At this time of year, it would seem to be the done thing for those who consider themselves to be experts in their fields to produce a list of 'predictions' for the coming coming year. If you've already lapped up the former Northern Rock CEO's predictions for global credit conditions, and you just want more, more, more - we present:
Dr Rant's Prophetic Prophecies 2008 ™
1. Alan Johnson to be found alive, and living in the wild with a troop of Barbary Macaques. For a while, we thought that no one had been selected to replace our dear Patsy Fuckwitt and for all intents and purposes, that would still appear to be the case. However, whilst gazing into the bottom of my mug this morning, the tealeaves were giving me a distinct 'Postman Pat' vibe, and I feel that 2008 will be the year Alan says/does something.
2. The MTAS junior doctor job application system to be replaced by a new Saturday evening BBC one reality show (hosted by Graham Norton) entitled "Any Job Will Do". 30,000 medical graduates from around the world will be whittled down do one, with the lucky winner given a job working for connecting for health as PA to Dr Simon 'Judas-Badger' Eccles.
3. The involvement of private companies in Primary Care, through APMS contracts, will be proven to be the disaster for patients, the taxpayer and healthcare workers that we all knew it would be. Did they listen? Like fuck they did! More specifically, the first and most obvious example will be the folly of awarding of the contracts to run two practices in Derbyshire to a private company instead of the doctors who were actually working there and making a difference.
4. The Conservatives to actually come out with an actual health policy. As improbable as it may sound, it will happen and I'm prepared to stick my neck out on this one. The current policy, of letting the shining beacon of fuckwittery that is New Labour's health policy illuminate itself for all to see, may be politically astute but there will come a time in 2008 when Dave will have to put his nuts on the table. Dr Rant knows exactly where in the shed his hammer is, so it better be good!
5. The third consecutive 0% annual increase in GP practice incomes. Practice staff like nurses and receptionists won't be getting a 0% increase from their GP employer however, so that means another take home pay cut for GPs. But, when one considers that we play golf all day and take home a quarter of a million quid, it doesn't matter really.
Dr Mustard demonstrates BMA approved Advanced Political Activism Techniques6. Fight! Fight! Fight! Fight! There will be blood in the corridors of Whitehall because Gordon's picked on the wrong group of 40,000 professionals this time, and GPs aren't going to roll over and play dead. We will not do more work for less money, and neither will we chase political objectives instead of doing clinical work that has been proven to actually make people healthier. Opening on a Saturday morning may win Clunking Clunker a few votes, but it won't really make anyone healthier, and if opening on a Saturday morning comes instead of during the week, those who need access will lose out to those who want access. The resistance is getting organised, and the GPC are standing firm. This is one battle Gordo and the DoH admindroids aren't going to win. Of course, that nice man Dave might find it all interesting, assuming his nuts haven't been flattened by a GP with a hammer........
Dr Rant
Dr Cardigan
Dr Blue
Dr Brown
Rev Dr Green
Dr Mustard
Mr Orange
Dr Pink
Dr Purple
Mr Salmon
Dr White
Mr Beige
Ms Scarlet
Dr Informed
50 comments:
A happy new year to all at the ranting shack - keep up the good work for 2008!!!
It's Tuesday!
Happy New Year.
To the barricades, chums. This is one thing that patients can understand! The prats in power thought that spending £11million on a biased and dire questionaire would have all the punters voting for Christmas opening and hanging their GPs. Instead of which 84% of the 2 million replies were happy as they were. Write your MP. Don't waste a stamp on them, they wnat 10% raise themselves! Use the interweb email system thingy. The more reasoned rants they get from GPs threatening to tell their voters what airheads they are the more they will get a pain in the marginals. They might even speak to boring gordon.
Fight Fight Fight..........I am one of the 84% who is satisfied 100% with mmy G.P and the opening hours.........they are just trying to get back at you guys for "doing them over" with your contract for which they were in agreement with............
Get politics out of the NHS as well as goldigger managers who come in, mess up and F*ck off with mega golden handshakes.....we need commited and loyal folks in the NHS management like we have in the clinical side......
Alan Johnson saying/doing something this year? Good luck with that...although on past experience of former union officials that sold-out and joined the dark-side (a.k.a. "New Labour") I think we may actually be better off if he keeps his gob shut...
