KT said:
>Decision process:
<1-4 snip>
> 5. If the patient does need seeing, and the caller is not
>amenable to reason - I go, see the patient and then (this is the bit
>requiring balls of steel) explain it was unreasonable and an abuse of
>resources to demand a visit, that the patient would not have been harmed
>by coming to the surgery, but that there may now be seriously ill people
>waiting for a doctor because of this. If they are not my patient I
>inform them I will be telling their own GP it was an unnecessary visit.
So in no time the patients get to know that if they are not amenable to
reason (and many this end are not IMHO) they will get a home visit? And you
are putting yourself in a situation of potential aggression if you attempt
to chastise.
>Now the kinder part of me sees that many people do not have the
>intelligence to see the difference between clinical and social need - if
>they are really really thick there is just no point in even trying to
>explain - the only *rule* here is to be safe, and it has to be
>*positively alright not to visit*.
The spectrum of what GPs will visit and what they will not is extremely
wide. We have docs who adhere to North Staffs rigidly and others who will
visit almost everything.
Trouble is get two docs on a busy week end shift who both are in the
visiting side of the spectrum and the Co-op is knackered with calls backing
up, On Call at Home being dragged out and turmoil.
>There are also those who really do have financial problems, or no
>friends, neighbours, etc. If I am honest then sometimes I may have
>refused a visit just to make the point, then sat in the base, watching
>TV, or talking - that's just mean.
Why? Years gone by it was normal to have a half crown in the spare tea pot
just in case you needed the doc? How many of those with *no money*, smoke,
drink, have a TV Video, etc. I don't think it would be asking that much to
require people to make provision of the cost of a packet of fags just in
case they need a taxi for the OOH Base?
>I admit to being irritated by "I'm a single parent family" and "I have
>other children" - the hours my husband works I too am often effectively
>a single parent family, and I too have other children - that is choice,
>and one cannot make your choice then expect someone else to pick up the
>tab. If either of these is proffered as reason for not coming to base, I
>am automatically antagonised so being fair is much harder.
>
>I suppose, after all this waffle, the only *rules* I try to stick to is
>be safe and be fair.
Be fair to yourself too. If they come in you could potentially see 8+ per
hour perhaps in a six hour shift makes 48 calls dealt with. How many
visiting probably no more than 20 if that.
People who refuse to come in to Base for non medical reasons must take
responsibility for their own illnesses.
Paul Attwood
GP Thanet
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