Lynn Woods wrote:

>
> A report presented to ministers last month said there were
> "unmistakable signs of pressure" on the emergency care system.
> Hospitals across the country came under intense pressure last winter
> to cope with surges in demand for emergency admissions. There has also
> been a consistent increase in recent years in the number of 999 calls
> being made and in the number of new attendances at hospital casualty
> units - with minor emergencies accounting for much of the pressure.
>
> Mr Malone confirmed that the Government was also looking at a public
> education campaign on basic life-saving skills in order to help people
> deal effectively with health emergencies. The campaign would teach
> people how to recognise an emergency, how to treat it and how to seek
> further assistance.
>
> Mr Malone said: "It is a question of not only educating the public how
> to handle emergencies but how best to access the best help."
>

This is the bit I'd like to concentrate on - after working part of Xmas
we coped with the usual madness - 50% trivial calls, 40% reasonable
& 10% genuine stuff, with a few real peaches thrown in - e.g.....

1. Girl aged 23 rings after sore throat for 15 mins - has taken NO
treatment
& requests visit please. Careful (& calm!) history reveals no lumps in
neck,
no pain on swallowing, nothing at all really, just her throat feels
"funny".

It is far easier today to reach for the telephone than the paracetamol -
we all
know where the phone is - but not the strip of paracetamol/aspirin etc.
We are
TOO accessible! Much of the crap should be screened out by a triage
system, leaving
doctors to deal with the rest, doing what we (in primary care) do best -
take histories
(+- examination), diagnose, (+- investigate) & treat/advise. The same
should apply to
duty doctor surgeries, minor illness clinics (or whatever). making it
more difficult for
the trivial to reach the doctor gives us the time & protection we need
to deal properly
with everything else - including the massive secondary to primary shift
that has already
occured without any accompanying shift in resources.

The second part of the girl's consultation revolved around her request
for a visit. I know
that our terms of service have changed & we have taken advantage of this
in my practice.
However - we still spend a lot of time "selling" the idea of coming to
the surgery instead
of expecting a visit - using our highly developed negotiating skills,
never actually saying no,
lots of open questions - you know what I mean. Half the consultation is
about whether or not
there is a need for a consultation (& with whom) - the rest deals with
the venue. "In 30 years
we've only had the doctor out 3 times". It doesn't matter that all 3
visits were inappropriate!
Patients NEVER see their own demands as unreasonable, merely the using
up of their allocation,
though they agree that calling the doctor unnessessarily is done BY
OTHER PEOPLE.

This attitude is a direct result of health consumerism & a service that
is under-valued because
nobody pays. I have no objection to Joe Public wanting late night
surgeries (to tie in with
late night shopping etc), home visits when he gets back from the office
& needs a BP check -
providing Joe will pay. At the moment, we pay for the privilege of
offering these services &
unless there are sound financial reasons for doing this (e.g. falling
list etc)
I can see no reason why we should.

I believe that the recent program of health consumerism does not sit
easily with educating the
public how to use the service(s). This applies to primary and secondary
care.
Joe has been told much of his rights on recent years & I see little
evidence that he is going
to be as keen to exercise his responsibilities...

Happy New Year :-)
--
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*Alan Hassey email [log in to unmask] & [log in to unmask]*
* http://www.midwife.demon.co.uk/ >>>>>> PGP public key available*
* GP, GP Trainer & GP Computer Adviser (NYHA), Skipton, N. Yorks.*
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