My message to the GPC is "Bring it on!" and see how far it gets you. I can see the headlines now: threats of mass resignations from the NHS, non-cooperation with the Government. Sorry, but they won't have the public on their side this time.
Yeah and look how much it hurt the dentists...they are all living in cardbaord boxes now.
If the public are not onside (after being informed of the why and who of the situation) then they are going to get a hard deal either way.
If they support the gov and things do go all the way then the doctors get drafted in to work for the DoH will be a real improvment for them...
the folly of awarding of the contracts to run two practices in Derbyshire to a private company
to ChilversMcRea, aka 2 GPs (who have formed a private company). Were the practices Creswell and Langwith? Why, do you know, were they 'sold' to ChilversMcRea rather than to the doctors in situ? (One obvious explanation, of course, is that CMcR are using salaried GPs, as opposed to the Partners running the surgeries previously. If so, shouldn't you be saying something about these blackleg GPs?)
Also, why is this 'folly'? What have you got on ChilversMcRea (Drs Sarah Chilvers and Rory McRea)? I think we should be told...
John says: If 84% were happy, then 16% weren't.
That means every time you're in a room with 7 people, there's likely to be at least one who finds current surgery hours difficult.
Maybe they're a teacher, like me. How happy would you be if your children weren't taught becuase they're teacher had to take a morning off work to get to a routine appointment?
uncle dave has started talking about his "policies" sadly far too much about supporting the 3rd world nhs and far too little about giving the power back to the patients
one good thing he did say was that we will all be able to choose our own GP again instead of the one imposed by the PCT, thank fuck somebody has seen sense on that one
dont think politicans are going to solve the UK health mess, good old fashioned economics will be the only medium to long term solution
no one
Jayann
Chilvers McRea are under the microscope, and will be examined in more detail in the near future. They do not represent the the traditional ethos and soul of General Practice, and profit by providing a smaller proportion of appointments with real doctors. Currently they are struggling to find ANY doctors at all to work sessions. There is very little continuity available as doctors don't work regular sessions as they are locums. This deprives the doctor and patient of the greatest benefit of general practice - the 'safety net' of contiuity.
Why should a proper ongoing and lasting relationship between doctor and patient be the preserve of those who live in 'nice areas'? In Derbyshire, the less well off in society are getting a worse service because of political dogma driving their primary care provision into the private sector?
Finally, I think you'll find that Sarah Chilvers isn't actually a 'doctor' in the traditional sense of the word.
Frank
none of my extended family have had continuity of access to GP in any of the more traditional practises that they suffer up and down the country
where exactly are these fictional GPs who offer continuity in the current nhs? obviously the rants live in a rather different demographic to the vast majority of the rest of us
dr rant (Frank) many thanks for your reply.
They do not represent the the traditional ethos and soul of General Practice
oh that's pretty clear, they're Entrepreneurial GP Plus. But they might still have replaced substandard practices with something marginally better (I see they haven't).
I think you'll find that Sarah Chilvers isn't actually a 'doctor'
armed with that information, I found out what she actually is! Well well. (But Rory McRea is a GP... .)
anonymous, my GPs offer/provide continuity of care (during normal surgery hours, obviously) so did the doctors at three previous practices -- two in London, one in the North, one in Cardiff. I do though know that there are GPs who don't, and decades ago now, in London, I was registered with some GPs who didn't; it wasn't satisfactory at all. Also unsatisfactory, of course, is that if someone finds a practice that offers such care, they may not be able to register with it.
I might prefer them to be taught by a teacher that knows the difference between "they're" and "their", and might even be able to spell "because".
;-)
More seriously, I'm part of the 16%, but there is no way the GPs should be expected to provide this service without substantial resources being provided to them.
I can't help noticing that Chilvers McRea have been peering into the crystal ball as well.
What could be round the corner ?
Well, according to C&M its;
*more self care.
*more points of access [? supermarkets, etc].
*more private funding.
*more private provision.
http://www.nhssb.n-i.nhs.uk/org/files/nursing/conferenceMarch2006/sarahChilvers.pdf
Getting the picture ?
I couldn't get that page, but the more self care thing's been floated recently: we get to manage our own heart conditions to save GPs' time (I can't now find the story, sorry). It's an extension of the allegedly successful Expert Patients' programme, I should go to about 5 of those but suspect they'd be bad for my blood pressure...
*more points of access [? supermarkets, etc].
