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Public asked for their views on primary care


BallaDoc
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On 1/20/2021 at 3:15 PM, Apple said:

Oh they have been, and still are, but they will leave all this controversial stuff to Manx Care. There was and is a lot of the actual operational activity around all of this not yet known. The Peel pilot outcomes review is probably on line somewhere but ehe last I read in ? March last year there was so much that still had to be put in place, not least more funding.

Anyway, its only money, and patients health. 

The Peel pilot outcomes review? What Peel pilot? I'm obviously missing something. 

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@Zarley

The project In Peel, (originally called the Peel pilot) soon to be unveiled the South, is the integration of care in the community.

I have sent you the reports as I could not send on the forums for some strange reason.

 

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2 minutes ago, Apple said:

@Zarley

The project In Peel, (originally called the Peel pilot) soon to be unveiled the South, is the integration of care in the community.

I have sent you the reports as I could not send on the forums for some strange reason.

 

Thank you! I've just opened the first file. Much appreciated. :flowers: 

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On 1/20/2021 at 10:48 AM, wrighty said:

NI does not fund medical treatment. It was designed for ‘social security’ - sick pay and state pension I think. 
 

NHS is funded by general taxation, and doesn’t guarantee you get seen by a doctor. With the greatest respect to my primary care colleagues, I’d suggest most people who want to see a GP would be better off seeing someone else - physio, nurse, pharmacist etc - and allow GPs to concentrate on who they need to see, rather than patients who’d like to be seen. 

 It might well be correct that people “who want to see a GP would be better off seeing someone else..”

There are however problems-  not only of  who to  see,  and how do they decide who to see, but where do they find these people who are able to see them?

The notion of the  general practitioner being the “gate keeper of the NHS “ was spouted decades ago, but it still has some relevance.

As a specialist ,you see patients who have been referred to you and therefore have been already “ filtered” by primary  care physicians. Your opinion is sought because your knowledge and skill and experience  is very sound and deep , but  with respect , not necessarily broad.

The primary care physician’s  knowledge is expected to be broad  and  not necessarily deep,  but deep enough to recognise, diagnose and treat a range of conditions and  be able to refer appropriately when needed.

This filtering is probably more successful sometimes than others,  depending on the referee,  but it is likely to be more successful than a patient  with unusual symptoms deciding which of many Departments  they should self-refer to and arranging their consultation.

Edited by hampsterkahn
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I’m not sure what the ‘Peel Pilot’ was meant to achieve on the ground? 

Despite the surgery staff being ever-helpful and accommodating, where possible, especially with my elderly father’s care, I’d still like to be able to get an appointment to see a doctor sooner than is possible at present. Even a telephone appointment involves a substantial wait. 

At the same time, colleagues I work with, from different areas of the Island, don’t seem to have this problem.

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13 hours ago, Zarley said:

First, thank you for posting the consultation. I wasn't aware of it, but I've filled it out, fwiw.

Second, I'm interested in hearing your opinion. What changes would you, as a GP, like to see in the public?

Difficult to know where to start sometimes, but here are my top three suggestions:

1. Learn where the "delete" button on your phone is.  In these strange days of lockdown, GPs are having fewer face to face consultations and more virtual consultations, including asking patients to send in selfies of suspicious moles or rashes.  This usually works well, but my heart sinks when I get a batch of 10 photos, all blurry, and showing a barely recognisable part of the body (is it an elbow? A heel? A breast?).  Just send your best 1 or 2 photos please, and hold the phone at least 10cm away from whatever you are trying to photograph. 

2. Remember that GPs are human and need sleep too, so use the nighttime MEDS service sensibly and don't phone in the middle of the night for things which can wait till morning.  Like chasing up test results ordered by your GP.  Or asking for a sick note.  Or an opinion on symptoms you've had for weeks but "I can't get an appointment with my own GP" or "I'm just coming off my shift and MEDS was more convenient".  I gave up doing any night time MEDS work for this reason.

