Comments on Dr Rant: I Predict a Riot

A cure for yellow fever may restore some balance a...

2008-01-08T20:50:00.000Z

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.

Morphine induced nightmare;sides sides ides, all g...

2008-01-08T18:54:00.000Z

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.

I have a problem with so much anon posting.Not tha...

2008-01-07T17:01:00.000Z

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?

Wo,That was probably part of it's intention. ;-)

2008-01-07T13:37:00.000Z

Wo,

That was probably part of it's intention. ;-)

Anonymous said "In my 14 years in medicine I have ...

2008-01-07T11:39:00.000Z

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.

No one,The sickening thing about the troll that ha...

2008-01-07T02:21:00.000Z

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.

So texperience of working in the practice is not w...

2008-01-06T23:03:00.000Z

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.

oh dear so much ill will for so little reasonRe "d...

2008-01-06T18:55:00.000Z

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

Oh and i don't want to learn from you. You only ha...

2008-01-06T18:12:00.000Z

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?

Go on then tell me which area of the country so i ...

2008-01-06T18:10:00.000Z

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).

re "I worked at practices in Coventry and surround...

2008-01-06T16:36:00.000Z

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

The problem with a nurse being able to do 80-90% o...

2008-01-06T15:21:00.000Z

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.

Sorry but nurses do teach juniors on the wards...f...

2008-01-06T12:09:00.000Z

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!

"I have met many competent nurses, but not one wit...

2008-01-06T07:26:00.000Z

"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.

"Hehehehehehe", rasped the devil, rubbing his 'han...

2008-01-05T23:29:00.000Z

"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 did not characterise nurses as being unintellige...

2008-01-05T23:04:00.000Z

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.

Anonymous - do you now the difference between a di...

2008-01-05T22:22:00.000Z

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

In my 14 years in medicine I have not come across ...

2008-01-05T22:05:00.000Z

In my 14 years in medicine I have not come across one occasion when ANY nurse has taught ANY doctor on the ward.

Can dreams be that 'fucked' anon ... Lolanon 2

2008-01-05T21:45:00.000Z

Can dreams be that 'fucked' anon ... Lol

anon 2

Experienced nurses can do 80% of an experienced do...

2008-01-05T17:40:00.000Z

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

John says: If 84% were happy, then 16% weren't.Tha...

2008-01-05T16:37:00.000Z

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.

1. It is not stereotyping but an incontrovertible ...

2008-01-05T14:50:00.000Z

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.

No one.Hope i'm not too straight forward foryou bu...

2008-01-05T12:13:00.000Z

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).

John,I appreciate that it's easy to say teachers h...

2008-01-05T09:11:00.000Z

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"...

John says:Sorry for the typos.I think commenters o...

2008-01-04T20:33:00.000Z

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?