Thursday, 17 September 2009

The Doctor will see you now?

Sorry not posted for a while but those nice idiots at BT who screwed an extra half billion out of the Government to fund the N3 super fast dial up connection seem to have done the same to our local internet service lately. After many phone calls to India we are now sometimes getting 4kbs connection which I am sure given that dial up was 44kbs is good value for money.

However moan over and hoping that this will hit the blogosphere sometime before the next century starts. While attempting to very slowly crawl the web we saw this article in the GP magazine Pulse.

Now to those of us at the coalface this is not exactly news but what is concerning is the numbers involved. What is interesting is the use of non medical “consultants”.

Other bloggers have commented on “consultants” for example “consultant” physiotherapists and “consultant” nurses. This is another example of the current Party’s progress though ignorance initiative. If it is dumb give it a degree out of a cornflake packet or make them a “consultant”. Then allow them to “treat” patients instead of nasty expensive doctors.

In the good old days the word “consultant” was spelt “senior” so a Senior Physiotherapist meant exactly what you got. A senior complimentary therapist not a doctor. Similarly with nurses but a senior nurse was still a nurse not a consultant which implied a doctor with a lot of years of experience in training and several exams passed in order to earn the title of a real consultant.

According to the article 36% of trusts contacted said they did not allow GPs to request that a patient saw a medical specialist (doctor) rather than a specialist nurse or allied health professional. More Party “Choice”? Allow a Party dummkopf manager to decide what medical care is best for you comrade patient all in the name of Prudence? We think it is call "World-Class" Commissioning.

Locally this system is up and running (very badly). We get lots of letters from these “consultants” who if we had done what they do now when we were junior doctors we would have been killed by the real consultants. But still they are “consultant” “practitioners” (failed doctors like the “pratitioner” word a lot).

What is more frightening is that some of these idiots don’t just get to “treat” you they actually read the referral letters and decide what "treatment" you get in the first place. This is particularly a problem with orthopaedics locally and one of the team has quite a lot of experience of how badly patients are mistreated by the local “consultants”.

They have accumulated a lot of cases where something as barn door obvious in a referral letter such as:

“had sudden onset of leg pain followed by weakness in the leg which has persisted and worsened day on day with associated muscle wasting on that side. I think he needs an urgent MRI scan in case there is something surgical that can be offered . . . .”.

Any guesses what the GP is asking for? The letter was sent to an orthopaedic surgeon urgently but no surgeon saw these patients.

The letters were intercepted via Choose and Book and then read by a “consultant” complimentary therapist. What in any First World country would have resulted in an urgent MRI scan in Mr Brown’s dumbed down “consultant” led NHS resulted in several months of painful complimentary therapy as the muscle wasting and pain got worse after each “treatment”.

After several months, the patients finally got their MRI scans (as per the protocol) which showed (guess what?) a prolapsed disc pushing on a nerve causing the pain and muscle wasting. And guess what the “consultants” did then?

They stopped “treating” their patients “it is too dangerous” and referred them several months late to see a consultant orthopaedic surgeon. The real consultant knew straight away what was needed for they, like the patients’ GP, were qualified doctors, not a complimentary therapist, sorry “consultant” complimentary therapist, and did the surgery.

Amazingly the patients then got better. Remember who we referred the patient to first? Remember who sorted the problem out? Remember who got in the way?

Remember too dear reader that a GP can refer direct to a complimentary therapist if they choose to do although the local Politburo prevents direct referral to an orthopaedic surgeon via its organs of “Choose and Book” and the “Referral Management Centre” both organs of a four letter description.

We here at ND Central think it is an excellent idea to let people who are unable to operate, and indeed have never operated, see patients and decide who needs surgery or not. If you are trained as a complimentary therapist the only thing you are good at is complimentary therapy - not surgery. Unfortunately local Commissars don’t see things like that.

The figures in the article are quite frightening with some trusts allowing 50% of GP referrals to be seen by “hospital specialists” and the average 28%. We seem to recall that patients were meant to see consultants in outpatients a while back not “consultants” or junior doctors?

Praise be to the Party for over training doctors but replacing them with “consultants”. Will the next stage NHS review be planning a return to year zero to improve UK healthcare? We know that worked well some where else in the world and with all the cuts being forecast . . . who really needs doctors when the local shaman is so much cheaper?


