More Crap GP Work

First off – I didn’t know that the survey was going to come out that colour – somewhere between previewing the post and it appearing on my blog the colours decided to ‘run’ into one another.  I hate un-accessible web content.

Forgetting to put in a ‘not medically trained’ option in the Medical question was all my fault.  And in answer to one of the comments, I didn’t know that Johnnies got the hump if called ‘St Johns’.

I was working on the FRU again for a shift, I’d turned up to work on an ambulance, but there was no-one else to crew up with me.

One of my first calls was to a possible heart attack in a GP surgery.

Once again I found the patient (a very pleasant lady) sitting out in the waiting room.  There are a number of treatments that should happen with someone who is having a heart attack.  First they should have a full set of vitals, then oxygen should be given along with an aspirin and, if the blood pressure is good enough, a squirt of GTN.  It’s pretty standard stuff and does a world of good for the patient (aspirin alone increases your chance of surviving a heart attack by around 25%).

So – how many of these things had the GP done?

Well – he’d taken some vitals, but they were very different to what we got in the back of the ambulance.  However vitals can change and I wouldn’t want to call the GP a liar.

At no point had the GP given aspirin, GTN or even waved some oxygen under the patient’s nose.  The receptionist was helpful, and she led the patient from the waiting room into her office so that I could better assess her without everyone in the waiting room listening in.

I checked the patients blood pressure, gave her some GTN, an aspirin and put her on oxygen.  All things that should have already been done by the GP.

Thankfully the ambulance was pretty quick in turning up, and the patient went off to hospital.

I had a chat with the GP – it’s a chat that I’ve had a couple of times now.  It’s a chat about how possible heart attacks shouldn’t be sat out in the waiting room, about how ISIS-2 and NICE say that an aspirin should be given.  How GTN is a good thing to give such a patient, and that oxygen can really help with the pain and anxiety.

“I don’t care about that”, said the GP, “I just want her to get TROP-I.”

TROP-I is a special blood test to determine a heart attack.

He then didn’t want to hear that perhaps sitting a woman out in the waiting room with a potentially life-threatening condition was, on reflection, a bad idea.  I know GPs are busy, but is a two year old with an ear infection really more important?

I’m left in awe of GPs who don’t seem to want to treat anyone.  Like nursing homes I’m sure I only meet/remember the rubbish ones.  But if my mum was having a heart attack and went to the GP I’d be fuming if they sat her in the waiting room for an ambulance.  It’s not hard to give someone an aspirin, it’s not hard to give them oxygen and it’s definitely not hard to keep an eye on them in your examining room while you wait the (less than) eight minutes it takes for an ambulance to arrive.

I’ve mentioned before how the LAS will visit and help train rubbish care homes – I’m begining to wonder if we should also go to GPs and let them know what the ambulance service (and by extension the local A&E departments) expect.

24 thoughts on “More Crap GP Work”

  1. The…ahem…'official' LAS slang term for johnnies is much worse than what I put here…Not that I agree with it, mind you.. just saying…

  2. Tell me about it…. Ii was Streaming Nurse in our department yesterday and saw a 59-year-old lady with chest pain. As she walked in, I could see she was rather pale and after she'd given me no more than 60 seconds worth of her history I was walking her through to Resus. She'd gone to her GP that morning with a history of palpitations from about 2300 previous night and chest pain that had woken her from sleep. Her GP 'referral' letter noted the history along with tachycardia (140 bpm!!), irregular pulse and pallor – yet instead of giving aspirin, nitrates etc he 'advised' her to drive herself to A&E!!! Her 12-lead showed a new fast AF with global ischaemia and she eventually went to CCU. Now I've only been qualified for 4 years and in A&E for 3 but I could see the combination of chest pain/looks like crap/feels sick = Resus/oxygen/nitrates/aspirin a.s.a.p – why couldn't he?

  3. Ye gods, you wonder what some GPs are thinking of. Mind you, hospitals sometimes aren't much better. About 3 years ago my mum, then 81, got taken in to A&E in the middle of the night feeling very poorly. Admittedly she's been on pills for things like high blood pressure for longer than I can remember, so a diagnosis might not have been easy, but I was astonished (and furious) that she was sent home two and a half days later without any real determination of what was wrong with her – which itself caused her to worry and make herself feel worse. Two months later she was back in hospital for a fortnight over Christmas/New Year, and they finally diagnosed two leaking heart valves! Three years later she's still around, although consuming a small pharmacy's worth of pills each day, and an oxygen bottle a week – back then I wasn't too hopeful she'd still be around in three months.It's surprising what little secrets a family can conceal – I was around after this when mum was giving the district nurse her lifetime medical history, and it wasn't until then that I discovered that I was born by Caesarian – I'd wondered why of four births I was the only one not born at home, but back in the 1950s Caesarians were still quite rare…

  4. Nothing Changes. My stepfather wasn't feeling too well – he'd sat up in a chair all night and went to see his GP. Said GP was a fair distance as my stepfather hadn't re-registered when he moved in with us. The GP decided he'd probably had a heart attack so he called an ambulance – to meet him at home. My stepfather had to drive home about 5 miles in traffic in a heavy car with no power steering to wait for an ambulance that put him on oxygen and took him away. He lasted two weeks in the ccu before he died. I was a lot younger then and grieving otherwise I would (and should) have reported the GP as incompletent or gone round and decked him.

