The curse of making busy healthcare professionals responsible for AdminisTrivia…

Dr Zara Aziz Patients feel the strain of fiscal pains

In the Guardian yesterday Dr Zara Aziz, a GP partner in a NHS Practice in Bristol, shares some great insights into what a typical day looks like in the modern office of a caring NHS Family Doctor.

I thought it might be interesting to look for lessons that we can draw around the opportunity for more effective processes to make a difference:

There is an ever-rising demand for surgery appointments. On a Monday morning the phones ring incessantly; by 10am all the day’s appointments have gone

For people who work in other service industry’s it must seem incredible that the family health needs of a local population are being force fed through a such an outdated bottle neck that not only costs healthcare providers (they have to pay their staff to answer all these calls even though this would typically be the busiest and most productive time in their working week) and is so unappealing to patients (have you ever experienced a 9am-10am Monday morning telephone gauntlet?).

Yet in reception our secretary deals with a constant stream of letters detailing patients’ encounters with the out-of-hours services at the weekend

Hmmm… presumably this means that the documented work of an OOH Locum Doctor (or worse the expensive specialist teams at the hospital!) at the weekend is being filtered into a Family Doctors workload manually by a secretary? Why are we talking about “letters” in 2013 when every Family Doctor in the country practices in front of an internet connected PC and the vast majority also have a smartphone in their pocket?

Going by Alexandra Oswald’s TedX talk I think the Kenyans would laugh at us if for one minute they could believe we actually have some of the worlds most talented medical professionals struggling to work with such bloated IT systems and documentation processes…

Demand continually outstrips capacity, despite us taking on more staff and offering more surgery appointments. I find that patients raise more and more problems during their consultation. They may have taken time off work to see me and wish to deal with all their medical problems at once. They may be suffering with depression or are simply unable to cope. Ten to 15 minutes isn’t enough for most of these consultations. This can impact on patient safety, as the last problem on the list may well be the most serious

Can impact on patient safety???? Lack of patient information and documentation is by far and away the no 1 reason that Doctors lose medical malpractice cases.

Is there anyone who cannot see the trends that are happening with relation to healthcare needs? With an ageing population, higher expectations of an active lifestyle (we’re all being worked longer) alongside increases in public healthcare marketing spend (encouraging patients to go and talk with their family Doctor) why would anyone expect there not to be ever more patients who wish to discuss ever more concerns when they eventually (after getting through the 9-10am telephone challenge) meet with their Doctor?

Why aren’t we looking at the other side of the coin and asking why are we failing to serve patients increasingly diverse needs by using clinically validated tools that can improve access while ensuring patients are getting a chance to air the issues they feel are important and Doctors not only get the chance to efficiently listen to all of this also benefit because it can also be automatically coded into their electronic medical records.

Most GPs spend a good portion of their day dealing with Department for Work and Pensions medicals, writing “fit notes” and supportive letters for housing claim

I could put together an online Q&A for patients needing DWP fit notes and have it added onto the Instant Medical History questionnaire engine in no more than a few hours. With a feedback form for a few Doctors who use this with their patients it could probably be refined so that it covers 99% of requirements inside a month.

Now imagine the potential for template based fit notes to then be used across the NHS by patients and non-medical staff to help free up the expensive time of Doctors so that they can get on with the specialised work that they’ve been trained for and we all want them to be spending their day doing?

There are days when you see a lot of minor illnesses, but amid the coughs and colds there will be significant health problems. As a trainee a few years back, I struggled to find patients with mental health issues. Now this forms a significant part of my workload. No one seems to be immune; stress, anxiety, breakups and problem drinking are on the rise in all social classes

I wonder what Dr Aziz would think of a tool that costs only a few cents that could be posted on her clinics website, used on a tablet or PC in the waiting room and could ensure every patient can be consistently screened for mental health issues with the expertise of clinicians with decades more experience than her and all the time in the world?

A patient of mine, Mike, came to see me on a Friday afternoon, just before his night shift as a security guard. He is 44 and was last seen at the surgery three years ago for an ear infection. He does not have much of a medical history. He is shaky and makes little eye contact. He admits to feeling a bit low, but his main concern is insomnia and panic attacks. He hasn’t slept in days. He worries about losing his job, his house, even his family and friends if they find out that he is not “right in the head”. He has taken a pay cut to keep his job and cannot meet his debt payments. It has taken a lot of courage for him to open up, and he knows he needs help. It is easy to prescribe an anxiolytic (to reduce his anxiety), but his problems are caused by social factors, which are much harder to influence. Our mental health services are stretched to the limit and as I refer him I know that he will be waiting a long time to get “talking therapy”

The resources that governments are providing to mental health services might not be something any family Doctor can do much about but isn’t it incredible that a patient like this had to suffer the sleepless days and the 9-10am telephone gauntlet before they could actually open up about such sensitive issues?

I know 88 year olds who go online to book their holidays, pay their TV license, make video calls to their grandchildren, etc, etc, so what’s wrong with a healthcare system that it requires a young man to feel the need to wait for days without sleep before he feels capable of phoning up and asking a secretary for an appointment because he feels he might not be “right in the head?

The mental and physical burden of ongoing economic hardship is getting heavier. It is vital that our health service remains free at the point of contact for the vast majority; otherwise already wide health inequalities will worsen

Great point but where’s the self reflection? Where’s talk of the responsibility that Doctors have to make themselves accessible to their patients via the technologies that the vast majority of their patients are using throughout the rest of their social and working lives?

Perhaps I’m just too critical of a status quo because I think it all too often leads to unacceptable patient experiences like this or this? What do you think?

About David Doherty
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