to think you'll miss your GP when they're gone...

[macdoodle]

I have been roundly criticised on other thread for trying to express this. And whilst I admit that highjacking someone's thread may not have been the best way to do it, the crisis in NHS GP is very real.
I have bee around MN for a very long time now, and sometimes the anti GP sentiment is astounding and utterly depressing.
So read this...he is not a GP (I am), but this article absolutely sums up the current problems and morale in GP at the moment.
I have been a doctor for 20 years and a GP (or in GP training) since 1999 and can honestly say that NHS GP is in very real danger of being gone very soon.
For those who continually slate GP's , please tell me what your better suggestion is, because I trained in a country with no national GP service, and it really isnt better in any way.
www.conservativehome.com/platform/2014/03/from-adrian_hilton-the-looming-manpower-crisis-in-gp-land.html

Several GPs in my practice missed my late stage cancer over the course of 4 or 5 appointments.

Something isn't working.

(Ps. I'm fine now, but as a result of them missing it I needed far more invasive, life-threatening treatment than if they'd recognised the signs in the first place)

In any given job there are great people, good people and the miserable bastards. It's unfortunate if you get the latter when you of family are ill.

I personally feel it would be a very sad day if we were to lose the gp service as we know it. I have absolutely no complaints re my gp. And it's not a job I'd do for love nor money, dealing with the British general public, when they are ill. Lethal combination.

Larry no one is suggesting if a patient needs a scan they won't get one - red flag signs like weight loss, bleeding, abdominal mass etc will be seen urgently. But your average IBS patient doesn't need a scan as it doesn't change their management.

Private systems have too much medicine and use unnecessary tests and scans to reassure patients and charge them more. Virtually all patients going through A&E in the US get a CT scan, a phenomenal amount of radiation when it is not needed.

The skill in general practice is to work out who needs what and use resources efficiently but I never have any problems referring someone if they need investigations.

I've not RTFT for the sake of my blood pressure.

GP here and OP I feel your pain. It's why I barely post on MN after getting into numerous rows with various NHS Naysayers on here.

The GP bashing (as is the teacher, police bashing etc) on MN is ridiculous. It's demoralising and shows how blind the majority of the British public is towards the REAL problem - ie: the Government.

From a brief glance at some replies I see the usual 'you all earn 10000099837474 pounds a year'. How about fuck off and check the facts because that certainly ain't true.

People telling us to suck it up because we chose our profession which means we often work flat out all fucking day often not getting chance to wee/eat/drink/breathe. Yeah, we knew how tough it is. Doesn't mean we can't find it difficult and moan about it like every other worker in every other job who has it tough.

Do patients really want the person they go to when they are worried about something to be knackered, bursting for a wee, dehydrated and hypoglycaemic and solve their entire medical and social problems in 10 measly minutes? So why is it accepted that we do that? BECAUSE OF THE FUCKING GOVERNMENT.

And before anyone head tilts to ask if I'm ok, or that I seem angry or that they are glad I'm not their GP...
A) Yes, I am angry. I'm angry we are being made the scapegoats for the state of the NHS by Jeremy Fucking Cunt and The Daily Fail
B) I am ok. Now. But I wasn't last year when I was working so damn hard I ended up in hospital with some serious health issues. I've now had to take a step back for the sake of my own health.
C) I love my patients and the majority love me. I love my job, I love helping people. That's why GPs do what they do. None of us our perfect, we all live in fear we're going to fuck it up.

And breathe.

I feel a NC coming on...

I don't like the implied threat of "you'll miss us when we're gone"... If there is widespread dissatisfaction with the service, then it's perfectly reasonable to ask whether there is a better alternative. I am in favour of an insurance-backed system. I just don't think that this government could run a whelk stall competently, so expecting it to provide decent healthcare for all is a pipe dream.

DP is a Consultant in the NHS and works in oncology. He went to the funeral recently of a woman whose GP had treated her for an ear infection for months, when a CT brain would have revealed a fucking massive tumour. A lot of GP fuck-ups end up being his patients. His view is that GP's are fine for geriatrics but the everyone else should be able to access specialists directly.

I work abroad and have excellent healthcare , with everything funded by insurance. It really is a better, more efficient system. Typically scans and x-rays are performed on the spot if required, so it removes a whole margin of error and delay, as well as administration. If your GP is crap, you see another, usually on the same day. I complained about a gynaecologist who answered her phone during a consultation. (Old fashioned I know but I find that so rude!!) They apologised profusely and found me another, more senior gynae and fitted me in later that day. They really don't want unhappy patients because they realise there is a choice. That is what I think is lacking in the NHS.

