17 August 2008

Go and see your GP

That's the advice you get at the Walk-in Centre if you go in with a cough. Because they are not qualified at the Walk-in Centre apparently. The nurse is very professional. But the profession she belongs to is nursing. And for diagnosis what you need is a doctor. To give her her due she did tell the patient that. Dr Grumble has seen worse outcomes from the Walk-in Centre - much worse. Confident but utterly and dangerously wrong diagnoses. It's not surprising. Diagnosis is difficult. GPs have a difficult job. Nurses have a difficult job. GPs are no good at nursing. They have not been trained to be nurses. And vice-versa. Whoever set up these places should have realised that.

If anybody should have known of the inadequacies of the Walk-in Centre it should have been the reporter from Pulse. GPs must have been telling him this for a long time. We all make mistakes. But if the reporter from Pulse failed to get the message what chance has the poor ignorant punter from the council estate?

The story is here.


Anonymous said...

The Walk-in Centre nearest to Pulse Towers claims to offer as main services:

Contraceptive advice
Coughs, colds and flu-like symptoms
Information on staying healthy and health promotion
Minor cuts and wounds - dressings and care
Muscle and joint injuries - strains and sprains
Skin complaints - rashes, sunburn and headlice
Stomach ache, indigestion, constipation, vomiting and diarrhoea
Support for stopping smoking
Women's health problems, thrush and menstrual advice

So coughs are number 2 on the list. Perhaps if had gone for condoms he would have done better.

Incidentally the expertise of these nurses includes the whole of dermatology which is impressive. Some people spend years training in dermatology. There's a name for them I think.

Elaine said...

The other thing I found interesting was the advert on Pulse for the BMA - it gave the impression that they were running a bit scared of Remedy.

Dr Grumble said...

The BMA certainly ought to have a lot of things to worry about at the moment. It is largely an organisation for GPs (or that's the way most hospital doctors view it) and, as Dr G has pointed out on many occasions, general practice as we know it is under great threat. Whatever the failings of the BMA that should be its greatest concern now.

Dr G is baffled by the government line on this. Why destroy general practice the greatest strength of the NHS? Do they really think walk-in centres save money? In the example given in Pulse everybody's time was wasted and quite a bit of NHS money. But this has not stopped the politicking on polyclinics. How is Darzified general practice going to be better or cheaper? Or is Virginification what this is all about.

Oh well. At least Gordon Brown is now listening to Dr G.

the a&e charge nurse said...

What is the message, Dr Grumble ?

As I see it EVERYBODY is suffering from something nowadays [until proven otherwise by a doctor] - or at least thats the kind of mind set that seems so prevalent in our culture.

The journo, a healthy young man, was well enough to go to work.
He had a cough for THREE WEEKS but still didn't make an appointment to see his GP [if he really was that concerned].
When he did finally decide to obtain help he insisted that he should have been offered an unequivocal diagnosis [based on a vague complaint].

Why should patients with proper diseases continue to be deprived of medical attention/treatment because of the vast sums squandered on this sort of nonsense.

We all know WICs are simply a device to divert the worried well away from GPs - the sort of minor health complaint that sensible individuals would have taken care of themselves not that long ago.

Yet such is the anxiety nowadays that certain customers [like the journo whose emblematic tale you highlight] STILL WORRY, even when no significant features are highlighted.

You might think of this as a doc vs nurse issue but I think the malaise goes much further than that.

Dr Grumble said...

A&E Charge Nurse, Dr Grumble agrees with all your points.

Since this post Dr G has been to see two of his relatives who are both GPs who say that the nurses they know in these set-ups are good and they haven't come across anything important they have missed. But then if the idea is that they deal with the worried essentially well then there wouldn't be much pathology to find.

Dr Grumble's experience of these places has been different (but the patients he sees have been highly selected). He has seen one missed pneumothorax and one pain in the chest which turned out to be bone metastases. Neither patient came to any harm as a result but it did seem to Dr G that the nurse would be better employed elsewhere.

As you say we are not educating people to deal with self-limiting conditions. In fact only yesterday when Dr G was in the post office he saw a big sign on the wall instructing him to see a doctor if he had a cough going on for longer than 3 weeks. Which, of course, is what the journo had so you can't really blame him. And it seems the nurse didn't think there was anything much to worry about and was probably right. And depending on the exact clinical details it may be that a GP would not have done very much.

How often does a young person without a chronic disease need to see a doctor? It should surely be rarely. Dr G has not seen a GP for over 30 years. Nor has he treated himself with any prescription medicines. And if you only need to see a GP rarely, say once every few years, surely it is not too much to ask you to make an appointment with your GP rather than just drop in to a nurse on your way to work.

Your points are good ones. Nurses may actually be the right people to instill a little common sense.

Anonymous said...

79 of 100 WiC attendances attend their GP or A+E within 48 hours. Now what is the point of that?