GP (Family doctors) are supposed to be intelligent right?So here is a question for you all, answers on the back of a £10 note…
And elderly patient enters your surgery. She is asthmatic and is having real trouble in breathing. Do you?
A) Start treating the asthma attack, giving the correct amount of drug, then when she doesn't improve, call for an ambulance, keeping the patient on oxygen. You then take her vital signs, and observe her closely until the ambulance arrives. You even manage to phone the hospital to refer her to the correct speciality.
Or…
B) You give her the paediatric dose of the medicine (The dose you give to under-twelves). When she doesn't get any better, you call an ambulance and sit her (without oxygen) out in the waiting room where here wheezing can entertain the toddlers playing there. You write a letter to the hospital, but as you haven't written any vital signs on it, you can't have even taken her pulse in then first place.
Warning, if you answer (B), you then might have to put up with a slighty miffed FRU person explaining that you might have just been a bit silly…
There are a scarily large number of GP's who just cannot deal with anyone who might be seriously ill.
Still that's what the L.A.S. are for, and also why we still rush on blue lights and sirens to patients who are being looked after at their GP's.
sadly true. will never trust a GP's diagnosis. turned up at too many people seen by their doctor and told they have heartburn or a chest infection only to, after a few standard questions, know that thier having an MI. I guess that we have more time than doctors to make even simple enquiries but it's still very disturbing to think that GP's can miss serious signs/symptoms.–also, have you ever walked in on a GP doing CPR on a bouncing bed, or giving fluids to someone who he'll describe to you as pulsless, apnoeic with fixed and dilated pupils. scares me that even basic cpr or recognition of a dead(or at least seriously ill) person is beyond some inteligent, well educated, highly trained doctors.
everyone makes mistakes but if mistakes can be made by doctors, and i hope it is because of time constraints, then the system is wrong……sorry, bit of a bee in my bonnet about this.
As a GP receptionist I can honestly say the GPs I work with would all be like the GP in comment A. Not only would they be like GP 'A', they would also bring the asthma nurse in to closely monitor the patient. And just as an added extra, one of us receptionists would keep a close eye out for the RRU and/or ambulance, make sure the front driveway is clear for them, and then whisk them straight through to the patient as soon as they arrived. I think we deserve a brownie point for all that – even if we are only doing what we should be doing.But I am well aware of a few GPs where comment B would most certainly apply – shame, as it doesn't take much more than a bit of common sense to get things right.
With basic first aid training you're told again and again to monitor vital signs. Do GPs forget this as soon as they walk through the surgery doors?
Sorry, I haven't got ten quid.But I would tend to stick with the first option.
No, they don't forget it. AFAIK the problem is that most GPs don't actually have any basic First Aid training.I'm a member of a St. John Ambulance unit at university, and the medical students that are members of our unit say the only First Aid training they receive is as a SJA member. So otherwise when they graduate they know how to do all sorts of clever diagnoses and prescribe drugs for this that or the other but don't know how to do any basic lifesaving First Aid.
I'm frightened to say this but it's true…where I work, regular mandatory First Aid training is provided annually for all of us but there seems to be no follow up or consequence for those doctors who don't show up…. some do; but many don't.
My GP is a great guy and I would consider him option a)….. he also knows his limits and when to call for help…. I have been in another GP Surgery with an ill friend and someone collapsed and I moved to help expecting any minute for Doctors to race in and help…… no such luck…. I asked a relative for more information and eventually found out they had recently been diagnosed with diabetes and eventually I got a doctor to get Glucagon, no one was IV trained, when I asked if there was a defib in the building anywhere they just looked blankly at me…You think GPs are a nightmare in the surgery trying having one help you at a RTC….