And what health care provision do people who can't afford insurance have in the country that you work, OldFarticus?

And to blame an individual GP for something they didn't pick up is a cheap shot.

If GPs has adequate resources, time for patients and less complicated and dictatorial referral systems they would, on the whole, be even better at their jobs.

Not read thread yet, will in a min but I have to say I love my GP and my GP surgery.

I got a letter from her this week saying she was concerned about me and the impact my chronic lung disease is having on my life and can I make an appointment to come in and chat to her about what other support I can get.

My whole GP surgery are just amazing. I so appreciate them

OldFart an insurance based system would not necessarily have helped that patient. The survival of most brain tumours is dismal no matter when they are discovered.

And yes its a cheap shot when you give us the side of the story from your DH with no other details, I bet the GP has done a significant event analysis and you have no idea of the outcome of that or any legal claims.

Just how much radiation do you want to expose yourself to with these 'on the spot' X-rays and scans??

Oldfart you're husband sounds like an arsehole charming. Wouldn't be getting any private referrals from me with that attitude.

The UK comes almost bottom of that study for 'healthy lives' outcomes, which shows 'infants and patients who would have survived if they had had a timely and effective diagnosis and treatment'. So it shows:

• we don't spend much money per head, but for that money we get a lot of healthcare services
• we give everyone access to the same healthcare
• we deal well with the management of chronic illnesses
• we think about patients well, care is integrated across different parts of the service
• the system is safe and joined up
• you don't have to wait that long for an operation once it is determined you need one

• we deal very badly compared to others with either diagnosing people or providing them with the healthcare they need early enough to prevent them from dying from their treatable illnesses.

I am huge supporter of the NHS in terms of 'free at the point of care' but there are seriously things that need to be improved, predominantly in diagnosis and rapid treatment. The study itself says 'The U.S. and U.K. had much higher death rates in 2007 from conditions amenable to medical care than some of the other countries, e.g., rates 25 percent to 50 percent higher than Australia and Sweden. Overall, France, Sweden, and Switzerland rank highest on healthy lives.' (Quite why they are quoting 2007 data I don't know, but they are, so I have to assume it still relevant, esp given our ranking has not improved in the healthy lives category). If in our healthcare system you are far more likely to die from treatable illness than in other countries, something needs to change!

Looking to the US model, however, is clearly not the answer at all and I am not sure the government can see that.

I love my current GP, BTW, he is great. Speaks to you like a grown up, listens to your views, does diagnostics tests (eg swabs to be sent off etc) on first visit, very cautious with children's ailments, instills his staff with same ethos. Operates a great telephone triage system whereby they call you if you have an acute or urgent need on the day and get you into the surgery in the afternoon if the telephone consultation deems it necessary.

macdoodle that's what I thought! What a terrible attitude, a better person would be liasing with local GPs, coming to do some training in practices, offering to speak at a meeting etc

Hope you're ok or

Oldfart, your post has wound me up more than any other single post on this thread. Because your H more than any other should no better, and as long as primary care and secondary are are battling rather than working together then we get no where.
Could you please ask your oh so superior consultant husband, when he feels ear infections/recurrent/persistent or otherwise, be referred for a CT scan? Does he have ANY idea how many ear infections a GP sees a month (a clue, it is a LOT), apart from the fact that where I work (1) I dont have direct access to CT scans ummm "of the ear"?? and (2) waiting lists for GP scans are excessive. Should I refer all ear infections to ENT?? oncology?? Are there guidelines on this I am not aware??
Maybe rather than slagging GP's off to his spouse he should be offering to update and teach the idiot GP's??
And as for your amazing insurance based system, thats great I have no issue with it really?? Can you clarify please as requested, what health care provision those who cannot afford insurance get in your country.

If that's your partner's attitude, then he's a disgrace oldfarticus. As an NHS oncologist, he really should know better. Thankfully, I am much more appreciative of primary care (I'm also in oncology) as my husband is a GP. I know how incredibly hard he works. And maybe you your DP needs to get his head out of arse and educate himself on how many "ear infections" turn out NOT to be brain tumours and then he would be better placed to judge the GPs. Really, I can't believe a consultant could be as stupid as you've described him. Wtf.

I have access to all the CT, MRI and PET scans in the world. My husband doesn't. I'm still astounded how many tumours he picks up just on clinical acumen. He lives and practices with a level of risk that frankly would reduce me to an insomniac forever.

Oldfart let your oncologist partner speak for himself about missed cancer diagnoses or have a word with the GP himself instead of pretending to be an expert by proxy.