3. Take what you read on Dr Google with a pinch of salt.  I have no objection in principle to patients using Dr Google, because sometimes it can alert the doctor to the possibility of something he hadn't thought about, which can be helpful.  But remember that although Dr Google is good at giving you all the possibilities, it is very bad at putting them into context and giving you the probabilities.  For example, if you check your kid's temperature at 2am and it seems a bit low, it may be because they have sepsis.  But in the absence of any other symptoms of sepsis, it's much more likely that it's a result of the body's natural diurnal rhythm, in which everybody's temperature drops at night.  (Another reason why I stopped doing MEDS night work.)

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Under pressure, it is understandable if the doctor sees themselves  as the supplier of a service perceived by the patient to be free and therefore not constrained by the usual financial supply and demand, and feels the demand for their services is therefore infinite.

A survey showed over 80% of GPs  fear litigation and have altered their approach to be defensive,  referring more and ordering tests as a result.

The GMC and one of the medical indemnity insurance co. (MOS) have shown  consistently that the main cause of complaints is not, as might be expected,   so much  about diagnosis( or rather misdiagnosis ) , but is mainly about the practitioners manner and communication especially around  serious illness  and communication about diagnoses .The sort of thing that would come under the old heading of “bedside manner”.

Most doctors , I would suspect would probably be able to count their totally unreasonable, impossible and nightmarish patients  on their list over 1-2 thousand on  the fingers of one hand.It would seem then that  the whole system depends on most people, for a huge majority of the time,  being  incredibly reasonable which is a hopeful foundation.

But there does seems a mismatch on both sides regarding expectations and that is where the work needs to start.

 

Edited by hampsterkahn
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That was a bit of a directed questionnaire, there wasn’t much room for movement and it seems a bit wishy washy. 
People want to see a doctor, dentist, hca, pharmacist or whatever when they need to, that’s how it was in the 70’s so how come it’s so hard to get it right now?

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15 minutes ago, hampsterkahn said:

Most doctors , I would suspect would probably be able to count their totally unreasonable, impossible and nightmarish patients  on their list over 1-2 thousand on  the fingers of one hand.It would seem then that  the whole system depends on most people, for a huge majority of the time,  being  incredibly reasonable which is a hopeful foundation.

But there does seems a mismatch on both sides regarding expectations and that is where the work needs to start.

 

As you say, it is in part a numbers game.  There are some 85,000 people on the IOM.  If only 1 in 10,000 of them is unreasonable or inconsiderate and phones the doctor in the middle of the night unnecessarily, that's 8 or 9 people phoning through the night, which wrecks my night and most of the following day, which makes me not want to do it any more, which is why I don't do it any more.  In theory, there should be very few people phoning MEDS in the middle of the night: if you have a life threatening emergency you should go straight to A&E, and if it's not life threatening, wouldn't it at least wait until 8 am?

Part of the problem may be lack of public education about how MEDS works.  Some people seem to think that MEDS is a bit like an international call centre, with rows of bored doctors sitting at computer terminals eating pizza.  When I used to do MEDS night shifts and got a call at 3 am from somebody who says "can you just look up my results on your computer?" I used to reply "no, because I'm  in bed" and got a small crumb of comfort from the stunned silence which followed.  It just hadn't occurred to them.   

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13 minutes ago, 2bees said:

That was a bit of a directed questionnaire, there wasn’t much room for movement and it seems a bit wishy washy. 
People want to see a doctor, dentist, hca, pharmacist or whatever when they need to, that’s how it was in the 70’s so how come it’s so hard to get it right now?

Because the supply of medical consultations has not kept up with demand for them.

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2 hours ago, BallaDoc said:

Difficult to know where to start sometimes, but here are my top three suggestions:

1. Learn where the "delete" button on your phone is.  In these strange days of lockdown, GPs are having fewer face to face consultations and more virtual consultations, including asking patients to send in selfies of suspicious moles or rashes.  This usually works well, but my heart sinks when I get a batch of 10 photos, all blurry, and showing a barely recognisable part of the body (is it an elbow? A heel? A breast?).  Just send your best 1 or 2 photos please, and hold the phone at least 10cm away from whatever you are trying to photograph. 