A close friend of our families had a MI and went to the GP who sent him home saying it was gastric. In hi rehab group of 10 other, 6 had the same experience when they presented to their GP's. A good rule of thumb, here in Australia anyway, is only visit GP's that are current members of Aust College of General Practiioners, they at least have to remain current. Yep, dont know about other countries but here down under you can get your licence 50 years ago, never read another medical book and still practice….WTF
Right, I'm going to stick up for GPs. Yes there are rubbish ones out there. But there's rubbish nurses around and rubbish paramedics and rubbish teachers. We can't avoid them.I think there are a lot of excellent GPs out there. And being an excellent GP is really hard. They have limited resources and are expected to have expansive knowledge of every medical specialty and the whole social services/support packages too.
People always complain about their GP. They complain if they can't get an appointment, or if the GP is running late. They complain if the doctor doesn't spend enough time with them, or if they won't do a home visit. I certainly couldn't be a GP (so am sticking with anaesthetics).
Yes, Tom , you did encounter a rubbish GP who put a person's life in danger. But please don't tar all GPs with the same brush. They're only human.
And as they're only human they can only do their best. Yes it is inexcusable if they don't do their best, but humans make mistakes, and sadly when you're working with peoples lives then sad mistakes will always be made.
So unless you're perfect and all paramedics are perfect then please don't generalise about GPs so much.
You think that's bad? I have a good friend with severe asthma who has been battling pneumonia since July. She has been in and out of the hospital more times than I can count, and she's on oxygen 24/7. This past week she's had to go in 3 times because she's turning blue. So time #4, she goes into the ER (A&E), goes through triage, shows them her blue fingers, and is then left alone for over 2 hours! In the waiting room, where they are using air freshener that is making her worse. I cannot even begin to express how appalled I am.
If you look through the archives, I do occasionally tell people about the good GPs I meet. The ones who stick around in the Nursing homes waiting for the ambulance to turn up. The ones that hang around the sick patient's home to make sure they are alright before the ambulance comes.To be fair to GPs, I don't know them all (and the better ones are less likely to call us out for inconsequential causes), but… Sometimes it does seem that there are a lot more GPs out there who will get ?MIs sitting out in the waiting room (or outside the surgery having a ciggie), neglect to gove their patient's oxygen or think that 75mg of asprin is the right dose for ACS.
At no point do I say that this is a reasonable sample – but I do meet a lot of crap out there.
(And yes, there is crap in a lot of things, but I think us ambo people have more regular supervison/training, so any bad habits/lack of knowledge tend to get picked up fairly quickly).
Yes, they are expected to be experts in everything, but for two things, 1) they can refer patients with 'wacky' stuff to the specialities in the hospitals, and 2) When I was district nursing I knew all about the social services – there ain't that many…
This particular GP didn't make a mistake, instead I think they had a failure of common sense… A potentially serious one as well.
Gaaaah!
Well, I have to say, as my second post here, I will be careful.My GP is a tosser. I can give you examples;
Going past Doc's one day, elderly Pt, staggering up Doc's path to reception. I concerned, go up and ask if she is OK. What's the problem. Badly mumbled reply comes back, with quite obvious apathy in right side of body. I am thinking CVA? Triple 9 it. Shout for help, ensues Doctor Wanky Bollocks, saying everything is fine, Err, no. I am actually holding her up here Doc, she has slurred/bizzare speech, and it just doesn't feel right. Can we get an Ambulance? No need, she looks as though she has been drinking! Just help her though to the seating area in reception.
Well thanks Doc for that insightful advice you can blab out at at least 6ft away, I am holding her up, she doesn't smell of booze. She is unsteady on her feet, and can only hold my right hand to steady herself against me. Half of her face, is just not working. Thanks for that, really. No really, you stand there and pass moral judgment as you see fit. Wanker.
It took a passerby, a young gent, about 17, to ask if we were all right. “No, can you call an ambu, to this location, please!”
With said, Doc, huffing off back into the building.
Thanks for the support, thanks for supporting her, thanks for supporting me. Thanks for supporting the crew, who turned up and ferried her off. Thanks for saying thanks to the passer by who helped(It's ok I did that for you BTW and thanked the crew)
Also, thanks for telling my wife, with an ectopic pregnancy, that it was all part of the process of being a mum. Again. NO. Your piss poor actions nearly killed her, thank J H C, her mum came round. Also, thank Fook, the Amubu crew came with a Doc on board.