I find the recognition that having scans willy-nilly is a bad idea because. unless genuinely needed, they give unnecessary high doses of radiation to be very heartening. The point about private healthcare in the US overdosing patients with radiation from uber-precautionary scans is well made. To some extent that is true also of private healthcare in the uK, I think, except that you can easily say no and be heard.

Just a small correction .. We are not here to provide general satisfaction with our service. We are here to do the jobs we have been trained to do.

And what health care provision do people who can't afford insurance have in the country that you work, OldFarticus?

A state-backed insurance system is just that - those who can afford their own insurance pay it. Those who can't are subsidised or fully funded by the government/taxpayer. So poor people get exactly the same access to healthcare as everyone else, but the government does not get involved in the delivery of healthcare.

How can we have a sensible debate on the NHS when people seem to know so little about the alternatives? The NHS system has been copied by precisely nobody. Any serious debate about alterantives is just shouted down by those with a vested interest, in much the same manner as this thread has gone.

The aggression from NHS staff on this thread is pretty telling. If there is general dissatsifaction with GP services, then it is only right to consider alternatives. Most professionals would accept that as a given - why do GP's have such a problem with it?

I am not a medic but treating someone with cognitive/balance problems for an "ear infection" for months without further investigation seems a bit rum to me. We all fuck up, and GP's are human - but the fact is, a bad call from a GP means that cancer is more advanced and difficult to treat when it gets before an onco. That is what pisses DP off, and he knows the good GP's from the shockers, thanks largely to the stage at which his patients present.

But yes, apaprt from devoting his whole waking life to treating people with cancer, for less money than I earn for a comparable training period, he is obviously a complete arsehole...

(In the interests of fairness, the NHS pension is fucking awesome, so long may his NHS practice continue!)

Oldfarticus said the GP treated the patient for an ear infection for months. Surely the patient should have been sent for a scan when the infection didn't clear up. Treatment guidelines at least in America say that an ear infection that doesn't clear up should be referred as possible cancer www.cedars-sinai.edu/Patients/Health-Conditions/Ear-and-Temporal-Bone-Cancer.aspx

But I guess in the UK GPs don't have access to scans "um, of the ear" so a patient with that kind of cancer is just screwed?

A good friend died a couple of years ago. He was being treated for depression by his GP even though he and his partner went back over and over again to say so wing wasn't right. I remember after visiting him I sat in the car and told my husband "he has a brain tumour". Husband agreed with me. By the time my friend was finally diagnosed it was too late for treatment and he died a month later. Are you seriously telling me that GP who missed something a layperson recognised easily has nothing to answer for?

I really don't understand why we aren't allowed to talk about the fact that GPs do fuck up and patients die because of it. I understand that GPs are having an extremely hard time of it right now and that surely needs to change. However that doesn't mean that mistakes should be whitewashed and not spoken of. I blame the government for the overall horrible mess but surely some individual GPs who repeatedly misdiagnose cancer need to be picked up on and retrained on this aspect?

what adult says "fucking awesome"?

Click on "symptoms" on my link and you will see in bold that an ear infection that doesn't heal should be referred to a specialist.

Where has anyone said on the thread that doctors who make mistakes should get away with it? Nowhere. There is a process including complaints, retraining, compensation - are you saying that no doctors in private healthcare make mistakes?

To reiterate, the survival of brain tumours is abysmal whenever they are diagnosed.

Brain tumours like all cancers are better able to be treated if diagnosed early. My friend's cancer had grown to the point it was inoperable when he was finally diagnosed. The lack of compassion for those who have died needlessly due to misdiagnosis on this thread is shocking.

There have been several posters who have said that pointing out mistakes made by GPs is akin to bashing them. I am not trying to bash, I feel awful for GPs and enraged with the government for letting this happen

However from the OP "Could you please ask your oh so superior consultant husband, when he feels ear infections/recurrent/persistent or otherwise, be referred for a CT scan? Does he have ANY idea how many ear infections a GP sees a month (a clue, it is a LOT), apart from the fact that where I work (1) I dont have direct access to CT scans ummm "of the ear"?? and (2) waiting lists for GP scans are excessive. Should I refer all ear infections to ENT?? oncology?? Are there guidelines on this I am not aware??"

Yes there are guidelines about which she is apparently unaware. Whether these are applicable in the NHS I don't know but regardless,something is seriously wrong if referral in the US is standard and in the UK completely dismissed because of lack of access to scans "um of the ear". I would like to understand why that is.

what adult says "fucking awesome"?

Well, I just did (but I was trying - and apparently failing - to be ironic!) Did you have something worthwhile to contribute to the debate?