Probably pharmacists though I may have underestimated the pharmacy lobby, there's a story that Boots are going to run all the 150 health centres, one per PCT, that Darzi's proposed.
More private more private more private, well yes... I fear and dread this.
Thanks for reading their stuff, I did notice they go to a lot of conferences sounding off about how to provide medical care (as opposed to providing it themselves, and presumably they're too important to see patients now) but was too fed up to read it myself.
If private companies are to be involved in primary care, how does that fit with patients being discharged to primary care for chronic condition management?
I've posted about my rheumatology appt today, http://benefitscroungingscum.blogspot.com/2008/01/please-sir-i-want-some-more.html
though I'm sure you know all those problems already. But, not having been for what we managed to find out from the notes was 15 months instead of 6 it did seem much worse to me. Any predictions for this kind of area?
Bendy Girl
We have a local walk-in centre in a Boots shop. I went to a meeting at which a nurse from there said "we can do anything a doctor can do". I've never been there since. I want to be treated by people who know their limitations.
ah but the nurse is reflecting the reality of how little many GPs actually do, or more often their locums
refer to an infinite waiting list or dish out antibiotics, what other skills does ur average GP bring to the table?
Shit you're right.
Let's all go home and do something more worthwhile...
'refer to an infinite waiting list or dish out antibiotics, what other skills does ur average GP bring to the table?'
Sounds like the sort of self-righteous wanker who has bugger-all wrong with them and only ever goes to the doctor's to moan about the NHS and demand antibiotics for their viral infections. Tosser.
Well, anonymous, my GPs have diagnosed all sorts of problems, and referring to a specialist requires a knowledge of which specialist to refer to. I've had an eventful life with many accidents from the top of my body to the bottom, and sadly I've also inherited a fair few physical and mental problems. I went through a phase also where I seemed to go down with every ailment coming my way. As a result, I've seen an amazing number of doctors and nurses, here and abroad, civilian and military. I've seen some fantastic nurses and when they do their job well, they have skills that many doctors don't have, but their diagnostic skills are largely limited to one or two specialist fields. I see a GP because he has a rounded view of my health and can spot all sorts of things.
My GP isn't perfect, and he annoys me sometimes. But he's a damn sight better than the alternative.
My dentist has a fantastic nurse. She's extremely good at her job and without her my dentist couldn't do his, but I wouldn't want her doing my fillings.
Dear Anonymous teacher:
Two things: 1) appointments in my surgery are available at both 8am and after 6pm. I refuse to believe that no doctor consults after 4pm in your local surgery.
2) Teachers have the longest holidays known to man.
Mind you, as we will apparently only either refer you or give out antibiotics, why would you bother?
Dr Rant, I was at med-school with Simon Eccles, and he was a right prick even then, but I'm curious to know what he's done to deserve the splendid epithet "Judas-badger"! Can you enlighten us?
rahere why the fuck do you think everyone works so close to their GP that they can make it back to the odd surgery that stays open to a really late time like 6.00 pm, for fucks sake
and yep i can point you at quite a few GPs that dont open past 4 pm, well theyre open but only a receptionist there till 5.30
once again you lot showing your total lack of understanding of how crap GPs are from the customers point of view
the sooner we can self refer to consultants and get anti biotics from the pharmacy like many places in europe the better
fuctards
no one
John says:
Sorry for the typos.
I think commenters on this thread who criticise teachers' holidays have little right to complain about people who think that doctors all earn massive salaries and spend their days on the golf course - please don't let this turn in to a trading of stereotypes.
More seriously - if I teach from 9 to 4, and have work to do in school to 5, and an hour commute, then a doctor who's only available from 8 to 6 isn't useful. If the surgery is next door to work that's fine, but then they won't be local when I'm at home.
And even if I don't teach first thing, or can leave early, that leaves me with no flexibility.
How much additional compensation do you think teachers deserve for all the late (6/7 to 9/10 pm) evening sessions they're called upon to do - parents' evenings; open evenings; plays; concerts etc. Personally, I'd much rather do such things during the day, but we're told that we can't reasonably expect parents to work that flexibly...
And maybe if some daytime surgery hours were switched to evenings/Saturdays, that might discourage so many of the chronic abusers of the system ranted about so entertaingly here?
