To think GPs are on the whole useless

[yellowflowers]

Everytime I go to the GP they either confirm I have what I think I have or say that I haven't and then when I go back a week later still with symptoms tell me I was right all along. I really cannot see the point of them beyond being a barrier between us and prescription drugs and so they can refer us to specialists if you are clever enough to look up your own symptoms and treatments and know a good source from a bad source. I feel with the help of google I could do as good a job as most GOs - "oh hello Mr Smith, you have an itchy arm do you, you have 'itchyarmitis. Here's some itch cream and if that doesn;t work I will give you an itch pill" or "hello Ms Jones, you have found a lump have you. That's probably okay but I will send you to a specialist just in case it isn't."

Can you tell I have had an unproductive trip to gp today?

But really, I am yet to meet one who knows more than a relatively intelligent person with access to a computer and half a brain.

I was a Sister on a Trauma and Orthopaedic Ward - I know Joe Public can be hard work and while I do not have experience of Social Work or Housing Officer (I can imagine they have it tough too) some of the stuff DH experiences is - and that's just the stuff he's allowed to tell me!

YANBU but there are some really good GPs.

BUT my DS was nearly seriously harmed be a negligent GP at 3 weeks old. He fell ill and I called GP, who asked to see him. When I arrived he was positively screaming at top of his lungs, a weird mottled colour and hot. GP was so affronted by the crying that he did not examine him at all, told me was hungry and that I should take him home and gives sips of water! He'd written me off as a hysterical mother and wanted the crying baby out of his office. But DS is my second and I knew that it was not right that he was not feeding and behaving so strangely. So I ignored GP and took him to A&E where he was whisked into intensive care and diagnosed with severe sepsis. He was hours from death. If I had been a first time mum I'm pretty sure I would have gone with GP's advice. When I lodged a formal complaint he actually lied about what happened, claiming that he took temperature, heart rate etc. He even claimed that he'd recorded his heart rate as 79 bpm!! Even I know that a healthy newborn has a much faster heart rate than that. And when he was admitted and put on life support, his heart rate was well over 220bpm because he was so poorly. At least make it convincing.
The GP didn't even apologise.

Can you tell I'm still angry?

And breathe...

YABVU, there are some many wonderful ones out there

If you've had a bad experience, don't tar them all with the same brush

YABU!

YABU

However, I have been suffering frequent migraines. The GP on Friday saw that I was on a high dose of Propanolol, and decided that he would give me some other medications.

I was prescribed Maxalt Melts 10mg

Today, I read the packet prior to taking one. It clearly states that if you take propanolol you shouldn't take 10mg in one dose, but should be limited to 5 mg.

I phoned the pharmacy, and it turns out that propanolol increases the plasma concentration of Maxalt by 75%!!

So although I think that you are being unreasonable, it never hurts to double check your GP's prescribing.

YANBU to think that your GP is useless. but YABU to suggest that mine is too. My GP and in fact the surgery as a whole is brilliant. So please stick to slagging your own one off!!

By the time I finally/if ever reach hospital consultant status I will have about 10 years of post-graduate training to be half-way competent in ONE small speciality area of medicine. I couldn't be a specialist in chest, heart, gut, endocrine, neurology, haematology, oncology, rheumatology or dermatology. That's just in medicine. Then there's surgery, obstetrics, gynaecology, and 25%+ of the GP's working day, psychiatry, none of which I have taken much beyond end-of medical-school level.
GPs have to deal with ALL of this. In a 10 min consultation. Of course they don't know everything. Of course they don't always make the diagnosis. It is not a GP's job to know everything about everything - how could they? The skill set is knowing who to refer, when, for what, when is watchful waiting the right thing, when is it blue light time...don't forget "tests" are not all benign e.g cancer secondary to CTs, perforation during endoscopy etc. And much more.
I wouldn't be a GP. Far too scary/difficult.

If you know of a seriously incompetent GP surgery, is there a way of whistle-blowing? I mean, getting someone in authority to take a look, while remaining anonymous and out of it yourself?

