In message <[log in to unmask]>, Rachel Hopkins
<[log in to unmask]> writes
>
> Please educate an ignorant GP registrar
> and tell me what is wrong
>with changing your patient from warfarin
Nothing wrong - if that is what the surgeons and anaesthetists think is
needed before planned surgery
>( a notoriously bothersome
>medication) to subcut (self-administered)lowmolecular weight heparin -
>which doesn't require any monitoring? If you are already supervising
>his/her warfarin INRs
I'm *not*
>presumably you will save a lot of effort and if you
>are not it shouldn't create much extra work to give a prescription for
>heparin instead.
I like this phrase - "much extra work". It isn't a question of writing a
prescription but of liability, patient education (the patient's daughter
thought the prescription would be for tablets..), and nursing time ( and
may I remind you that GPs don't employ practice nurses to perform work
which has already been funded in secondary care?)
> The only trouble I spot is teaching the patient or
>relative to do subcut injections- in my experience, not too difficult.
Possibly not - but how long does it take? I've got patients - and not
only diabetics - who have been taught the technique.I would hate to have
them shown on a friday and left without help over the weekend for
surgery on Monday! :-<
>
>> Can anyone tell me, *is* this part of "usual medical services"? How many
>> of you have been asked to do this? and how many have done it?
>
> Are "usual medical services" = to "what was current practice when
>I was an SHO"? :-)
No - what we're paid for!
>
>> Just curious - I'll still say no..;-)
>
> Just curious - why?
1.legal responsibility
2.no facilities - especially when the change date just *happens* to be a
friday... does the day of the week have anything to do with this? could
it be co-incidence?
3.not the first demand that GPs should acccept legal and financial
resposibility for undertaking proceedures which are included in the
costing of the contracts NHS Trusts have with the Health Authority
Mary
--
Mary Hawking
Kingsbury Court Surgery
Church Street
Dunstable
Beds LU5 4RS
tel:01582 601289 (home)
01582 663218 (surgery)
fax:01582 476488 (surgery)
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