John,
I appreciate that it's easy to say teachers have long holidays, and that may be as much of an old chestnut as saying GPs all earn 250k and play golf all day, so your point about trading stereotypes is a good one - that wasn't what I intended and I apologise! Your specific cicumstances may make it more difficult to get an appontment than many of my commuting patients find it, but you specifically said "routine appointment", and I would respectfully suggest that your holidays come round often enough that regular BP or diabetic checks, for example, could be planned to coincide? I know that saying this will appear to some to be trading stereotypes again, but it's not intended to - rather I would draw attention to that word "routine", because it's the blurring of the boundary between that and "unscheduled" that seems to be causing many of the problems - we simply cannot provide both to a high standard 24/7. Nulab are about to take advantage of this fact by allowing Tesco et al to get their feet firmly in the door! As we are shortly to be forced to provide evening surgeries until 8pm, I suspect we'll find out whether your theory that chronic abusers of the system will be discouraged is right - as I also do a fair bit of out of hours work as well (not being one of the mythical £250k GPs!) I am afraid that it's not looking good on that front! The only thing that is stopping them over-running unscheduled care as well is that there remains enough distinction between out-of-hours and routine to allow me to be firm about refusing to do things that are definitely "routine" when it's 10pm on a Sunday....No doubt "no-one" would think this makes me a "fuctard", but if we are going to dismantle that distinction without having a sensible debate about the ramifications of doing so simply because it's become too easy to portray any dissenting doctors as venal and self-interested then I really do fear for Primary Care. If it really was just about having later GP appointments, then it would be difficult to argue with (provided it was properly resourced), but there are so many things that follow on from this apparently simple plan and how it's being implemented that the entrenched views of both sides risk a truly damaging Pyrrhic victory for whoever "wins"...
No one.
Hope i'm not too straight forward foryou but your a lying dick.
I worked at practices in Coventry and surrounding areas...not ever did i work at one (or know of one) that stopped seeing patients at 4.
(oh and i lived in one of the "inner city areas" you so often go on about...sorry to say not all doctors start off with money in the bank.
Maybe on the study/ admin day you tried at 4 and were told to stop being a botherer.
Coming from both sides of the medical fence (wow even medics need to see the GP at times) i can say your an exception rather than a rule (maybe they just don't want to see a swearing belligerent "fucktard" like you after 4).
1. It is not stereotyping but an incontrovertible fact that school teachers have long holidays. The state school entitlement to education is 38 weeks a year which leaves 14 weeks holidays. Private schools tend to have even longer holidays. Lots of teachers do some work in the holidays e.g. running sports activities and staff in senior management often come in to work for some of the time but to suggest that there is no time to make routine GP appointments or kids would be left without a teacher is ludicrous.
2. If a less routine but not urgent appointment is called for, it is hardly beyond the wit of man/woman to go early i.e. after the kids finish lessons and defer the paperwork just like other people do.
3. Teachers have a very high rate of sickness absence and so there is ample evidence that lots of them do not find it impossible to take time off work for more urgent appointments.
John says: If 84% were happy, then 16% weren't.
That means every time you're in a room with 7 people, there's likely to be at least one who finds current surgery hours difficult.
Actually, it would be less, as they couldn't get there.
Anonymous said...
I might prefer them to be taught by a teacher that knows the difference between "they're" and "their", and might even be able to spell "because".
Fucking Barclaycard mate!
Nutty said... We have a local walk-in centre in a Boots shop. I went to a meeting at which a nurse from there said "we can do anything a doctor can do". I've never been there since. I want to be treated by people who know their limitations.
Experienced nurses can do 80% of an experienced doctor's work. 10% of the remainder is bound by legal provisions such as prescribing or by the patients reluctance to accept anything less than 'doctors orders'. 10% is absolutely and totally worth the skills and knowledge of a doctor over a nurse.
I already do much of my doctors work. I order up routine tests, diagnose simple ailments and complex needs relevant to my specialism and recommend pharmaceutical treatments based on my own skills and knowledge. It is not impossible for a nurse to sepcialise in a particular area and learn as much as the constultant knows. In my current role I modestly inform, I know more than my consultant does in many different areas of the job. He excels in only medicine. This is because I have 14 years post-grad experience and have used that to learn and practise in many different methods. He has 6 years in generalised health, and one year only in the specialism we work in. Do not patronise nurses as being unintelligent Nutty. We merely work in our own spectrum, which includes, as a part, medicine. Many nurses also provide non-pharmaceutical therapies which are clinically evidence-based best practice interventions such as cognitive-behaviour therapy. (No, I don't do therapeutic touch, aroma therapy or homeopathy).
