I have been fascinated by the debate between Drs Risk and
Jenkinson, but I can't see what the arguement is for here. Of course
investigations should be valid and usually the result should be expected
to alter patient management. But that's a very narrow way to look at
general practice. Investigations can be done to investigate, or to
reassure or treat anxiety. In the latter case, surely they should be
assessed as to their value as methods of reassurance, which could equally
well be cost effective. The challenge is to decide whether the patient is
better off with or without the investigation. Some patients are
marvelously reassured by a simple test, others are not and may only be
encouraged to focus on physical symptoms.
Choosing to perform an investigation in order to reassure does
not have to be "doing everything for everybody", and it's not necessarily
expensive or wasteful. A young man recently asked me to check his blood
pressure because he was having band-like headaches at work. It was a lot
esier to check it for him and then discuss work stress than refuse his
request and explain a blood pressure check wasn't indicated. If he had
requested an MRI scan, the balance of the equation would be different...
Also:
Doctors sometimes need the reassurance of "unecessary"
investigations too!
Don't let's despair yet: general practice is fun!
__________________
Dr Rachel Hopkins
GP Registrar, East Oxford Health Centre
GP Registrar Observer at RCGP
Ahmad Risk wrote:
>
> Doug wrote:
>
> > Right here and now the way we practice is determined as much by
> > cultural expectations as medical propriety and the cultural
> > environment is one increasingly of "I have a right to know".
>
> It is a case of refusing collusion.
> I reckon I spend about half of my consultation time trying to:
> a) temper expectation
> b) marry what is *possible* and *feasable* with what is best for the
> well being of my patient
> c) not to collude with cultural expectations of what is not possible
> d) not to nurture unrealistic demands on me and on the system as a
> whole
> e) tell people it's OK to cross the road and it's just snot that will
> go away by itself, don't expect me to wipe for you!
>
> > Surely this is more appropriate today (tomorrow is another day)
> > than the econo-centred (not doctor centred) Risk model.
>
> It's not really a case of Risk econo-centred model. It is a case of
> getting real. After all, somebody has to pay for health care. So
> far, that somebody's been the taxpayer and the doctor who can not
> and will not say no. The former has been saying: "I won't pay but I
> want everything" for decades, and the latter still says: "I will
> work more for less 'coz I am really a nice guy".
>
> Well, my esteemed Doug, the here and now is a health system that is
> cracking up with collapsing A&E, beds blocked with elderly patients
> who can't be discharged to nursing homes, more and more secondary
> work being dumped on the cheapest professional labour in the land,
> hospital closures, dump in the community, rhetoric stolen from Mao,
> gp training schemes that go begging for takers across the globe,
> consultants who are too scared of the power suits that they became
> impotent, nurses who are paid in monkey nuts and being asked to take
> on more, politicians who lie through the teeth and inhabit some
> weird planet yet to be discovered by the SS Enterprise.
>
> Culture? Don't talk to me about culture when a lot of what I see
> around me is despair and we have not the guts to speak out.
>
> Yeah, let's do everything for everybody all of the time and get it
> over and done with. Eventually, the cleaning lady from RSA will
> come along, pull the plug and finish her song.
>
> And guess what? We will still be under the anaesthetic!
> --
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