And you know, with all this under his fat lazy belt, the cretinus retard still can pratice.
This is unrelated to your post, but I've just seen the story on the front page of today's Metro and wondered what your take on it was:Mother wins 2.8m after suicide bid (or as the Metro put it, “Suicide bud costs the NHS 2.8m”).
Apparently she overdosed on 45 co-proxamol painkiller tablets in a suicide attempt, and manages to get 2.8m from the NHS because she failed to achieve a complete recovery.
I wonder how many ambulances and crew 2.8m could pay for? How many more lives could be saved if the money had been put to better use??
grrr.
Sorry, the link should point here, and the Metro headline was of course “suicude bid…”
Sounds like sort of GP who, whilst waiting for the ambulance, would be extolling the virtues of the smear test and flu jabs to scrape in that extra bit of cash :/
I know there are good doctors (I have worked with some), but… ever since this happened (some years ago), I have been angry about this.The GP came to visit my dad at home, he had been becoming more and more confused. GP took my mum into the kitchen to tell her that my dad had senile dementia, then just buggered off. No time for her to ask him what this meant or ask questions or for him to give any idea about supports etc. OK, no one died or anything, but surely basic human instinct should have suggested this might be a bit of a blow and she could do with some sort of support!
i guess if there is a 'good 'side to this, it has made me more aware of the fact that people need info when they get a diagnosis. And that there is a vast army of people out there who just get on with picking up the pieces when the doctors leave.
On a separate note, I have been wondering about doing a weblog (tend to get put off when I think I could not keep up the standards of logs like this one!). The problem I have is how to deal with confidentiality. Any ideas?
I've worked with some rubbish docs in my time, the ones who yell “stat” after every sentence as if they are (a short and fat) George Clooney, I've also worked with some rubbish nurses “What do you mean she's an alcoholic, she's got a Moben fitted kitchen”!!!!!!!!!!!!!!!I suppose its all down to common sense, training, keeping the training up to date and applying it all together.
Was once asked by a Fire Officer, in an Emergebcy, who would people look to for guidance, we all answered as one – The Doctors – after he'd stopped laughing, he explained it was better to look to the nursing staff, they at least turned up for Fire Lectures and knew what to do.
Problem is that in medical school, and nursing school, once you get in- there is an enormous reluctance to kick anyone out, even if they really aren't up to the job. With the current (US) nursing shortage, as well as the shortage of GPs (Low compensation, high malpractice costs) there is no incentive to expel any students not up to the job, or to expect excellence. So if you go to the biggest hospitals, the best run clinics, you will get the good ones. Otherwise, you get the ones that should never have made it through the program.Once saw a urological surgeon freak out in surgery when his patient had an arrest.
Yeah, my GP was from the same school. One of my neighbours is now dead (as in fatal) because Dr Tosser dragged feet over refering; another is blind in one eye (same reason); over the street nearly lost her leg to his misdx; another sports a rather nifty colostomy bag because the tosser wouldn't visit – he just suggested otc analgesia telling her that 10/10 agony/pyrexia was a normal post partum by product: result? herniated intestine>septicaemia>yards of innards removed. What amazes me is that ,even though he's secretly known as the local Shipman, all these people don't burn down the bloody surgery. Invariably, I've self-dx'd accurately before going to him for affirmation/script if necessary. Most things I've self-treated over the years.And, yeah, after 25yrs he managed to inflict his medical superiority on me too when I WAS seriously ill and unable to dx. I guess the next time we'll have the pleasure of each other's company is in a formal legal setting.
I have every sympathy and all the time in the world for med staff who are working their backsides off in really tough circs to get it right. This little git is just smug and incompetent. Fortunately for those of his patients who have amazingly managed to survive he'll be retiring soon.