  5. I worked a nasty head trauma on the street one night, had nothing with me, no gloves, kit, nothing. I managed to hijack passersby and get them to give me their shopping bags to cover my hands and their kids' PE kits to apply pressure to the wound.Halfway through a long, lonely and arterially bloody wait for a crew to arrive, I heard a voice pushing through the crowd “Let me through, let me through, I'm a doctor!”

    She crouched down opposite me, looking across the patiend and said “Hi! I'm a doctor! Can I help?”

    “BRC.” I replied “I need a pair of gloves, do you have any?”

    She looked at the puddle of claret on the floor, my hands wrapped in Tescos bags and came to a conclusion.

    “No, no, I don't…I'm…I'm sorry.”

    And with that she stood up and walked away.

    Cheers lady, much appreciated.

  6. I'd be very tempted to put in a 'near miss' untoward incident report at work, maybe with a copy to the good people at the PCT complaints department. After all, there was a high likelyhood the ?MI could have resulted in something far more tragic. If the boot was on the other foot, I'm sure a flurry of paperwork would have been sent in the direction of your management 🙁 A high and mighty approach to poor quality patient care doesn't do, and this individual needs a reminder of why they are who they are for the sake of the next poor soul in such a predicament.

  7. I often wonder what a GP thinks they *should* be doing in their job, as they tend to treat things like patients as an annoying distraction.I always feel like I'm taking up too much time when I do bother going (which is very rarely).

    And how come they seem to have stopped all useful local services at GP surgeries?

    I have a chronic illness so keep having to go for blood tests. But because I'm not over 60 I have to travel to the hospital, which is quite far away. Oh how I love sitting in a room full of twitchy needle-phobics, getting coughed and sneezed over, and then stuck by a vampire suffering from line hypnosis. No wonder I keep putting it off.

  8. I work as a Technician in the Home Counties.My colleague and I went to a GPs practice where the GP stated that she suspected that this man was having an MI. The genlemen was a 52 year old male, overweight and former heavy smoker – so it was quite possible.

    My colleague then asked her if she had done an ECG. “No.” she replied “I was too busy with my other patients!

    We looked around and the practice was closed – there was no one else about other than the receptionist.

    Again the patient had no O2, no aspirin and no GTN.

    When I asked my colleague about our options or reporting the GP (I asked him as I'm new to this and he's not) he told me that there is little that we can do. GPs are way higher up the chain than we are and who are we to question their medical treatment.

    As others have said – if that were one of my loved ones I would be livid with the care that was given.

  9. Ok, Now that, and I'm sure many others, GP scares me.It isn't that they didn't recognise what's was going on with the patient, they did. But they appear to cared more about their bottom dollar and getting more money people through than what else they could be doing for that patient. Busy or not, that's what they are their for, patients, or have they lost sight of that.

    ..And in answer to one of the comments, I didnt know that Johnnies got the hump if called St Johns.

    Only the ones that aren't thick skinned enough. 🙂

  10. Well, us mere mortals may not be in a position to judge the treatment of GPs' patients, but we can raise concern with those who can – their peers.

  11. Just another example of how the 'profit' driven NHS operates, even at the level of GPs. I work with ex-NHS managers, district nurses and nurses who are earning roughly the same or less money but left the NHS because of the money-centric attitude that has permuated from top to bottom.

  12. all health care professional including doctors must follow best clinical practice. If they dont seem to be bothered or interested when like in this case, then maybe questions need to be asked about this so called professional. Doctors are percieved to be too high up the food chain for paramedics or technicians to question their actions, but patients do it all the time by complaining to pct's or the GMC, so why not do that..then if there is a case to be answered then the doctor or any other health professsional can be aksed to explain themselves in front of a selection of their peers and see what they make of their actions.

  13. Thank you! This is a courageous article to have written and if this sort of thing is commonplace your article would seem to have the power to save many lives.I am so pleased you've written it that I went through the slighly tortuous process of registering just so I could say thanks.

    More power to your elbow.

  14. I have been lucky to spend time with the ambulance service the last coupple of weeks. We indeed also had to visit a lady at a GP surgery who had gone in with Chest-Pain.Cue Blue lights and sirens rushing to GP's

    on arrival receptionist took us to a room with lady lying flat on a couch, 100% oxygen mask going and GP came in having done Pulse and BP AND GIVEN 300MG ASPRIN..

    WELL DONE – The GP was verry sorry she haddnt done a 12lead ECG as the machine was in the back of another doctors car who had gone home (also with the AED and spare 02 bottle) Meh!

  15. Why do they not like being called St Johns??? I'd much rather that than “Johnnies” if I were a member. Isn't “Johnny” slang for condom?Love to know the reasoning here….