2. Remember that GPs are human and need sleep too, so use the nighttime MEDS service sensibly and don't phone in the middle of the night for things which can wait till morning.  Like chasing up test results ordered by your GP.  Or asking for a sick note.  Or an opinion on symptoms you've had for weeks but "I can't get an appointment with my own GP" or "I'm just coming off my shift and MEDS was more convenient".  I gave up doing any night time MEDS work for this reason.

3. Take what you read on Dr Google with a pinch of salt.  I have no objection in principle to patients using Dr Google, because sometimes it can alert the doctor to the possibility of something he hadn't thought about, which can be helpful.  But remember that although Dr Google is good at giving you all the possibilities, it is very bad at putting them into context and giving you the probabilities.  For example, if you check your kid's temperature at 2am and it seems a bit low, it may be because they have sepsis.  But in the absence of any other symptoms of sepsis, it's much more likely that it's a result of the body's natural diurnal rhythm, in which everybody's temperature drops at night.  (Another reason why I stopped doing MEDS night work.)

Thanks Doc. I appreciate you taking the time to answer. 

1. Makes me think of people who take in a whole jam jar full when asked to provide a urine sample. 😂

2. MEDS should have a triage person taking these calls and only passing it on to a doctor when it's actually an emergency. Could be ideal work for a retired nurse or doctor who didn't mind working nights. I don't blame you for giving it a miss. 

3. Six years ago I was a moderator on a forum related to a specific chronic illness. (did this for 14 years) It included a section for people worrying they had the condition and for these people, Dr Google was NOT their friend. Google was also a bad idea for many of the newly diagnosed. 

Suggestions to use only reputable sites, and listing said sites, usually fell on deaf ears. There are some very good, reputable sites. Unfortunately there are many, many more charlatan sites and Google doesn't differentiate between them.

Dealing with the Worried Well while IRL trying to cope with my partner's cancer diagnosis and subsequent death within eight months is what made me hang up my moderator's hat. I could no longer deal with the hysteria. 

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11 minutes ago, 2bees said:

That’s what I was getting at Wrighty, there’s little point in asking questions about what people want when they cannot provide the infrastructure to provide the care they need. 

The demand for healthcare will always outstrip funding available for it.  Therefore supply of healthcare has to be rationed.  Doing this overtly is too difficult - there have been various attempts across the world, they all have their problems, and when a 75 year old NHS is virtually the national religion suddenly saying 'we can't provide X or Y' or 'you need to fulfil certain criteria before being seen about Z' there's an inevitable political outcry and plans are shelved (or brought in by stealth).  So public healthcare bumbles along in a relatively mediocre fashion, lurching from one crisis to the next, while rationing sits in the 'too difficult' pile.

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3 hours ago, BallaDoc said:

2. Remember that GPs are human and need sleep too, so use the nighttime MEDS service sensibly and don't phone in the middle of the night for things which can wait till morning.  Like chasing up test results ordered by your GP.  Or asking for a sick note.  Or an opinion on symptoms you've had for weeks but "I can't get an appointment with my own GP" or "I'm just coming off my shift and MEDS was more convenient".  I gave up doing any night time MEDS work for this reason.

I suspect some people think there is a full time person covering MEDS all night or at weekends (wasn't this the situation at one time?) rather than someone on call.  So they treat it as the equivalent of 111 in the UK, as an advice line for stuff that isn't urgent enough to dial 999.  

13 minutes ago, Zarley said:

2. MEDS should have a triage person taking these calls and only passing it on to a doctor when it's actually an emergency. Could be ideal work for a retired nurse or doctor who didn't mind working nights. I don't blame you for giving it a miss. 

Well according to their website they do:

What will happen when you telephone MEDS

A trained receptionist will record your detail and pass to the on duty Nurse Practitioner, Urgent Care Practitioner or MEDS GP. 

The receptionist will ask you a series of questions to support the clinician in triage and insure that patients are prioritised in order of clinical need.

In addition to this they will ask you Covid Questions relating to temperature, cough and travel. Please answer these honestly it will not impact on the care that you receive from the Out of Hours team.

I suspect there's a need to look at how information about the service is communicated.

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