Anonymous said...

I share your concerns. I am a nurse, but do not consider that I have the knowledge base of a physician, although I know my particular field very well. Doctors, like nurses, make errors of judgement and this will always be the case. I also realise that GPs now commonly hand over what are considered routine tasks to Practice Nurses who are competent in these procedures. In doing so, they are unintentially diluting their roles.
But this is by the by. I correspond with a lady that I 'met' through a particular condition support site. Her symptoms are highly suggestive of a phaeo - and I do have an in-depth and personal reason for knowledge of this condition - but today she has been fobbed off by another nurse specialist. Her cardiologist thinks she may have it too, but I do not believe he has researched enough to consider the variables of why a urine collection might be negative. But she sees him now and again, but mostly 'specialists' or 'consultants' who are not doctors. I am so afraid for her.

Anonymous said...

Northern Doc, yours is among the best MD blogs I've come across. When I read your columns I'm reminded of the movie "V'. Have you seen it?

You're a superb advocate for patients.

Best wishes,

Vincent (American MD)

Anonymous said...

When will the hospitals/managers etc start to get some stick or complaints from patients? This system is a farce, as you pointed out the pt took longer to be seen and the delay and increased expense was entirely preventable.

When are the government/DoH going to see that all these "consultants" or noctors as Dr Rant used to refer to them, do not actually save money. Bouncing patients back to primary care or to unhelpful therapies is not actually cost effective.

The noctors in our area just generate anxiety and more frequent clinic and primary care follow ups. The heart failure noctors are the worse and continue to increase beta blockers on pts with a diastolic of 60! Lunacy!

I would wager my knowledge base is easily equal to that of a noctor in any given specialty and so think a SPR or consultant should assess pts I refer, give an accurate diagnosis and management plan, job done.

Lets start a campaign encouraging people to complain about treatment/delays caused by noctors, that should put a fly in the ointment sorry poultice!

UK dietitian said...

Well, I guess I am a 'Compl-E-mentary Therapist' although perhaps thats another Govt term to help blend the self-styled enthusiastic amateurs out there into the expertise of the professions allied to medicine...
I used to be called a 'Chief Dietitian', a title afforded on the basis of knowledge (nutritional and medical), skills, and mentorship of junior staff. I don't know enough to diagnose complex gastro conditions, medical or surgical, but I do know more than most surgeons as to how the gut works and the optimal treatment approach to management (and no, it's usually not parenteral nutrition for months on end).

My new title is 'Principal Dietitian' which makes me sound at best like a ballet dancer, at worst a prima donna. All it means is that with the loss of 'Manager'/ 'Therapies manager/ any other 8b or 8c grades, I now spend a disproportionately frustrating amount of time on futile management issues at the expense of patient care. This week it took me 8 emails and 3 phone calls to obtain a colour cartridge for our printer, taking I guess an hour of therapeutic time. And the numbercrunchers wonder why dietetic contacts, that crude, post-Korner method of workload, has declined?

Anonymous said...

I think you should learn the difference between the words "complimentary" & "complementary" This failure tends to diminish your credibility in many eyes, since a hallmark of intelligence and education is a thorough knowledge of ones own language.

Northern Doc said...

Thank you all for your comments especially Vincent MD for their kind words.

Being a GP in the UK means frequently being an advocate for patients when they hit the many brick walls of NHS management inability that delay patients getting anything approaching first world treatment. The best they can hope for is "world-class" commissionning treatment which is a joke to anyone with a MD after their name as it is certainly not (first) world-class in any way or form.

Regarding the movie V do you mean the 1980s sci-fi flick or the 2005 V for vendetta? Both have similar themes.

Regarding Anonymous and complimentary versus complementary.

We are aware of the difference and use the complimentary word in its meaning of "given free of charge by way of a 'compliment'".

The 'compliment' is given by NHS managers to patient as the treatment is cheap and not very effective and it shows the high regard in which patients are held by these people.

It is said that sarcasm is the lowest form of humour but requires the highest form of intelligence to understand it. We reserve the liberty of poetic licence.

Thank you all once again for your interest and taking the time to post comments. We notice several other UK bloggers have put fingers to keyboards over this issue.