Jeff
We get recommendations for treatment all the time that are wrong, and
sometimes even dangerous. The originators our our local hospital trust.
We have tried in the past to "communicate". One of the best examples was
last year when an elderly lady was admitted with a falling Hb, was
transfused, and was found to have erosive gastritis. They also discovered
that she had atrial fibrillation, so sent her out on ASPIRIN. When
challenged, the consultant insisted that he was sure that the lady wanted to
reduce her risk of CVA - despite the fact that her risk of dying of a GI
bleed was many more times greater and the asprin was clearly
contra-indicated. A wonderful example of how protocol led medicine has
seriously impaired the quality of holistic medical care that patients
receive. (When the risks were explained the patient herself definitely did
not want to take aspirin). The consultant was not fazed by our complaint at
all.
I have not yet got to the stage that a local GP has, where in this situation
he reports the doctor to the GMC.
When such a clear-cut case can have such an unsatisfactory outcome, is it
any wonder that for the majority of cases, most primary care clinicians
(doctors and nurses) just change what is necessary and get on with caring
for the patient, rather than trying to "communicate" with the other
clinician.
And in our area there are a number of GPs who never routinely visit
terminally ill patients, and are likely to have prescribing skills in
terminal illness which are lacking compared with those of a trained
palliative care nurse. We do visit these patients regularly, and I would
expect communication with me if anything was changed, just as I communicate
with them (usually in the written patient notes, or by direct face to face
contact).
Laurie Miles
-----Original Message-----
From: GP-UK [mailto:[log in to unmask]] On Behalf Of Jeff Green
Sent: 04 December 2005 10:31 pm
To: [log in to unmask]
Subject: [GP-UK] Communications breakdown?
Snippet from a nurse on the palliative care mailing list.
"Her GP has prescribed ********* for this but I've advised her not to take
it"
This sounds like a communications breakdown to me.
Should the members of a patients care team be giving conflicting advice?
And if the answer is no - could I ask you to think about the barriers your
practice has which prevent effective communication.
Jeff
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