to absolutely hate the anti GP/doctor bashing mentality on MN?

[macdoodle]

When most if not all the doctors/GP's I know personally and professionally have a lot of training, and are doing the best they can, despite ridiculous government rules and beuarocracy, and dont get paid a fortune, far from it!

In fact I know IANBU, so much so, that I am taking a break from MN because the lot of you dr bashing makes me feel slightly ill, and some of those calling their GP's twats make me feel so angry I may say something I will regret

Yes there are, and that just proves yet again, how ignorant people are as to how GP are regulated and monitored and how they work!

We have a robust system of SEA (significant event auditing), it is a contractual obligation for practices to undertake at least quarterley, and GP's are expected to participate and discuss it in their annual appraisals. It is expected to make up a part of the revlaidation process.

Actually misdiagnosing an ectopic as cystitis, is not that stupid or ignorant. Ectopics are notoriously hard to diagnose especially in early pregnancy.

Who appraises them? Who does the revalidation? I don't think most people know these things, I know I don't. How often does revalidation take place? I'm not trying to be provocative, honestly, but I would genuinely like to know.

No, that's not the same thing Macdoodle. Every single case decision can be reviewed in a legal practice. Detailed independent file reviews that happen quarterly (which also happen in both legal and accounting practices to my certain knowledge) are not the same thing as having every decision reviewed.

I don't think it's manageable within the construct of the NHS - not challenging GPs so much as the imperfect system that they have to operate within.

And really, when the patient is telling you loud and clear that it's not cystitis, why wouldn't you refer to get it checked out?

Being a GP is a thankless profession imo. If you get it right - that's what the patient expects, if you get it wrong - then you're lazy, stupid, incompetent and negligent.
The human body is complicated and to a large degree unpredictable. The art of medicine is uniting what you can see in front of you with what you know to be the case in general to come up with a diagnosis. Small wonder that this isn't a 100% accurate process. I think many posters on this site expect the impossible from their GP - and from the NHS in general.
Macdoodle - I hope you stick around.

There isn't time or necessity to review every single decision. When I'm working I see around 90 people at week and some will attend with more than one problem. There are 5 of us doing similar. Reviewing every set of notes would be a more than full time job if it was done properly. And I would estimate around 4-5000 consultations a quarter. That review would take some time . I used to work in a very rural practice with a small list size and we had 15 minute appointments but there aren't the hours in the day to give longer appointments in my current practice. We already employ more doctors and take less pay home. I've been a full time GP for 11 years and have never earned 100k.

I appreciate that I am paid by tax payers and always try to treat patients the way I'd want my own loved ones to be treated but I know I'm not perfect. But being paid by you doesn't mean I'm owned by you. My practice manage received a formal complaint about me being off work for too long on maternity leave when dd2 was 4 weeks old - she's now 7 weeks! I suppose it's a compliment that I'm wanted by my patients but my first responsibility is to my family. I still have to keep on top of my ongoing learning for my yearly appraisal while I'm off and go to meetings about the running of my practice - I was at one with dd1 in tow when she was 10 days old. I'm ok with that but do get a bit peeved when people believe the Daily Mail hype about lazy GPs.

And the reason the coalition want GPs to decidenon where the money goes in the NHS? So they can cut the budgets and blame someone else for any resultant unpopular decisions.

OMG mollycuddles - a complaint about you having maternity leave

I hate the DM for the lies and misinformation they spread about all manner of things - GP salarys are just one of the reasons I hate them - so wrong.

However, if you really want to unite MN in "anti a profession" stance the suggest starting a thread with the term "health visitor" in the title. Luckily I am thick skinned and have worked with more than my fair share of crappy ones so can usually sympathise.

OP YANBU but brush it off - you know you do a good job, my own GP is fantastic and I wouldn't be without her. I also work with very good P's who take more than their fair share of bashing from Joe Public.

I had a letter from my practice this week as they are reviewing their 'cancer patients' warmed the cockles of my heart, it did. With that kind of perception, I'm glad there are some decent GPs there.

But really, stop moaning, I'm a social worker by trade, you have a long way to go before you get to our level of attack.

Surely you can't review a decision unless you have the patient in front of you?

