>
>Toby asks " should'nt we spend more time trying to diagnose and treat those
>patients that are actually ill?" Which ones are those Toby? And which other
>member of the PHCTeam has the education and the balls to say to a patient
>"youre one of the 53 percent of my patients who
>are somatising (lying) ? " Sadly a Nurse Practitioner is not much good at
>that and a hospital
>consultant certainly is not. Thats the thing, you need 9 years of
>boimedical training to tell a patient with bizarre symptoms that they are
>physically safe and should be counselled. Sorry
>but given the present undergraduate structure the GP remains preferred
>first contact.
>Dave Young , Derby : )
One of the reasons patients consult for non-medical problems (or at
least problems that don't need a doctor to diagnose and treat) is
ignorance. Another is consumerism ("it's my right"). Another is the loss
of self-reliance. I could go on and on and...but another reason is that
GPs are their own worst enemies when it comes to accepting
responsibility for things that needn't concern them. Nurse practitioners
are perfectly good at diagnosing and advising about minor illness, and
may be more effective than GPs at helping patients to understand that
these problems don't need medical interventions. I can also see a role
here for health visitors (if they could get out of backing up inadequate
social service departments ;-)
The main thing is to change the organisational approach. OOH co-ops have
demonstrated that nurses can give telephone and face to face advice
without running to a GP every five minutes and without patients becoming
seriously ill because of missed diagnoses. Likewise for many triage
projects. Change the organisation of care and patients will change their
behaviour. If GPs carry on seeing every kid with a cold "just to
reassure" or "just in case it's meningitis", then they'll only have
themselves to blame if they are overwhelmed and can't cope.
If you back up organisational change with clinical and educational
support, use clinical epidemiology and other "evidence-based" skills
throughout the PHCT, then you can soon have safe and effective triage
for minor illness and a higher quality of care for serious stuff.
Oh - and learn to say "no".
I rest my case.
Toby
--
Toby Lipman 7, Collingwood Terrace, Jesmond, Newcastle upon Tyne. Tel
0191-2811060 (home), 0191-2437000 (surgery)
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