No cheap and cheerful alternative to a doctor
When starting out as a junior doctor, everything is new and scary. One of the first encounters I had with a patient was when a nurse paged me to prescribe paracetamol.
I went to the ward and the nurse pushed the prescription chart in front of me.
I froze. I knew what you gave paracetamol for, and I even knew the pharmacology behind how it worked. But how to actually prescribe — the doses, what to write and where, how often it should be given and so on — was something that doctors weren’t taught at medical school.
The nurse looked at me and, barely able to control her smugness, whispered ‘1g QDS’ (abbreviated Latin for ‘four times a day’). I scribbled it down.
We weren’t taught how to prescribe drugs at medical school because that’s not the hard bit. The hard bit is knowing how they work, why they work, why some interact with others. The hard bit is working out what’s wrong with someone. It’s differentiating between a sub- arachnoid brain haemorrhage and a headache that takes six years at medical school and countless years of training afterwards.
That’s why the majority of prescribing on a ward is done by the doctors. In fact the juniors rarely prescribe anything stronger than a painkiller without the say-so of a much more senior and experienced doctor.
My heart sank when I heard the latest hare-brained scheme from NHS bosses to allow paramedics to prescribe medication. under controversial reforms, ambulance workers with special training will be able to take on duties traditionally performed by GPs and hospital doctors, so more patients can be treated on the spot.
Let’s be clear here: this has nothing to do with what’s best for the patient. Like the proposals to get GP receptionists to triage patients, NHS bosses are just trying to stop sick people coming to hospital and seeing a doctor.
The NHS is bursting at the seams and — amid desperate staff shortages and underfunding — bosses are getting increasingly desperate to plug the tidal wave of patients deluging A&e. But you can’t cut corners with cheap and cheerful alternatives without there being consequences.