malehealth blog spot: DR GEORGE

A Quality Service?

2006-06-06T23:25:00.000+01:00

There was a lot in the press today about a new idea to find out whether GP’s and their practices provide a quality service. For most GPs we sighed heavily and wondered how much more paperwork we would have to complete and how many more hoops we will have to jump through.

We already have a new contract that means we have to achieve certain targets and this gives us a certain number of points at the end of the year. It is therefore possible to see whether your practice has done well in this respect. The targets cover clinical care, administration, patient surveys and many other aspects. It is very comprehensive.

So to hear of yet more targets makes us wonder just when we might be allowed to get on with seeing our patients and striving to maximise the care we offer to all our patients.

All Change!

2006-05-25T20:52:00.000+01:00

One thing that is certain in the NHS is that it is reorganised every 10 years or so. This last week has seen the latest alteration to the structure of the NHS in your local area.

Primary Care Trusts (in England) were merged last week – roughly three PCTs into one. This means that many people in these organisations won’t know if they have a job next year. Local health professionals won’t know who they will be dealing with in the near future and it means a whole deal of uncertainty.

Just as we had built up some good relationships with local managers then it all changes and we have to begin again – how frustrating! Of course it is the politicians in London who decide all this and for those of us working at the coalface it all seems very remote and we wonder why they want to change it all yet again.

Then again – it is 10 years sine the last change so they must have realised it was time to do something – even if it is not clear why it needed doing…….

money money money

2006-04-18T22:35:00.000+01:00

If you listened to the BBC today they were suggesting that GPs were earning around a quarter of a million pounds each! I wish! It does seem that a few GPs out of the 35000 of us do earn a vast amount but the majority do not come anywhere near this figure.

The focus on money is unfortunate given that the new contract GPs are working with is improving the health of the nation to a massive extent. The calculations show that the work we are doing will prevent 9000 heart attacks or strokes over a five year period. For me the prevention of just one heart attack is enough but to prevent 9000 is fantastic.

For GPs to do this work takes time, effort and the use of many staff in our practices. Most GPs are working flat out to help our patients. We all try and improve the health of our patients and to be told by the press that we are ‘fat cats’ or ‘not worth the money’ or ‘not needed’ can be very hurtful but we will carry on treating our patients to the best of our ability and hope our patients appreciate this!

Spotted Dick

2006-03-23T14:29:00.000Z

For those of us who had lots of school dinners we know that this was a dessert that quite often tasted better then it sounded.

Now I am a GP though it has an altogether different meaning to me.

Quite often I will see a young man (usually he is young but not always) who has discovered some worrying spots on their tackle. It usually causes great consternation as all sorts of horrible things go through their minds. Will I need to go to a GU clinic – what will they do to me? Am I going to pass it on to anyone? Will it get worse? Will I need an operation on it??

Last month a young man, aged 20, came to see me with spots he was worried about. I had a chat with him and found out how long they had been there, and whether his partner had any problems.

Of course I needed to take a look and a quick glance made it clear to me that he probably had warts on his penis. This is sexually transmitted and can be dealt with by a GU clinic (you can find the number for them from your GP surgery or in the phone book). I can reassure you that they will not do anything to you like the stories you might hear in the pub!

It is always important to use condoms to prevent these sorts of problems and if you do become infected I always try and say to patients that they should also tell their partners so they can get treated too.

I saw the same chap last week and he told me he had been to the clinic and they had dealt with him confidentially and with no fuss. He was pleased he had them sorted out.

Choice

2006-02-08T22:54:00.000Z

This is the BIG word in GP surgeries now. The government have asked (told) me to give ‘choice’ to all my patients who need hospital treatment. In reality they want me to ask whether my patient wishes to attend one of five hospitals when they need a consultant’s opinion. I know one of the hospitals very well – our good old local hospital which provides a pretty good service.

However the other four hospitals range from 40 to 150 miles distance from the surgery. I have never visited them and know nothing of the consultants there.

All the patients look at me in a strange way when I offer them this choice as if I have just told them Margaret Thatcher is our current Prime Minister! All they want is fast effective local health care. But tell that to the Department of Health!

So I will carry on getting strange looks from my patients for the time being and see if the politicians change their minds!

A close call

2005-12-05T20:03:00.000Z

A man aged 61 came to see me a few weeks ago about his tablets. He mentioned towards the end of the consultation that he had a ‘pulsation’ in his stomach. This made my ears prick up and I examined his belly and indeed found a pulsation there. I decided to arrange an ultrasound scan (the one woman have when they are pregnant) fairly quickly.

I had an email very quickly from our local consultant saying this chap had a fairly large aortic aneurysm (a bulging of the main blood vessel in the abdomen). He needed seeing soon in the out patient clinic so I informed my patient, reassured him and arranged the appointment.

However he left me a message a few days later to say that the pain in his stomach had worsened. This rang alarm bells so I spoke to him and admitted him to hospital for more tests. It turned out the aneurysm had got bigger and was about to burst – something which would be likely to kill him.

The story has a happy ending though because an urgent operation was done, with him recovering well over the next 10 days on the ward and I went to see him at home the other day to find him in good spirits and looking forward to another 30 years of health!

I don’t want any of you to panic about this. Aneurysms are rare but I did want to get the message across that if something feels not quite right in your body then have a chat to your GP about it – if only just to reassure yourself!

