GP face-to-face refuseniks take note: If I can read your Twitter rants, so can your patients


There’s a picture doing the rounds on medical Twitter (it’s a thing – doctors love Twitter, many post incessantly) of a coffee mug with the words ‘Do not confuse your Google search with my medical degree…’ printed on it.

I get it. A little knowledge is a dangerous thing, and all that. The ease of access to medical info online means we civilians often get the wrong end of the stick.

But really, it harks back to the bad old days of paternalistic medicine. It’s very, ‘Don’t worry yourself with the details, sir/madam. Doctor knows best.’ That sort of energy.

I know, it’s a joke. But do they realise we can all see what they’re saying – that they’re not just writing to their GP colleagues?

The same goes for all those GPs who seem so incandescent at NHS England’s recent edict that they should offer face-to-face appointments if a patient requests one.

Front cover of GP magazine Pulse

Front cover of GP magazine Pulse

Agitprop approach: Front covers of GP magazine Pulse. In February, Pulse ran a front page that carried the words, in poison-pen-letter-style print: How the media created an anti-GP storm

Fairly reasonable, you might think. But not so, according to numerous GPs on social media.

Indeed, given the hysteria, you’d think they were being ordered to do something appalling – not just go back to a way of working a bit more like they did before Covid.

Over the past nine months this newspaper has warned of the harm being caused by the shift to remote consultations. These measures were brought in at the start of the pandemic, for obvious reasons, but have inexplicably remained in place ever since. Patients in their droves – I’ve never seen a mail-bag like it – have spoken up about being shut out.

Doctors themselves, in the Mail on Sunday, have argued that the system, in which patients are triaged by phone or online before being allowed an in-person consultation, is deeply flawed, even dangerous.

But a hardcore minority of GPs seem to have dug in their heels. They will not be told. They will keep on doing what they choose – seeing patients in person ‘where necessary’.

And in many cases, this will doubtless work perfectly well.

But we know there are pockets where the situation, for patients, is dire.

There seems to be a flat refusal to acknowledge this, or accept that some in their ranks deserve criticism. Instead, they say it’s they who are the victims: of a creaking, overstretched system (true, but more of that later) and of a media-orchestrated witch-hunt, which is utterly false.

One GP on Twitter wrote: ‘May 2020 hospitals at risk of collapse = clap for the NHS. May 2021 #TeamGP at risk of collapse = bash the GPs.’

Patients in their droves ¿ I¿ve never seen a mail-bag like it ¿ have spoken up about being shut out, writes Barney Calman (pictured)

Patients in their droves – I’ve never seen a mail-bag like it – have spoken up about being shut out, writes Barney Calman (pictured) 

Another warned: ‘Please stop the politically driven hate campaign. Many of us have quit after a wave of attacks and abuse from sections of the press and public. Pretty soon, there won’t be any of us left.’

And another: ‘Dear Patients. The reason you’re finding it difficult to get an appoints with a GP isn’t because we are lazy, workshy, scared of catching Covid, refusing face to face appointments, or any of the other b******t reasons reported in the right-wing hate pamphlets. The reason is… there are too few GPs, primary care nurses and the funding doesn’t go far enough. Next time you have difficulty getting an appointment don’t blame us. Blame the Government you voted for.’

That one got hundreds of shares and likes, mostly from doctors.

Occasionally, a civilian will pluck up the courage to post on one of these ranty threads something like: hang on a minute, my surgery has been welded shut since March 2020.

Doubtless, for every one of these, there are scores more patients, silently reading and thinking – how can I put this politely: how unpleasant these GPs are.

That bothers me. Doesn’t it bother the GPs? Maybe they’ve not considered it.

The hysterics are being led by doctors’ political group the British Medical Association, and rabble-rousing GP magazine Pulse.

In February, Pulse ran a front page that carried the words, in poison-pen-letter-style print: How the media created an anti-GP storm.

The June edition featured a sign in a GP surgery window saying Normal Services Resumed – with ‘resumed’ crossed out and ‘imposed’ scrawled next to it.

This agitprop approach, aside from being misleading, also seems inappropriate given the level of distress among patients and GPs.

A GP¿s assessment of a patient should begin the moment they enter the consulting room, says Barney Calman (file photo)

A GP’s assessment of a patient should begin the moment they enter the consulting room, says Barney Calman (file photo)

And Kate Mansey’s story shows so very starkly why these refuseniks are not just wrong-headed but – unwittingly or not – putting lives at risk.

Of course you could say, well, even if she’d been examined, the doctor may have come to the same conclusion. Abdominal pain is a fairly nondescript symptom.

But severe central stomach pain that eventually radiates to the lower right abdomen – as Kate’s brilliant 111 operator accurately called it, the right iliac fossa – is a tell-tale sign, if not the definitive symptom of appendicitis.

I know this thanks to, er, doing a Google. Should someone tell Kate’s medical-degree-holding GP? 

If that hadn’t been convincing, the week-long incessant vomiting and explosive diarrhoea should have been a pretty good indicator that something was seriously wrong.

As Kate said herself, she barely recognised herself in the mirror – she looked so ill.

A GP’s assessment of a patient should begin the moment they enter the consulting room: the way that patient walks, the colour of their skin and eyes, their general demeanour, all inform a diagnosis.

So yes, confronted with all this, Kate’s GP could still have mistaken her burst appendix for a stomach bug, or they might have realised she needed urgent surgery.

But that’s the thing, we will now never know.

As it stands, the trust that existed between Kate and her GP has been broken, I’d say irrevocably, because her GPs can’t possibly say, hand on heart, they did everything they could have done to help her.

It’s a story we are seeing repeated over and over.

And that is the tragedy of what’s going on right now – or at least, another tragic outcome.

Some tweets have been really worrying, with GPs clearly in distress. Dreadful, but... they¿re still tweeting many, many times a day, writes Barney Calman (file photo)

Some tweets have been really worrying, with GPs clearly in distress. Dreadful, but… they’re still tweeting many, many times a day, writes Barney Calman (file photo)

No one is under any illusion that the situation was perfect before Covid. Primary care was already short of thousands of GPs, while patient numbers spiralled. But in the majority of letters we received, readers said the same thing: they had all been perfectly happy with their surgery until March 2020.

As I’ve mentioned, the new online eConsult system is also causing problems. Amid all this chaos, GPs report being at breaking point due to the influx of email forms. Patients are bombarding their doctors with banal questions – ‘Should I go on a plant-based diet,’ was a recent fave – which all have to be read fully so nothing’s missed.

As one GP I know said, they didn’t sign up to work in a call centre. Many find working remotely unsettling, because they’re worried they’re going to miss something, so I find the reluctance to return to the old methods doubly baffling.

Some tweets have been really worrying, with GPs clearly in distress. Dreadful, but… they’re still tweeting many, many times a day. Sometimes hourly. Surely doctors should know how mentally damaging heavy social media use is?

And, again, I’d remind them: your patients are probably reading what you’re writing.

My advice: log off. Better still, delete the app.

Resolving this mess will be tough. And constantly worrying about what’s happening on Twitter is only making it harder.



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Written by bourbiza

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