Of course, report them to the PCT.

Yes Yellowflowers. They just have those medical degrees because the wall would look awfully bare otherwise.

And I'm sure it helps when they have to spend time explaining to google happy muppets that they haven't got a rare metabolic disorder, they're just fat.

Can you report them to the PCT anonymously, though, Pocketmonster? Does the PCT protect its sources?

YABU, my GP is fabulous.
I have a really good relationship with her.

On the other hand another GP at the practice is a horror. He said that DS screaming every time I breastfed him was a minor inconvenience and he would grow out of it. Turned out he had a dairy allergy.

I posted about this on the other thread - but the issue is that there is simply not enough review of GPs clinical decision-making

Take a legal practice or an accountancy practice. Every single case will be subject to review. Doctors are human and will inevitably make mistakes. However no other profession allows complete autonomy in decision making in the way that GPs have. It's quite simply not safe.

Macdoodle posted that there are quarterly reviews. But there are only quarterly reviews of certain files. There is no mechanism of automatic case-review. This is a fundamental problem.

But how would you review every case? A GP can see at least 20 people a day and it can take years for you to be in a position to realise care wasn't optimised. Exactly how would you review every decision without the luxury of knowing the outcome?

"This is what the medical industry thrives on... Insisting the public are stupid."

Bollocks. The public is not 'stupid' but medication can be toxic/harmful if not used correctly. We can self-diagnose a headache and take paracetamol quite safely in the recommended dose. But every year people fall ill because they've accidentally OD'd by taking several cold cures at once.

A big cause of premature death is the tendency - despite free access to healthcare in the UK - to say 'it's probably nothing so I won't bother the doctor'.

Stick to lactation counselling CarmensanDiego. You sound bloody dangerous otherwise.

Nice personal insults and selective quoting, Chil1234. I'm currently finishing a sideline MBA in healthcare so your worst fears may be closer to realisation than you think

Of course people will overdose, either intentionally or unintentionally. Of course many drugs are potentially dangerous.

I'm not arguing for deregulating the entire industry.

There is however a serious debate to be had about levels of personal responsibility and consumer empowerment when it comes to healthcare.

"Every year people fall ill because they've accidentally OD'd by taking several cold cures at once."

Sure, and every year people crash cars, amputate limbs with power tools and burn themselves on the oven.

I can buy a chainsaw on Amazon right now without a clue how to use it. But I can't buy a tube of eczema cream without getting permission from a doctor.

Why? Which one is honestly more dangerous for the average Joe to buy?

The healthcare environment is changing. People are becoming empowered in more areas of their lives and doing things online that they would never have been able to before. Fifteen years ago, few people would be able to book a plane ticket without a travel agent.

There is a push to people being able to manage their own chronic conditions. For example, you can carry an epi-pen and administer it yourself if you know how. Years ago, you'd have had to go to the doctor for a pregnancy test. And so on and so on.

Come on.. look at NHS Symptom Checker. The NHS are ENCOURAGING online self-diagnosis. Really... analysing 'baby rashes' via multiple choice quizzes?

So if I'm 'bloody dangerous' then so are they.

You're tarring everyone as an idiot if you claim we shouldn't have cold cures because some people would overdose. Yes, that's a risk - so you reduce the risk where you can. There are all kinds of ways to do this whether those be an interview at the pharmacy counter, patient education or better packaging.

I'm questioning whether the reliance on doctors has gone too far... In the US, it definitely has. Healthcare is big, big business. Overprescribing and overtreating are at epidemic proportions, as is an absolute over-reliance on doctors who conduct extensive and expensive testing for conditions most NHS doctors would prescribe a cup of tea and a sit-down for. The pharmaceutical company is hopelessly corrupt and sales reps line doctors waiting rooms with their briefcases and giveaways.

The backlash to this is many people quite happily and comfortably self-treating, without ending up on the thousands of drugs many doctors here would push your way, along with the side effects that go with them.

