A Good GP

I often moan* about GPs mostly it's when I go to a really sick patient who is sitting out in the waiting room. On more occasions than I can count I've been called to someone who looks like they are having a heart attack and the GP is nowhere to be seen – instead they are dealing with a nasty case of nappy rash.

I understand that GPs are under time pressures, but sometimes the care that people who are actually sick receive makes me spit feathers.

So when I meet a GP who knows what they are doing I feel like shouting it from the rooftops.

I was sent (miles out of my area, but that is nothing unusual) to a person having an allergic reaction in a GP surgery. I've got to admit that I fully expected to walk in and see the patient sitting in the waiting room clutching a letter from the GP, a GP that is hiding somewhere.

But no.

Instead the GP had recognised a fairly severe systemic allergic reaction. He'd laid the patient down, was giving oxygen and, by the time we had arrived, had given two drugs via injection and put an intravenous line in. Because of the GP's actions the patient's allergy was resolving nicely.

And the GP was incredibly polite to my crewmate, the first responder and myself. I've got to say that I was mightily impressed with the actions and attitude of this GP. The GP had also made some suggestions as to what had caused this new allergic reaction and had all the patient's notes printed out for us.

The only thing about this that is a shame is that I find it so surprising and unusual to come across such a good GP. I'm always aware that I only tend to go to the bad GPs and that the area in which I work probably isn't high on the wish-list of jobs for GPs who can interview well elsewhere.

Still – it is nice to see someone else out there doing a decent job in a crappy system.

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*And the first person to go 'oh really…' in a sarcastic manner gets a damn good thumping.

19 thoughts on “A Good GP”

  1. “the good is oft interred while evil doth live on” as the Bard mentions.The good ones fail to get a fair share of the comments, the evil ones doth hog our attention. 'tis a weakness of the human psyche.

  2. Maybe because the GPs are really good, you dont usually goto them? Iv had a simliar experience with one of our GPs – a locum though – she noticed that I was having an allergic reaction to my insulin (not good), and she immediatly gave me epi (?) and called me a big white taxi, and sat with me for 10mins and talked to me, instead of shoving me out of the door and sending the next patient in, even thoguh she ran late for the rest of the day and missed her train home!

  3. My first jobs in the NHS were in GP surgeries, and only one had an emergency situation procedure/plan. We all had a part to play and looking at it from a (nearly) registered nurse perspective, it really was an effective procedure – for some reason there were a lot of patient's in the area that want to have heart attack/anaphylaxis/severe asthma attack on our premises. But all of the Drs were adament that that persons care came first. And any patient in the waiting room who moaned had a letter sent to them stating that inapropriate behavior was not tolerated…blah, blah, blah. But as I say that was 1 of 4 places I worked….Glad you managed to meet a GP who understands what care actually is….

  4. We do not have oxygen at our surgery, nor do we have any IV fluids.This is because we are so near to the hospital and also there is no supply available to us short of a bit of theft! The drugs we stock for emergencies go out of date. I've suggested many times that all GPs should have a central supplier so that they could have the relevant drugs etc without having to buy a whole box of each, it's such a waste.We are very polite and friendly and grateful when we have to “entertain” LAS, Dr and nurse on hand, summary printed, referral letter, x ray form and bloods taken if appropriate.Trouble is, LAS (being nearby) tend to turn up so fast we have to run around getting the bits ready only to find the ambo has already arrived!

    Would not dream of dumping patient in waiting room.

    All this amounts to common courtesy to both patient and LAS staff, you don't need a medical degree to be a)caring,b)polite.

  5. Your story is very similar to the situation in a not so distant county.I have been to many a Barn Door MI who was just sat in the waiting room waiting for his ambucab, and yet we also get called out on emergency for a minor trivial ailment that 'obviously needs and ambulance'!

    Drs are a bit like marmite – you eiother love em, or hate em!

  6. oh really…?;-)Sorry, I was just appalled that there were 7 comments already and no one had done it. You can thump me if you like.

  7. I was rather shocked too. In fact I was planning to do the deed if no one else had. But would you have been prepared to come all the way to Lancaster to administer said thumping?

  8. Shame you can't name and unshame the good ones :)Still – might be worth dropping a line to the clinic with the URL, if they have a website with an email address. One thing that definitely increases good behaviour is publicly recognising and commending it.

  9. We went to an elderly lady whom a GP had visited at home.A first responder was on scene by the time we had got there and the GP had just left before we arrived. The GP had her notes and knew the lady.

    This 999 response was due to the lady suffering with D&V and the GP had booked her into the Medical Assessment Unit (MAU) – bypassing A&E.

    We got her onto the ambulnace and began taking some history ourselves such as, 'when was the last time she had either D or V, to which she replied she'd had neither.

    All she had had were terrible pains in her back.

    We very quickly ascertained she ahd an abdominal aortic anneurysm which needed immediate surgical attention, so we duly alerted the nearest A&E & bypassed the MAU.

    It was known to the GP that she had an anneurysm, but he neglected to inform us of any such history.

    The lady was in surgery within an hour of our arrival – damn we're good!

  10. Write some letter of commendation to local trust – make the point that they're doing far better than everyone else. Maybe you'll get more like that

  11. Whenever I go to the doctor with a scheduled appointment, they are running late. They have a duty doctor who takes care of people who are ill “on the day” and other doctors have appointments. I don't mind though – I'm quite sure I've had more than my 10 minutes on occasions. These things happen. I'd rather everyone got decent care.