It is also well known in medicine that experienced nurses teach junior doctors on the wards.
ah but the nurse is reflecting the reality of how little many GPs actually do, or more often their locums
No, the nurse is actually usually pretty supportive of the doctor's role. But the nurse has a job to do aswell.
refer to an infinite waiting list or dish out antibiotics, what other skills does ur average GP bring to the table?
There's a 10% (guesstimate) need for specialist skills of a GP to pick up rare conditions, as well as provide care to complex +/or chronic conditions (the genuine fat-files – not your malingerers). That is where GP's should be supported to focus most of their attention and time. But even training nurses up to do more GP work is not giong to answer the problem for the GP, as they will have to pay them commensurate to their skill and duties. To ease the pressure, the worried well (at least ?30%) need to get a grip on themselves and their health issues and stop wasting ALL of healthcare's time- like the one's TTWO describes:
The Truth Will Out said...
Sounds like the sort of self-righteous wanker who has bugger-all wrong with them and only ever goes to the doctor's to moan about the NHS and demand antibiotics for their viral infections. Tosser.
Nutty said...
Well, anonymous, my GPs have diagnosed all sorts of problems, and referring to a specialist requires a knowledge of which specialist to refer to.
Who you think supports the specialist? Nurses know, recognise and can spell all the relevant specialists and their purpose.
I've had an eventful life with many accidents from the top of my body to the bottom, and sadly I've also inherited a fair few physical and mental problems.
Hmm.. I smell a fat file.
I went through a phase also where I seemed to go down with every ailment coming my way. As a result, I've seen an amazing number of doctors and nurses, here and abroad, civilian and military.
A pretty fat fat file.
I've seen some fantastic nurses and when they do their job well, they have skills that many doctors don't have, but their diagnostic skills are largely limited to one or two specialist fields.
Actually, nurses can do all the same diagnostics that doctors do. Pathology labs do the rest.
I see a GP because he has a rounded view of my health and can spot all sorts of things.
The nurses refuse to see him anymore.
My GP isn't perfect, and he annoys me sometimes.
Aww.. I bet he loves you. Does he send you flowers and appointment reminders if he doesn't see you in a week?
But he's a damn sight better than the alternative.
That being?
My dentist has a fantastic nurse. She's extremely good at her job and without her my dentist couldn't do his, but I wouldn't want her doing my fillings.
Ignorant cunt.
Rahere said...
1) appointments in my surgery are available at both 8am and after 6pm. I refuse to believe that no doctor consults after 4pm in your local surgery.
2) Teachers have the longest holidays known to man.
He probably means they're not there when there when he needs them cos they're out doing house calls for flu symptoms.
Anonymous said...
the sooner we can self refer to consultants and get anti biotics from the pharmacy like many places in europe the better
Why do you need a GP? You seem to know how to treat yourself? If you did you'd realise most ailments are preventable. Most anti-biotics are no more effective than symptomatic relief - when you have a week long flu, I bet you insist on a 7-day course of anti-biotics?
John says:
Sorry for the typos.
Tyhats oK/ Not like we'd expect you to be perfect. Like we do our GP service.
More seriously - if I teach from 9 to 4, and have work to do in school to 5, and an hour commute, then a doctor who's only available from 8 to 6 isn't useful. If the surgery is next door to work that's fine, but then they won't be local when I'm at home.
You're never home; you work all the fucking time.
How much additional compensation do you think teachers deserve for all the late (6/7 to 9/10 pm) evening sessions they're called upon to do - parents' evenings; open evenings; plays; concerts etc. Personally, I'd much rather do such things during the day, but we're told that we can't reasonably expect parents to work that flexibly...
I work night shifts, weekends and evenings. Can you change the school hours to suit my needs please, depending which shifts I'm working next week? Maybe let me drop my kids off at 7am or wait til 9pm so I can pick them up from a late shift? Or maybe I can call you when I have to take my kid to the GP so you can schedule a routine lesson for a late night appointment?
And maybe if some daytime surgery hours were switched to evenings/Saturdays, that might discourage so many of the chronic abusers of the system ranted about so entertaingly here?