Quattrocento- it really isn't practical for all patients to be reviewed by two GPs. Obviously, unlike in the legal profession, the patient would actually need to be seen!
I am not sure if you realise that a GP will be in contact with probably between 30 and 45 patients per day, whereas a solicitor will only see a very small number per day and will spend far longer working on each individual case.
I think some members of the public have slightly unrealistic ideas of what it is possible for a GP. I think a lot of this is fuelled by the government encouraging the DM, etc to produce lots of sensationalist anti- GP headlines. GPs are generalists and not experts in every field. Hence they will not have a detailed knowledge of every illness and may well have to look things up. They also have 10 minute consultations, which includes looking at the notes prior to meeting the patient and typing a record of the consultation. This is really not a long appointment time and, with the huge volume of patients seen, it is inevitable that a minority of patients will be unhappy. Fortunately, from the government initiated patient surveys, the great majority are v happy with the service provided at most practices.

I know someone who was reviewed by the medical council. It took 2 years to review 19 cases. 2 years.

The NHS would cease to operate.

YANBU OP, get a bit sick of NHS bashing in general, I love the way a fair few think they know better than trained professionals ALTHOUGH (disclaimer) there are good and bad health care professionals and some times they can get it wrong.

GPs have it easy on MN compared to me though, I'm in CAMHS, hated 3rd most after HVs and SWs

Mollycuddles, who does your appraisal? How and how often are you revalidated?

On the wider point, I've always assumed that there is some safety in a large practice - in that a number of GPs get to see a patient's notes, and one of them might have the guts to say "That's not right" if they spot something very wrong. Presumably they could then speak to their errant colleague in the practice to find out what had been going on, whether they had a drink/drugs problem, or whatever.

Fairly well timed, but I just felt I had to come on and say that I've just seen my GP and have come out of the surgery feeling lighter than I have in a long time - He was bloody wonderful.

He hasn't given me any false hope/information but even to empathise that he was flying blind and appreciated I was worried, and went through the options open in various scenarios, was a huge relief to me. I now feel slightly guilty that I may have wasted an appointment slot (I haven't really, I'm genuinely trying to find the root of an illness), but that to me was good doctoring!

My personal bad experience with another GP at the surgery was mainly down to been practically accused of making things up when I'd gone in for a sick note for work (first one ever - I'm almost 30!)who managed to make me doubt further symptoms and really put me off going back quicker and resulted in me having surgery....

I think it's attitude in a lot of cases, that goes for any profession, but ones where your in a position of trust and people come to you already worried isn't one to be in if you have no people skills or get irritated easily. Hence I would never work face to face with the public - at least over the phone I can stick my tounge out!

I've only had positive experiences at my GPs practice

We have a yearly appraisal with a senior GP - it rotates around who actually does it as it is felt there was a risk that having the same appraiser every year could mean a more friendly relationship could build up with your appraiser risking collusion. As part of the appraisal we need to prove we are reflecting on our work, keeping up to date with new research, reading up and attending courses on the stuff we perceive as our weaker areas and analysing significant cases within the practice. That is at present all the revalidation that occurs but there are moves to formalise it into a 5 year programme to ensure we cover a broad range of learning opportunities and clinical areas rather than potentially staying within our own comfort zones. In my practice, and macd's too as she mentioned, we formally analyse cases where problems arise eg complaints, delays in diagnosis, all new cancers diagnoses, all deaths and we also randomly analyse other cases. This is done from the notes initially and where appropriate we also call patients back in after analysis if issues are spotted. This does take time and is one of the many things we do as "paperwork" which is fitted in between appointments, visits, letters and phonecalls. But I think it's pretty important. Preparing for appraisal is all done in my own time as my days are pretty packed already. (Must get back to doing some of that in next few weeks as appraisal is only 8 weeks after I go back after mat leave - oops)

All deaths? Do practices have to do that, or is it just because you work for a decent surgery? [sorry to take up your time...]

YANBU.

All practices have a contractual obligation to do SEA - significant event analysis and write up anonymised cases from the SEA process for the health board to prove we're doing it. The cases considered have to include significant deaths, cancer diagnoses, suicides, delayed diagnoses etc. We decided to look at all deaths on a monthly basis as all will have some comment worth sharing eg an expected death where patient died where they wanted and free of pain, family were satisfied and we had a chance to discuss with them at a bereavement visit is the ideal and there may be no lessons to be learned but sometimes it's good to stop and focus on things that go well. At our monthly death audit we highlight any cases that we can learn more from and we look at them in greater detail. A lot of practices do the same as us from my discussion with colleagues but I can't comment on all with any accuracy.

Thanks, that sounds like very good practice.