Flu

2005-11-05T21:39:00.000Z

We have had a run on our flu jab clinics these past few weeks – so much so that we have run out and are seeking extra supplies for our patients. I have had some patients say they need one to cover them against bird flu. Unfortunately the annual flu jab does not cover you for bird flu.

There has been a lot in the media about bird flu and some may think it is all a bit OTT. The risk is that flu in birds could mutate and affect humans. The problem is we don’t know what sort of flu virus it will be until it affects humans. There are thousands of different flu viruses already with extra ones coming along and that is why we can’t beat flu as yet with one jab for all for life.

The main message I would say is that if you are eligible for a flu jab then get one this winter and keep yourself fit and healthy. There is no sign of any bird flu at present and lets hope it stays that way!

Access to a GP

2005-10-16T21:36:00.000+01:00

I have been told that 90% of men in a survey wanted to see their GP either in the evening or at weekends. In an ideal world this would be great but it is just not possible given the shortage of doctors and nurses in the UK. There are not enough hours in the day. I know there’s been millions of extra pounds given to the NHS but most GPs honestly cannot see many extra doctors or nurses in the system. What this means is that we just can’t open 24 hours a day to see patients as we are over loaded from 8am to 7pm as it is.

My practice allows patients to book in advance for some of our appointments in each surgery but we also see every patient who wishes to be seen that day. This can cause enormous demand on our appointments. Quite often our staff are verbally abused by patients who can’t get an appointment at a convenient time for them and the abuse can be quite demoralising for our hard working staff. Sometimes they are even close to tears by the nasty comments from patients!

So please bear in mind the constraints of the NHS and have some sympathy. We really are doing our best for you!

Cuts Cuts Cuts

2005-09-21T22:05:00.000+01:00

Despite all the political hype there just isn’t enough money in the NHS. Only today I heard that our local health authority is millions in debt and can’t invest any more in our local health services. This has been a real blow to local GPs as they have been desperate to improve care to their patients. We have been planning on expanding our services in our surgery but with this latest bad news we won’t be able to. This is happening all across the UK and looks set to continue. GPs are very keen to move forward and embrace the latest medical advances but we simply can’t. We feel as though we are being held back through no fault of our own. This lack of investment in what we do is short sighted as it will only mean that more patients will end up in hospital which costs far more in the long run. How frustrating!

'While I'm here doctor'

2005-09-09T22:10:00.000+01:00

Can I make an appeal to all patients in the world? Please don’t bring your shopping list to your doctor. Remember I only have around 8 minutes to see you and there are 15 others wishing to see me that morning plus a few at home to see, then a further 16 that afternoon. There is nothing more frustrating than a whole list of problems that someone has saved up for their visit to the doctor. It can be hard enough working out one of your problems but when I am bombarded with 3, 4 or sometimes 5 different things it all becomes a bit too much. Now I know it can be tricky to get an appointment or your boss won’t give you time off but most doctors prefer to deal with a single issue so they can thoroughly think through your illness and ensure you get the correct treatment. Don’t take this the wrong way – just let us give you the attention you need.

I was told to come Doc

2005-09-07T23:22:00.000+01:00

A chap came today and recited these words that I have heard so many times before. Quite often men only come to see their GP after much nagging by their other half ! I am afraid this is true the world over with men as they tend to ignore symptoms and quite often only attend after they have been ‘told to do so’. Sometimes the delay can mean they have suffered longer than they should have. If only they had attended their GP a little earlier then their illness could have been sorted out sooner. So for any men out there with some symptoms they are worried about -----à see your GP!

Viagra or Not?

2005-09-03T15:59:00.000+01:00

This is the question GPs ask themselves many times. Ever since Viagra was
allowed on prescription we have had to follow a set of rules as to whether
we can prescribe Viagra on the NHS or not. It is one of the few medicines we
have to do this for yet we are allowed to prescribe thousands of other
medicines with no such rules.
Only this week I saw a young man doing very well in getting over his
depression. He also had an erectile problem which had been long standing. I
had done some preliminary tests to ensure his erection problems were not
caused by other illnesses and it was at this stage that I felt he would
benefit from Viagra usage in the short term.
However he cannot have it on the NHS as he does not fit into these fairly
rigid rules. I had to issue him with a private prescription for which he has
to pay over 20 pounds for 4 tablets.
He was so obviously going to benefit from the tablet and possibly it would
speed his recovery up from his depression if he could get back to some
normality with his sex life.
The government puts these rules in place and I sometimes wonder whether
those in positions of power truly understand the ramifications of their
actions by limiting certain drugs.
I will be seeing this chap in a few weeks to see how he is getting on so I
hope he will be much better by then.

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Back to the slog

2005-08-29T18:39:00.000+01:00

Well I have been away for 2 weeks on a very enjoyable holiday with plenty of unhealthy activities – and I am not just talking of the Cornish cream teas!

It is Bank Holiday Monday today and I popped into the practice to check things prior to work tomorrow. I was pleased to see over a 100 emails awaiting my attention and around 80 letters from consultants about my patients. All require detailed consideration and follow up to ensure patients are better or progressing as they should. There was also a lot of blood results on my patients that needed my consideration – most had been dealt with by my partners whilst I was away. There was also mounds of insurance reports and other paperwork! And all this before I even see a patient tomorrow.

The day after a bank holiday is notorious in general practice for being busy. It seems every patient and their dog calls for an appointment. It is frustrating for patients who cannot get through on the phone but we have 8 phone lines manned by a member of staff open from 8am for our surgery. Even then there is a wait for the phone to be answered. Some complain but many understand we are trying our best to deal with problems.