There aren't enough GP's to fulfil the normal hours – unless the GP pays for a locum who earns more than the practice partner. Switched? These are extra hours – to do routine examinations. Do you get the mechanic to open after 6pm because you can't get your car there during his opening time? Does your post office open late nights to meet your needs of 'flexibility'? Can you call your bank manager at any time and ask him to come out and see you cos you're a little concerned you might not be getting the right mortgage interest rate? Yet we expect GP's to do all of these.
My health is important to me, as is everyone's to themself. But I don't expect some poor bastard (or bastardette) to work his (or her) nuts (or ovaries) into the ground; especially when no-one else seems to have to. Oh, except nurses, police and fire who get rostered relief and unsociable hours pay for doing so.
Get fucking real.
Experienced nurses can do 80% of an experienced doctor's work. 10% of the remainder is bound by legal provisions such as prescribing or by the patients reluctance to accept anything less than 'doctors orders'. 10% is absolutely and totally worth the skills and knowledge of a doctor over a nurse.
I already do much of my doctors work. I order up routine tests, diagnose simple ailments and complex needs relevant to my specialism and recommend pharmaceutical treatments based on my own skills and knowledge. It is not impossible for a nurse to sepcialise in a particular area and learn as much as the constultant knows. In my current role I modestly inform, I know more than my consultant does in many different areas of the job. He excels in only medicine. This is because I have 14 years post-grad experience and have used that to learn and practise in many different methods. He has 6 years in generalised health, and one year only in the specialism we work in. Do not patronise nurses as being unintelligent Nutty. We merely work in our own spectrum, which includes, as a part, medicine. Many nurses also provide non-pharmaceutical therapies which are clinically evidence-based best practice interventions such as cognitive-behaviour therapy. (No, I don't do therapeutic touch, aroma therapy or homeopathy).
It is also well known in medicine that experienced nurses teach junior doctors on the wards.
In your fucking dreams
Can dreams be that 'fucked' anon ... Lol
anon 2
In my 14 years in medicine I have not come across one occasion when ANY nurse has taught ANY doctor on the ward.
Anonymous - do you now the difference between a dissecting abdominal anyeurism and a kidney stone ?
Of course you do
http://mousethinks.blogspot.com/2007/12/when-you-cant-see-wood-for-trees.html
I did not characterise nurses as being unintelligent. I am well aware that many nurses are very intelligent. I merely pointed out that a GP has had a training that they have not had in diagnosing a wide range of symptoms. I have come across many nurses with a high level of skills in one or two fields, but never one that has had a training in general practice to the level that a GP has.
As for having a "fat file", that's probably true, but it's not something to be ashamed of. Fortunately, my GP doesn't write me off just because I have had more than my fair share of ill health and injuries. I don't waste my doctor's time. I have seen my GP twice in the last twelve months. Most of my health problems were picked up on routine examinations or are the result of accidental injuries. But for those of us whose body and/or mind lets us down, it is important to have someone who can see the whole picture and can see the connection between different things.
At regular intervals, I see the practice nurse for various tests. Every time, the doctor has to be consulted on the results because the nurse doesn't know what to do about them (and it's a different nurse each time).
I have met many competent nurses, but not one with the breadth of skill and knowledge that my GP has.
I don't fawn over him. He's not perfect. He pisses me off sometimes. But I think that the training and experience he has count for something and I'm seriously worried that a system that lets people like me with "fat files" see a highly trained GP for free will disappear. Most of society won't care until they see their tax levels going through the roof to pay for extra home care for people whose health has deteriorated for want of joined-up care.
And when doctors do a dentist, watch people scream. Few people gave much thought to how important it was to have access to an NHS dentist. Now many people can't register with a dentist of any sort. The people that need one most can't afford a private one and because of the new pay structure, most NHS dentists won't take you on unless you've got a good dental history.
"Hehehehehehe", rasped the devil, rubbing his 'hands' in glee. "Divide and rule works every time brother poltards, see how they fight, fight, fight....hehehehe. Now, leave them at each others throats for long enough to make the punters terrified, then, call an election and they will accept McBigBoys with gratitude and flowers, heheheheheheh"
"I have met many competent nurses, but not one with the breadth of skill and knowledge that my GP has."