  16. I wish I could say I'm shocked and surprised but sadly I'm not. I'm just glad these docs are very much in the minority. Recently I attended a GPs emergency call for an elderly lady with chest pain. En route received a message from the GP to specifically request we did NOT treat the pt but simply transport her to hospital! No ecg, nothing. This in spite of the fact he had categorised the call as a blue light emergency as he thought the pain was cardiac in origin. The reason given was that he did not want to worry her! Well, she's old you know; would be a shame to spoil her day with a spot of bad news. Needless to say his request was ignored, ecg showed she was infarcting with widespread ST elevation, she WAS treated for the MI the GP quite rightly thought she was having but chose not to treat and was admitted to CCU where she was thrombolised and is making a good recovery with minimal myocardial damage. Her previous excellent quality of life may now continue for several more years. No thanks to the perfectly pleasant but inept family doctor who showed an incredible disregard for the wellbeing of one of his patients who trusted him to look after her to the very best of his abilities. Maybe having an excellent quality of life is of little significance if you're of advanced years. Let's just write you off. Doctor knows best after all! And they get paid how much….?! Makes you despair sometimes…

  17. The Order of St. John is military in origin, dating back to the Knights of Malta and the Crusades. I guess for some of them it would be like saying Joans of Arc. Using its proper title invoke umm, a sense of pride. 'St Johns' adds a conitation of being 'owned' where 'St John' shows membership. People would rather be a part of something than owned by it. &nbsp&nbsp My two cents anyway…As for other names Mr R, yes there are plenty. Some of them deservingly so, but you get that everywhere. 🙂

    The irony I have is the ones that dis the black and whites when they are talking to me whilst I'm wearing my pvt 1st aid co uniform. 'N the ambo's I know that are 'secret' members …

  18. OK, fair point. I hear what you are saying. If it was an aneurysm he would have been right to ask me to forego everything else and get her to hospital asap. Sometimes Dr does know best. I aint a doc, nor do I think I am. And yes, some of us can be procedure driven and sometimes a little knowledge can make us think we know more than we actually do. If it was a suspected aneurysm I would have to eat humble pie and just be an emergency taxi driver. That would actually be the best treatment for the patient.But I met this GP as he was leaving the patients house and we had a brief chat about the lady. There was nothing wrong with his examination and clinical findings. Classic MI story, no indication of aneurysm. He was correct in his diagnosis and the ecg he didn't want me to do helped confirm that.

    What got me were his comments to me about her being elderly and that being reason enough for him not to treat her and furthermore to specifically try to make sure I didn't either. It's the first time I've met someone who has deliberately tried to stop me from giving what they agreed was the best course of treatment for a patient based on what seemed like nothing more than their own whim. He couldn't defend his request when politely challenged on it other than the elderly, let's not worry her stuff. It was too unusual a request to comply with without further information.

    This was the first episode of ill health this woman had had for years. She lives an independant, happy and fullfilling life and may have a good decade or more of quality life ahead of her. She wasn't at the end stage of some chronic disease which may have to be taken into account in other circumstances. We're talking elderly here, not ancient. Fit as a fiddle and all that.

    The docs in CCU were none too pleased with him and may take the matter further.

    I'm guessing you are a doc yourself. Thanks for the link to that blog. Will peruse it at my leisure. If I'm giving this GP an undue hard time I'm not too proud to listen and learn.

    I would add as well though that while we might not have all the knowledge of docs, experience is a great teacher and after seeing plenty aneurysms and MIs over the years I would hope that I would seldom miss one now. The paramedics mentioned in the blog are no more representative of most of us than the GP I met is of doctors. The mere mention of the 'A' word is enough to have most of us getting our pt to hospital pronto. The sooner I can pass them on to you the better. An MI I can do something about, an aneurysm I can't. I've had enough bad experiences to try and work out the difference. I'd rather they expired on you than on me!

  19. That's cool. This doc does sound like a complete arse. I can only imagine the patient was a lady he knew well and had known for years and he wanted to protect her. It was still the wrong thing to do.I just wanted to point out that the protocol is not always the right thing to do. Glad we agree on that.

    You gave me a laugh. I'm not a doc. I trained as a medical physicist but I'm now a writer – big change! I still like medical stuff though hence my reading these blogs. I recommend NHS Blog Doctor, him and Reynolds have had a run in but I think they're both very good.

  20. last bit – interestingly an experienced County paramedic here in Bristol, Clive Haddrell, set up First Response Training, primarily to improve FA training for Doctors' staff and paramedical(as in associated to medecine) types.tfd

  21. I think that the trouble with some GPs is that due to the nature of most of their work i.e. consultation room and home visits they have lost the sense of urgency which is sometimes required of them when presented with patients with chest pain etc. Their sense of urgency might be to get to the next patient within the next seven minutes. Not right but that's the pressure they are under. Ambulance and lots of hospital staff deal with emergencies on a much more frequent basis. I'm not saying that to excuse poor treatment when it happens, just a thought as to why these stories sometimes surface.

  22. I too have been called to an MI sitting in a GP's waiting room. We have enough problems trying to communicate with the Doctors in A&E, let alone take on the ones in the community……………. and how many Doctor's Urgents do you go to and end up putting in a Hospital Alert Message…..! How much do they get paid……

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