In Wasting GPs’ time: ‘No, I can’t prescribe you new shoes’ Dr Faraz Majid writes about Patients wasting their GPs time.
“From requests for glasses to concerns over colds, it’s frustrating when people book GP appointments unnecessarily and it undermines our work… …Although GP appointments are for a maximum of 10 minutes, in reality it is less as many patients are late for their appointments. To put this in perspective, doctors in hospital get up to an hour to see a new patient and this is after having received some background from the GP. We see patients fresh, often with a completely new problem and no background information”
We need to be very clear that in 2015 it no longer makes sense to try and serve the needs of Patients you don’t know with fixed 10 minute appointments when you have no background information. Patients want us to flip the clinic model.
“Increasingly we are also being met with a shopping list of problems… …Inappropriate appointments being booked is another significant reason why the demand for GP appointments is so high. Self-management of trivial conditions is on the wane. A rising number of people are going to see their doctor within 24 hours of self-limiting symptoms starting such as a runny nose, sore throat, cough, diarrhoea or back pain. A significant number don’t even try simple remedies like paracetamol before coming. I have also had patients return after 24 hours to complain that their cold had not cleared despite being clearly told that it could take 7-10 days and reminded that antibiotics do not work on viral illnesses. Some will even book an appointment in out-of-hours on a weekend the day after seeing their own GP for exactly the same condition”
GPs who find it so easy to identify trivial conditions that are self limiting and could be self managed need to appreciate that for Patients it’s a very different story. Without +10 years of rigorous medical training/exams it’s not easy to judge what to do next. All too often Patients book appointments ‘Just in Case’ when what they really need is something more flexible than a 10 min office visit with someone who knows next to nothing about them or their concerns.
“There is a lack of awareness about what GPs do. I have had bizarre requests from patients including a request for me to “prescribe” new shoes for a woman from Afghanistan and a man from Slovakia asking me for a prescription for new glasses. Requests to prescribe (yet to be invented) “energy boosting medication” are not uncommon either”
I think we need to be more considerate of the underlying reasons Patients have for seeking help. I agree with ‘CelticChick‘ in the comments:
“There is also a rising anxiety among the public. “What if it’s …?”, “I can’t afford to be unwell, doctor” and “I want to be right for my holiday” are comments I frequently hear. There are increasingly unrealistic expectations among the public when it comes to their health, almost as if people believe they deserve to live until their late 80s without getting ill and that all illnesses are now treatable anyway”
I think there’s an important realisation that Dr Majid needs to arrive at. Most illnesses are treatable now. Most illnesses need care beyond the office visit. Patients and Doctors are equally struggling as we live through this transition.
“Of course, there’s also the internet. While it is hard to imagine a world without the internet now, for us as GPs it has caused a lot of problems and increased our workload. Medical websites vary in quality and the interpretation of each article requires years of medical training and no shortage of skill. The internet can lead to a lot of misunderstandings, wrong diagnoses and unnecessary anxiety among the general public which is then inevitably felt by GPs”
The internet also caused lots of problems for Kodak. Unfortunately the only way to stop it being a problem is to start taking advantage of the potential it provides. GPs I work with have not seen a case of croup for years because of information available online to parents so perhaps GPs need to do more to help Patients use online resources, pointing Patients to good sources of information is very low cost and easy to do.
In 2015 we need to approach Patients who are prepared to do research on the internet differently. I think more GPs should copy the work of my good friend Dr Chris Bickford MD in San Diego. Before we all started carrying smartphones he put up a sign in his waiting room with a weekly prize for the Patient who brought in the most interesting article from the internet. Today I can share a URL with you from anywhere in just a few familiar clicks. You no longer need make an appointment to show me what you managed to find on the internet and print off.
“The constant bashing of GPs by the media, politicians and the public is damaging morale in our profession and leading to a mass exodus of GPs either through retirement or migration out of the country. We have all been through a minimum 10 years of rigorous training and examinations, first at medical school and then in hospitals. GPs feel there is a lack of gratitude out there for the hard work we put in on a daily basis and that our work is constantly being undermined”
Dr Majid makes some very interesting points here and I wonder how much documentation of the consultation will help maintain the levels of respect that GPs have. I feel the RCGP is failing GPs with it’s very limited vision for the future, so it’s going to take a grassroots movement by GPs who see the opportunities (eg. for 20% of NHS GP consultations the Patient would be better off at the Citizens Advice office instead) that the internet provides for them to let Patients share information before they get an appointment.
Check out a new service called AskMyGP that is helping GPs modernise and read about the stunning work of Dr Amir Hannan – a NHS GP who hasn’t buried his head in the sand and is seizing the opportunity to use to internet to work with his Patients and help them better self manage their health.
Some fascinating insights can also be found in the lively comments thread
“Today 1 patient made a 10 min appointment with me for blatant hay fever symptoms- they didn’t have a clue hence tried no treatment, another today made a 10 min appt with me for conjuctivitis- she knew what it was but knew she would get a free prescription rather than go to the chemist. Another attended today a 10 minute appt because she keeps losing her blue (salbutamol) inhalers so she asked if there was an alternative that didnt involve inhalers. another attended a 10 minute appt today to ask for a blue badge but these have all been done by the council for the past 5 years and not the GP. Another man took up a 10 minute appt with me today as he did not trust the nurse to check his blood pressure properly- bizarrely he hadn’t even taken his blood pressure meds before attending. These were all routine appointments that should not have been seen. Our practice is cracking at the seams and many patients that do need to be seen are unable to get an appropriate appointment on the day. We have now decided as a practice that we can no longer expect many patients to use appointments appropriately and will soon start a new system whereby we (the drs) will triage every single appointment request and signpost them accordingly or give them an appointment if needed. We hope that then we will then be able to cope with current demand” drcheech.
An incredibly frank admission of how Modern NHS GP Practices are operating. The new system that’s being implemented seems like it’s going to further expand the issues. Imagine Ryanair decided to introduce a system where the Pilots answered (non-premium rate) telephone calls to ensure customers were being signposted accordingly?
“A patient saw me today asking for follow up care and a prescription as advised by the specialist who did a gastroscopy on him last Friday. He told me that the specialist had handwritten a letter for me, handed it to him and told him to bring it to my surgery to get a prescription and arrange follow on care. So I asked him for the letter, “it’s at home, look it up on your computer and give me my prescription “. I explained it wasn’t on my computer yet, that a version of it would be in a week but that the specialist had given him the handwritten letter to speed things up and allow us to sort him out before I got the formal typed letter later. The abuse I received was unpleasant, his time was wasted, my time was wasted. But there was no sense that he might have any responsibility for this, no, he “knew his rights”, I needed to “get my act together”, I needed to “sort out my IT issues” But retirement beckons, I have had enough of this typical, totally unrealistic and ever increasing demand. I am in my mid 50s and had planned to work until 65. No more. And today my GP Trainee, in her second year of the GP training scheme, resigned from the scheme. Enjoy whatever you manage to replace me with.” cuchulainn
I often hear critics saying that introducing technology takes Doctors away from the caring, human 1-2-1, relationships that Patients need but this is the reality in 2015 after the NHS spent more than $20 Billion on the National Program for IT. If the NHS simply went Mobile First that handwritten letter would be a message on the Patients mobile. We recently did a survey of Patients attending the clinic and couldn’t find a single Patient who didn’t have their mobile with them at all their Doctor appointments. This is consistent with the published findings at scale eg. in the US Kaiser Permanente Patients set a new world record for the rate with which they started using the companies mobile first mHealth portal.