Which is why they are required; but not for every snivelling little ailment and meaningless "sick notes" and the like. As I said; 10% (guesstimate) of GP work requires a GP, hands down. 80% can be completed by anyone with sufficient medical knowledge, such as a nurse, as there are clinical pathways and routine tests that are always indicated by one symptom or another. GP's are not the only ones who can take a blood pressure, temp resps and pulse rate - by which many provisional cardio-respiratory diagnoses are indicated. Nurses also conduct neurological exams, blood glucose testing, mental state assessments. Personally, I even write qualified reports for the court for various legal processes.
GP expertise comes in when those symptoms do not correspond with the lab results (that usually indicates the course of treatment) or when an experienced practised hand is required.
Only time I've seen a GP in the last 3 years was:
1. When assaulted, for legal documentation.
2. When required for VISA purposes
3. Because the home remedies I had tried for otitis media (right up to trying the pharmacists recommendation) weren't working and I needed prescription only medicine (which I did while I was getting my assault documented).
That's not because I don't get sick tho it's rare (especially for the smoking ageing overweight and lazy bastard that I am) - it's because I don't think the GP is responsible for my health. I am, and I deal with my ailments rationally; not dependently. Some people do get sick and require that service. Many end up there because of stupidity (poor health promotion), rather than misfortune.
As for "seeing the connection between things"; there's a connection with the time you consume and the size of your file; whether that be genuine or malingering.
Continuity is important in chronic case management, but that doesn't necessarily have to be the doctor. I recently case managed the same guy for the 3rd time in 2 years with repeat admissions; I knew him better than the doc's and he was discharged a lot sooner than if the doc alone had managed him. The doc merely signed off on my actions.
Sorry but nurses do teach juniors on the wards...from where things are kept to the CCU nurse in charge who looks over the ECGs for the new doctors when the diagnosis is not obvious.
The thing is they help the doctors do their job but i would be very worred about the doctor hen the nurse is doing 80% of their work.
Tainted halo even my ITU nurse friends admit they know very little compared to the doctors they work with in the field of clinical medicine.
Me thinks you talk a bit of rubbish.
From the nurses who ask us as students about basic medical terms and procedures (these are not the new nurses) to those who record a BM of 1.3...and when you get wound up they say...it's ok it was 2.3 earlier!
The problem with a nurse being able to do 80-90% of what a doctor does is whether they can recognise the remaining 10%. A friend recently went to a walk-in centre with a rash and was told that she had chicken-pox. Several of us advised her to see a doctor, which she did, to find that she was having a reaction to medication. If you take certain anti-epileptics, you can get Stephens Johnsons syndrome, which presents as a rash and can be fatal. A diagnosis of chicken pox doesn't cut it. OK, that's anecdote not data, but it's there to illustrate my point. If a nurse is going to be the first point of access, he has to be able not just to do most of the work, but to recognise *all* the cases that have to be referred to a doctor, not just some of them.
This isn't about whether nurses do a good job. It's not about whether nurses are useful. It's not about whether nurses can make a difference to recovery. It's about whether a nurse can act as a substitute for a GP.
re "I worked at practices in Coventry and surrounding areas...not ever did i work at one (or know of one) that stopped seeing patients at 4." who mentioned coventry? not me, yes I have lived in Cov, yes I think their PCT is shit, yes some of the crap doctors working there should be struck off, no I wasnt thinking about Coventry when I made those comments about hours
wild allegations of lying to someone doing exactly the opposite are not really the way to learn from each other
no one
Go on then tell me which area of the country so i can do a more in depth search and prove you wrong.
You constantly reffer to Cov, which you say is shit. Having lived there and been a patient i disagree.
Come on no one, you need to do better. So far you are poor/ rich/ live in Cov but have a GP elsewhere and other things all of which don't add up.
I now put you in the troll with delusions catagory...you may have problems but i am inclined to think many if not all are in your head or due to belief you are due some sort of standard which exists nowhere in the world (unless you pay lots for it which you keep decrying).
Oh and i don't want to learn from you. You only have one point to make, don't do it very well and even when good points against your view are made you ignore them and repeat.
