drum bangers working with a medically illiterate NHS England. This has ground us down to the point where we’ve ended up colluding with target obsession and fetishising ‘checks’ because a) we fear stepping out of guideline and b) we’re too knackered to think straight. This ritualistic medicalisation drains patients, too, making them ‘depressed’, which creates one more thing to ‘treat’.
Please, someone, put the brakes on this treadmill of nonsense. There is simply too much medicine, and too much of it is self-perpetuating. We need to take a calm and common-sense look at the self-imposed quantity and the target-driven ‘quality’, and dial back on both.
Such a culture shift would mean fewer protocols and more pragmatism, fewer investigations and more considered consulting, and less box ticking and more time to think.
It would make us all far better doctors. Looking in the mirror in the morning, we might even recognise a fulfilled and functioning GP peering back at us. Oh hang on, that’s the locum.
Dr Copperfield is a GP in Essex. Read more of his blogs here
Hear, Hear !
I won’t argue with any of that
Arguably a great opportunity now that the moneys tight to dial down the tickbox tomfoolery ? Sadly too many vested interests
All true.
Also don’t forget the role played by guidelines: EG BSG guidelines advising comprehensive investigation of every instance of derangement of liver function, no matter how mild.
I have a simple remedy for this:
GP guidelines only to be written by GPs. They could take recommendations from specialists but would have the deciding vote on whether the specialist advice is appropriate to primary care.
Completely agree. I don’t think this process was initiated by Drs – It came from politics and management – but there is almost universal collective collaboration. Its feckin nuts. It goes against large swaths of sensible advice from experienced colleagues picked up in the clinical years of medical school and it has effectively destroyed primary care in the UK
The excellent is the enemy of the good. I think it was Voltaire who first said this.GP land can only, possibly, be about the good. The excellent is unatainable and would, in truth, probably do more harm than good if we tried to achieve it. It certainly drives out the good.
I think Voltaire also said medicine is what we perform to amuse the patient whilst nature heals them
No chance of that now ! Medicine is what we practice to delude ourselves we are all powerful – vit d anyone?
Well said. Not to mention the “safeguarding” social worker job we took up. It has not made any difference except wasting time doing “training”, endless meetings and carrying the bug for social workers. This is not medicine.