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Agreed, but you would hope that a clinician wouldn’t fleece you
I always chuckle at the receipts/reports that patients bring to me when they've been on a cruise and had a mild case of diarrhoea and vomiting.
Observations are fine (blood pressure not too low, pulse not too high), and they're keeping fluid down.
Reasonable treatment would be a pat on the head, a glass of water or dioralyte, and reasurance and time.
"Cruise doctor 2000" treatment: Multiple blood tests (get sent off to a lab from the next stop), IV fluids. IV antibiotics. 2 days in the medical bay.
It's VERY easy to spend an insurance companies money why a clinician will benefit from it....
DrP
My mother saw the cardiologist in lancaster, I accompanied her on many appointments. I thought the service was amazing and very honest. Even when I took her to a and e there, despite being told off many times, the service was amazing.
Re private tests, I m in Spain ATM and paying for private blood tests, all routine but for me, well worth the investment. I could ask I suppose in uk, but q happy to go to private doc, get him to decide what I want, and get him to explain result. Paying, I can go tomorrow.
My private doc here in Spain refers to me as the worried well, I m q happy to take it and see it as a compliment.
Bottom line is, do you want me seeing patients, or do you want me reviewing documents that have been sent to me?
Bear in mind that I can’t do both.
If you're not being asked by a medical professional to do something specific that a medical professional needs to do - then I'm happy for your administrators to do the administrating. HTH
Yes, follow up outpatients appointments and clinical curiosity seem to have disappeared. Which is a shame both for patients and the clinicians. Following people’s progress and their gratitude is what makes the job so rewarding.
In a different, but similar system, I'm currently observing a project where developing criteria for public cardiologists to refer outpatients back to their GPs - the idea being it frees up the cardiologists to deal with new patients and reduces the waitlists. Simply throwing more doctors at the problem won't work, you have to come up with smarter ways of working.
There are lots of patients that attend 6-monthly/annual reviews for no real reason.
Key to getting this to work is developing good management plans that the GPs can actually use; presumably not the 10-page epics that Kramer is fed up with. That involves working with GPs to get it right... And if we can get it to work well with Cardiology hopefully we can spread it further.
If you’re not being asked by a medical professional to do something specific that a medical professional needs to do – then I’m happy for your administrators to do the administrating.
The ultimate responsibility for the safe transfer of care (and the professional consequences for errors/miscommunication) lies with the doctors involved, and many of them will want to review all these letters etc personally to make sure nothing has been missed.
2 days in the medical bay.
Isolation and observation might be appropriate on a cruise when it wouldn’t be at home.
Your correct course of action, as per NHS guidelines, is to lie down quietly and die, and not bother anyone with a phone call.
Sorry - somewhat jaundiced (??!!) viewpoint this morning having tried to get in touch with GP to make an appointment and received message - try again at 8am tomorrow. Am I "worried well", or do I have an early symptom of cancer? I'll find out eventually. One way or another.
Exactly, D and V at home is not going to spread around a cruise ship on 1,000s of people.
OK, I'll give you that!
However, and I'm aware there may be hard and fast rules, but a patient could isolate in their own room, OFF the clock of the expensive medic!
If you’re not being asked by a medical professional to do something specific that a medical professional needs to do – then I’m happy for your administrators to do the administrating. HTH
This was trialled in our area... the end result was that it didn't really work. Ultimately, dare i say it, it kinda needs all those years of training to figure out what is and isn't important in clinic letters too...
Ideally there'd be a set structure/format of clinic letters, with a big 'button' the DICTATING doctor has to initiate, that would then make that letter be put in front of another doctor for prompt action. If you don't trigger that process, then the letter is automatically filed. And responsibility lies with teh dictating person, NOT the receiving person in that case...*
DrP
- - though i can 100% garuntee ALL letters will fit this criteria - no one wants to be the last person holding clinical responsibility!
I don’t blame people for thinking it’s better, after all if you’re anxious, the more that’s being done, it feels the better.
And thats where I was at with my cardiology investigations.
Consultation first, explained the tests I could have, they explained that none were conclusive, but explained the evidence base etc. He even said I probably wont need a CT scan, and there is increased risk with a CT, but there are also benefits to having as much info as possible.
Call it placebo or whatever but knowing that my heart is in reasonable good condition is very good to know and I am sure brings other health benefits. Unfortunately on the NHS I wouldnt have even got an ECG let alone echo.
One of the sides effects of being put on a Statin is that my liver function test are now abnormal. I am now on the waiting list for a scan, but I dont know how long that will be. Its been 4 months so far. I could book in privately tomorrow for the same scan, save the NHS money, and then present the results to the GP. I see that as only helping my GP maintain my health.
All I’m going to say is that one of the biggest and most valuable skills in medicine is knowing when to do nothing.
One could say that is what we specialize in as GPs. It’s almost certainly how we add value.
Interestingly, the history of specialism in medicine arises from private healthcare systems where they realised that it was more profitable to charge for doing something than for a consultation where reassurance only was given. From that it arose that people would pay more for “specialists” and then “super-specialists” and thus the higher status of the specialist over the generalist.
And responsibility lies with teh dictating person, NOT the receiving person in that case…though i can 100% garuntee ALL letters will fit this criteria – no one wants to be the last person holding clinical responsibility!
1) Having DrP and DrJ on the same thread is confusing! I can't remember which one is the doc and which one is the basketballer 😆
2) Yeah, this is a generic thing across many professions where no-one wants to take responsibility. Kramer's comment about knowing when to do nothing is in this vein: sometimes you just have to say that, but it's easier to vaguely assign some random action item to someone else and they need to bat it back. Unfortunately many professions don't teach accountability.
The onus is on the letter writer to be absolutely clear on what they want to happen: does someone need to do something (and if so what, and by when) or is this just for the file? "FYI" should be a banned concept - there is no point in telling someone something else you want them to do something with that knowledge. There is more information in an average Inbox than anyone could ever possibly read or understand.
Having DrP and DrJ on the same thread is confusing! I can’t remember which one is the doc and which one is the basketballer 😆
Surely it's obvious from the quality of our comments on medical matters. And basketball.
The onus is on the letter writer to be absolutely clear on what they want to happen:
In a safety critical system, which is what medicine should be, the onus is actually on the letter writer to make sure that the action has actually happened. And if they’re doing that, they may as well action it themselves except in truly exceptional circumstances.
Having DrP and DrJ on the same thread is confusing! I can’t remember which one is the doc and which one is the basketballer
I HAVE been known to dribble a bit, and whoosh my balls around with style and grace....
one of the biggest and most valuable skills in medicine is knowing when to do nothing.
Absolutely.. it's the cornerstone of our job. But we're not doing nothing because we don't know WHAT to do.. we're CHOSING to do nothing.
It's why i'd struggle if we had a system whereby patients paid to see me.. I worry they'd fail to see the value is in my assessment and management plan, and not necessarily in giving/doing something.
DrP