With such a hectic, complex, time demanding job how do you have time to post on here so often during the day?
oh dear so much ill will for so little reason
Re "do a more in depth search and prove you wrong" what like look up the opening hours for the GPs quoted on their PCT website? ignoring the fact that those hours are in fact pure fantasy for real patients? the only research worth jack is the real experience of real patients
Re "poor/ rich/ live in Cov but have a GP elsewhere and other things all of which don't add up." I am fairly normal, I know lots of folk who live a similar lifestyle to me, it adds up perfectly well, just because I have spent long slices of my adult life in one city does not mean that is the only place I have lived, and indeed where I live and for how long and why I move and how much I earn has precisely fuck all to do with you, I'm leading a legal decent life trying my best to contribute and make the best of things - the fact the nhs, and folk looking at the world through its world view, doesn't understand or cope with my lifestyle is very much an nhs problem not mine, the nhs needs folk like me much more than we need the nhs
Re "some sort of standard which exists nowhere in the world " if you've followed some of the discussions we've had here at Rantville and Crippenshire I think you'll find more than one occasion when even the most committed nhs advocate has caved in and admitted how much better its done elsewhere in the world, there is lots to be learnt from other places as even the rants themselves acknowledge, and yep had lots of great medical care elsewhere in the world - I like great - great standards do exist in some places
Re "(unless you pay lots for it which you keep decrying)." where do you get this bollocks from? I have no objection to anyone spending their hard earned cash on medical care of any kind if they so desire
Re "how do you have time to post on here so often during the day?" fuck all to do with you, and shows how little you understand of the kinds of lifestyle led in the real world
no one
So texperience of working in the practice is not worth jack?
I can make a couple of calls as i have friends who are GP's all over...maybe them telling me they don't see patients after 4 will change my mind.
As for me i guess i was dreaming about sitting in a room with a patient after 7?
As for the bollocks, you have often said your extended family and others you know cannot afford to pay extra for care so its not a valid option for many...when its pointed out to you that even if they had back thier NI it would not cover much of the costs they would incur if they had to pay you just keep spouting the same shit.
How does the NHS need you more than you it? If there were no more chronic disease then the NHS would be better...like saying if everyone studied harder then schools would do better but still if you left the country i'm sure it would pootle along just fine.
Actually i think thee are better systems in other countries...but they don't employ the system you shout about its either a national insurance sheme or part national part private. No country has patients going where they want with no waiting times to get whatever they want.
No one,
The sickening thing about the troll that has singled you out,
(clearly with disingenuous, pseudo non points, clearly, for the provocative and sadistic amusement of a bully),
is that you would treat him in the consulting room, with the same skill and care as anyone else.
That this troll has picked on you is a reflection on its true nature, not yours, and no one else is fooled by it either.
Try not to get drawn in, you have nothing to defend. Ignore it.
Anonymous said "In my 14 years in medicine I have not come across one occasion when ANY nurse has taught ANY doctor on the ward".
This is utter bull shit. Nurses teach juniors all the time. There is a range starting with all of the little practical thins that you are NOT taght at medical school (e.g. that insulin is given in insulin syrynges not 10ml normal ones) righ up to experenced nurse practitioners giving tips on their area of experteese (endoscopy springs to mind).
No wonder we get a reputation for arrogance with this kind of tosser speaking for us.
Wo,
That was probably part of it's intention. ;-)
I have a problem with so much anon posting.
Not that i am against what has been said of No one... i think he is a bit of a simpleton who cannot see the woods for the trees.
As a medical student nurses seem to hate us but on becoming juniors they seem to warm up...from then on as long as your nice and human i think they teach us loads on the wards.
I doubt the poster was a doctor or if so then a very deluded one.
Maybe anon posting should be removed at least if people post with the intention causing trouble we will know how it is (i.e. if one side pretends to be on the other and post flaming material).
Victim support, No one is not a doctor as far as i am aware..if he is then i do hope you are correct and he would teat everyone with the same level of care. The fact that a doctor treats everyone the same (even though they may be a complete idiot) is a good thing no?
Morphine induced nightmare;
sides sides ides, all good points lost or murdered, patients die on trolley as staff disable each other with lethally damaged egos, Bigmac takes over then sues the Boots nurse that prescribed Boots own antihistimines for little Macs meningitis, parents taken flowers and apology to N.H.S. but only find a grave, church warden takes all mourners to garden shed where Boots nurse now works well with retired nhs nurse. They do their best without a doctor or equipment
NHS SIDE WARD
Blue world
Gang green
Blood red
dead.
A cure for yellow fever may restore some balance and prevent Michael Moore having to write the British sequel to "Sicko" in ten years time.
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