And yes. Many people screw up and miss seeking professional treatment for something which kills them.

The answer? Risk reduction. Look at what people really can sensibly manage. Maybe look at individual competences. What about licenses in 'Personal Care' or 'Drug Safety' before people can waltz to the pharmaceutical counter?

There's other ways to handle things. I'm not sure the poor old GP is the be-all and end-all of healthcare. Their role is changing all the time.

"You're tarring everyone as an idiot if you claim we shouldn't have cold cures because some people would overdose."

That's not what I'm saying at all. My point is that over-the-counter medication is, by definition, quite innocuous and still can cause serious harm if misuse - like your Amazon chain-saw. However, if we were to give the general public access to more powerful drugs without requiring medical assesssment beforehand then the chances of accident would be much higher. There's a reason why nurses keep a lock on the drugs trolley.

My concern is also what is missed when people self-diagnose. The person buying laxatives when they actually have colon or rectal cancer. The person buying eczema cream when they have a completely different skin condition. The person buying repeated thrush treatments but missing the fact that they need to be tested for diabetes. It goes on already.

The UK public health system is nothing like the commercial system in the US. In the US many people are self-treating because they simply don't have access to proper medical care. (Faith-healers do a roaring trade.)

I agree with most of this.

And there's a really good argument there for accessible, quality patient education. I also agree that there need to be some restrictions on drugs.

People shouldn't blindly waltz into Boots and buy a stack of cancer drugs because they're worried about a lump on their toe.

But I think it's important to question what drugs are illegal and why. If GPs are overworked and the NHS overtaxed, then we can look at where to safely reduce the stress.

There's also the matter of standardisation. Let's take a hypothetical common situation, say a patient asking for Viagra. Different GPs may respond to the same patient in quite different ways (putting emphasis on different side effects, being more or less encouraging, running different tests). In fact, the request could probably be quite simply dealt with an automated blood pressure test and a quick online test which simultaneously checks for contraindications or red flag symptoms and informs the patient of how to take it, the most likely side effects and the alternatives. You could handle the whole thing through a vending machine with probably the same level of effectiveness.

GPs have a role but I think it's a changing one. For many very competent and educated people going to the doctor, 9 times out of 10, they'll be like the OP - just going to get a referral to a specialist or a 'permission slip' for a drug they know they need. This is a bit of a waste of everyone's time to treat knowledgeable people the same way as a less informed 92 year old with no access to the internet.

To continue northernlurkers point about how you could review each case - my DH saw 73 patients on one day last week - not a particularly busy day and doesn't count all the patients he spoke to by phone - although on the whole his patients are happy a few do get grumpy that they can't have longer than 10minutes unless its a medical emergency.

Where I work it is run slightly differently and we are a bit more relaxed about dealing with your chest pain and depression in one appointment. It means we only see about 40 each on an average day and get numerous complaints about not enough appointments .

I think a large part of the dissatisfaction with GPs is unrealistic expectations from patients.

Using porcamiseria's post earlier as an example - she calls the doctor a twat for not examining her on being told she was pregnant. What did she expect the doctor to do? She probably had in her uterus an embryo the size of a full stop and there is no clinical need to examine her.

Why do people slate GPs for looking things up? Surely better to check doses, interactions and potential side effects than to just blindly prescribe?

Why do people get huffy when they are told that only one or two problems can be dealt with in one 10 minute appointment and can they make another? They are the same people that probably complain to be kept waiting because the patients before them also had a list of complaints that made the doctor run over.

Of course there are crap GPs. Just like there are crap shop workers, plumbers, electricians, bus drivers, call centre workers etc etc. But to say that GPs are on the whole useless is unreasonable.

One gp (male) told me to come back in a few days when I went after being unable to walk for couple of hours with extreme pain before passing a huge clot .... Turns out I had just suffered a miscarriage. 2nd opinion from female dr who had me in for scan the next day!

I agree there are good and bad. I have had some really good ones and some pretty poor ones, thats pretty much the same for most jobs though.