  12. I like your style 'Angry Tech'.I feel like an Angry Tech most of the time, whixh is quite dangerous.

    Haven't seen you on the blog before and tis nice to see a name which makes me chuckle before I read what's been written!

  13. Good analogy, marmite….I think this must be a country wide thing with regard to GPs, we have several in our patch that are brilliant, they have everything ready, they are with the patient, I have even heard of a GP on a home visit, calling us and then stating to the patient and family that “in an emergency never call a GP, call an ambo because they know what they are doing” Apparently she was visibly relieved to see the crew too.

    And then you get the “waiting room” GPs, who put the patient out in the waiting room on their own with chest pain. Or on more than one occasion from the same surgery, a chest pain at 14.00hrs, when we arrive the patient is pain free, on further questioning they had pain about a week ago and haven't had it since, it just took that long to get to see the GP. Am I cynical to think that the time of the surgery closing for lunch had anything to do with these very similar jobs?

    And then you have the “others” who look down their nose at you, now I know that I have not had the training that they have, but then I didn't want to be a doctor. They then say “well they will need a chair obviously”…. well chappie, we are not about to come into your surgery with the entire contents of the ambulance just on the off chance the patient might need it, we are medically trained, we can assess patients for ourselves, we will do this, we will do our own obs and then we will work out the best course of action, we might feel that the patient needs a trolley not a chair.

    Sorry as you might have guessed I met said GP yesterday and I am still a little warm under the collar about it….

  14. My personal favourite are the (usually out of hours) GPs who diagnose and prescribe antibiotics for chest infections OVER THE TELEPHONE!!!!! We pick up loads of them. Just amazing.

  15. It is always heart warming to see people who actually take pride in their work, and get on with the job despite the difficulties presented by the system.If I get sick I hope that I meet people like you Tom and the GP you mentioned.

    The driving instructor

  16. ::waves::i've been popping in and out, on and off for a while

    Great work with the blog, TR!

    Some GPs still never fail to astound me.

    A fellow tech and I were called to a surgery a few months ago. We were already out of place due to the need to pull us into a busier area for cover.

    Breathing difficulties due to asthma. I imagined it to be a bit of taxi run that needed keeping an eye-on. I had to interupt the receptionist to ask where the pt was. She pointed behind me to the waiting area where i found our patient (and friend). It was obvious which was the patient. Her colour was appalling and she was struggling! She was clutching the familiar letter. Well thank goodness… :;eye rolling moment:: Having lobbed ordinary oxy on (my colleague had gone for the chair) i hurried back out to the vehicle to get the salbutamol. I returned to the waiting room to find that she'd now been moved(WALKED, would you believe) up the corridor to the treatment room. I'd already been rather short with one of the receptionists. The doc appeared saying she was fine and had been given oral steroids a while back. It was doing nothing for her.

    I muttered something about following OUR protocols and carried on. I managed to draw breath at some point and apologise for being short with the receptionist(To the said receptionist). She nodded. saying”It's ok. It's the doctor isn't it?”.”Yes”. Someone must've said something to one of the partners as she appeared as we'd got our pt. in to the vehicle. I explained we were both EMTs and were tied to giving only salbutamol. And if i was a para i would do more.She was quick to see that more was required and she gave steroids(hydracortisone) IV directly.

    As she exited our vehicle she said she'd “sort things”.

    We moved our lady quickly the 26 miles to our nearest A&E.

    You can not be mucking about with people with breathing difficulties when so far from a district general hospital(DGH)

    I saw her a few weeks later in our chippy (spot the healthy diet the ambulance services follow – haha)

    They hadn't exactly kicked her out straightaway. Thankfully, she was looking good now… then.

    Job done – no thanks to the first GP.

    One of many cases.

    We get called to chest pains where doctors have left before we arrive. This goes against a nationwide policy re the treatment of cardiac-related chest pains.

    On quite a few occasions we are told “It's ok. They don't need blah blah blah” and we have to say

    “Yes we do. It's part of our protocols for such a case”.

  17. was this allergy case in Battersea?I'd always enjoyed really good working relationships with paramedics/EMTs with mutual respect- and have recently encountered some very good friendly and very capable paramedics/EMTs since i came to London 4 years ago. However there have been occasions when despite staying with the pt/ managing them well – the attending head paramedic/EMT have been INCREDIBLY rude – just like one of those old tyrant consultants who treat colleagues like scum and want to get you to play a power game. I used to get really upset as it is so distracting from pt care. (..and if it continued would have started hiding when the crew entered the surgery i think….unless the pt was very sick…). When they'd starting arguing with the working diagnosis – it was tempting to try to contact them when it turned out they were wrong….but life's too short..

    It was always a pleasure to work with paramedics/EMTs in rural areas – where you'd see the same team time after time + strike up an ongoing working relationship. I was starting to think it was one of the downsides to working in London – you get spat upon by the ambulance service + just have to take it on the chin.

    Happily in the past year the teams i've met have been really great – have appreciated my input + have put the pt first

    I totally agree with you – if GPs + primary care are not putting the pt first then there should be a way of easily reporting a 'significant event' – which is the best way of everyone learning and pts not being put at risk in the future

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