WHY DO THEY THINK WE’RE CALLED FAMILY DOCTORS?
...from a medic who warns GPs risk the very purpose of their being: having a human connection with their patients
THErE were no obvious red flags when I spoke to a man with a long history of abdominal pain recently, but doctor’s instinct told me I needed to see him. I’m his GP, but he seemed embarrassed to be ‘bothering’ me.
He assumed it was his irritable bowel syndrome playing up – but this time the pain was really getting him down.
When I examined his abdomen, there was clearly more than IBS going on.
I called the surgeons at our local hospital and he was admitted. It turned out he had a ruptured appendix and underwent emergency surgery. He later wrote to me thanking me for saving his life.
That was one of the more dramatic cases of the day, but equally important was seeing an elderly lady who didn’t have anything much wrong with her, nor anything very new to say: she just needed a human being she trusted to sit and talk to.
That’s fine. It’s very much part of my job to reassure patients, especially ones who are frightened and have suffered terrible isolation over the past 18 months. So it is disturbing to think that some GPs have got used to keeping patients at a distance.
In March 2020, GPs were told by the Government to ‘go digital’ and assess patients online, or in telephone consultations. Many are still rigidly following that guidance, even though the situation with Covid has changed.
A lot of GPs seem to have embraced the change, as it allows them flexibility to work from home.
But many patients absolutely hate it. Fairly or otherwise, thousands have come to believe their GP has shut up shop.
Almost everyone seems to know someone who has spent hours trying to get through to their practice only to be told they have to communicate by email – or who has gone private out of desperation.
WHEn Health Secretary Sajid Javid told MPs recently that it was ‘high time’ GPs got back to offering face-to face appointments, there was an indignant response from doctors who argued they were simply following official guidelines – and to be fair, they are.
That’s why it’s essential the Government changes those guidelines and issues a directive to GPs that face-to-face appointments should once again be the default (with the patient able to go virtual if they want to).
It’s also why I welcome the Daily Mail’s campaign supporting this urgently needed change.
Throughout the pandemic, the surgery where I work in north London has tried to continue as normally as possible, adapting as the Covid situation changed. We have maintained 15-minute fixed-time appointments, whether it’s by telephone or video. Too many surgeries vaguely offer to call people to discuss their symptoms later that day.
We started seeing patients in a more normal way about six months ago, though we do still have a system in place – and this isn’t my choice as I don’t run the practice – whereby a patient has to be triaged by a GP over the phone to determine whether they need to come in.
To me, that’s inefficient. If you do need to see the patient, they’ve got to book another appointment, so the first call on the phone is as good as wasted. I admit that when the Government advice to GPs to work remotely was first issued last March, it seemed sensible. We knew little about Covid then, and we did not have a vaccine.
I had a two-year-old daughter and my mother, 77, was looking after her during the day, so I was more than aware of the risk of picking up the virus and bringing it home.
GPs’ waiting rooms are always a breeding ground for disease, so the last thing we wanted was people sitting around giving each other Covid. But I was lucky – I’d trained at a surgery that did some emergency appointments over the telephone anyway, so I’d had plenty of experience of telephone triage. For a lot of GPs, phone consultation was a new skill entirely.
You don’t have any of the usual cues you get from a patient’s pallor or demeanour, so it’s all about rigorous questioning. I’ve picked up as many cancers over the telephone as I would normally. But I don’t think enough GPs have the same experience and, either way, it’s not always going to be a suitable approach. In many cases, vital symptoms will have been missed.
I realised just how bad the situation was at the peak of the pandemic, when I worked at Barnet Hospital as a front-of-house GP assessing patients as they arrived.
From listening to many of them, it was clear they were there because they felt it was impossible to see their GP. A 90-year-old woman told me she was only allowed to talk to hers now via ‘eConsult’, an online system she couldn’t understand.
All the patients I saw had fairly minor ailments such as knee pain, a minor allergy that had flared up that morning or a small complication with the contraceptive pill.
They were scared and unwell, but none of them needed to be at A&E. A quick conversation with their GP would have sorted the situation, but they all believed their GP was unavailable.
Clearly, we need to take action. But the pandemic isn’t totally behind us, so we have to think carefully about what we do next.
We know that while the vaccine is stopping people from dying, it’s not stopping people from catching and transmitting Covid. We’ve also all been cocooned for so long that as we go into winter all sorts of respiratory viruses will be waiting to take hold. Given all that, it still doesn’t make sense to fill up GP waiting rooms needlessly with vulnerable people.
So maybe the answer lies in patient choice. Let’s allow people to choose between a face-to-face appointment and a video or telephone consultation, having assessed their own risk and decided whether they want to come in.
I think patients would feel reassured if they knew they could see a doctor as a default. otherwise it’s easy to feel palmed off.
The irony is that most doctors become GPs because they like people. GPs aren’t known as ‘family doctors’ for nothing. We pride ourselves on knowing the people we care for.
If we don’t get this crisis sorted, we risk losing touch with the very purpose of our work. n