“It is no longer possible to practice good medicine in ten minute slots”

BMJ Dr Peter Bailey Galley slaves rebel

…(Jeremy) Hunt said that “Every patient is the only patient.” Is the man mad? My first patient in my morning surgery yesterday had complex visual symptoms that did not fit into any textbook description of eye disease. I had to tease out a clear description of her difficulty, that had already baffled her optician. She needed a careful eye examination and a full neurological examination, and then a referral for a secondary care opinion. By the time I had achieved this, I was already 25 minutes late for my next appointment despite having started five minutes early. Her Patient Satisfaction Questionnaire indicated that she was very happy with what I had done for her. Two more patients like this in the course of the morning meant that I was nearly an hour late for my last patient who made a formal complaint about me to the practice manager. It is no longer possible to practice good medicine in ten minute slots. The “quick” patients are now seen by nurses, making the case complexity of the people who consult the doctors much greater. Hunt makes the point that,

“One in four of the population has a long term condition—many of them older people. Within the next few years, three million people will have not one, not two, but three long term conditions. By 2020, the number of people with dementia alone will exceed one million.”

Does he think that such patients can be cared for appropriately given the current pressures on primary care physicians in general practice, out of hours services, and emergency departments?

Dr Peter Bailey, GP, Cambridge (UK) writing for the BMJ Group Blog

My thoughts:

Can you imagine the opportunity the NHS has to commission England’s most talented ophthalmologist to spend a day writing down all the questions she would ask of Patients who present with an eye condition and then having that expert knowledge added to a clinically validated Interactive Patient History Taking Questionnaire (that could also include the 9 million questionnaires that GP’s will deliver through QOF this year) that GPs could make available to all of their patients 24×7 via their practice website (something that would greatly assist their current efforts to take back responsibility for out of hours care) and on easy to use touchscreen tablet devices that Patients could use in their Doctor’s waiting room?

3GDoctor Interactive Patient History Taking Questionnaire

Related Posts:

Checklist chicken or egg: should we give them to Doctors or Patients first?

About David Doherty

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