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Subject:

Re: Ethics and militancy (was: monitoring in practice)

From:

Jel Coward <[log in to unmask]>

Reply-To:

[log in to unmask]

Date:

Mon, 31 Aug 1998 19:05:41 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (94 lines)

In article <[log in to unmask]>, Iain L M Hotchkies
<[log in to unmask]> writes
>
>Hmmmm.... not too sure about this.
>
>Remove the specific 'osteomyelitis'...
>
>"to prescribe painkillers for XXXX
>without making a diagnosis is negligent"

>I couldn't possibly count the number of times I have prescribed
>painkillers without having made a diagnosis. Not a specific
>diagnosis, at any rate. And I can think of numerous situations
>where I have prescribed painkillers for chest and abdo pain
>without knowing for certain what was going on (although I may have
>been fairly certain what *wasn't* going on).

Agree - but these are areas within your expertise and training - so you
have a right and perhaps obligation to apply your judgement.
>
>However, if someone comes in clutching their jaw, saying it hurts
>when they prod one of their back teeth, that their gum is swollen
>(or whatever - I'm sure you can fill in the blanks with a few
>symptoms), and that they can't get an appt with their dentist for
>nine years, then it *might be considered somewhat dispassionate*
>to withold painkillers and antibiotics, 

Dispassionate perhaps - but no more so than the dentist.  I am not a
sponge - I can absorb no more work.  (Remember - we do our own on-call,
we attend emergencies, we thrombolyse - I think not treating something I
do not have the skills in really only a minor blemish)


Now - I could use the dispassionate word when talking about GPs not
attending emergencies/not being proficient in CPR etc - remember that
one from a year or to ago?  ;-)


>knowing full well, as
>we surely do, that this would be the first step taken by most
>dentists.

- no, a dentist may well realise a need to drain the abcess (if that is
what it s) stat - who knows - i don't - **because I am not a dentist**
Can I refer you back to Declans post?

>
>Yes, I wholeheartedly agree that in an ideal world dentists would
>all have some sort of easily accessed 24 hour service (hell, even
>an easily accessed 9-5 service) but they don't. Sure, fight them
>in the political arena, in the medical press, but make the patients
>suffer in order to prove a point? Over such a (realtively) trivial
>matter?

No, no, no, no, no - it is not us that 'makes the patient suffer' - it
is those who are qualified to treat them but refuse.  We are not
qualified to do it.

I hate seeing animals suffer - but it is not my job to treat them if the
vet won't.  I can make a reasonably good job of concreting - but it is
not my role to fill the holes in the road just cos the council wont (and
these are probably far more dangerous and costly to our patients than
toothache)

>
>The fact is, I agree with your sentiments wholeheartedly. But when
>it comes down to it, and there's a patient sitting in front of me,
>I'm going to give them antibiotics and painkillers (and the advice
>to consult a dentist forthwith), as, I suspect would 99% of GPs.
>

That is fine - it is your choice - I would have no argument with it.

Not me though - or many GPs I have worked with and met - I think your
percentages are probably wrong.

Most dont get to present to me - either they know what I will do - or
the receptionist directs them to the dentist - or if OOH and they speak
to me then I explain - and let them wait to see me if they wish but with
the clear knowledge beforehand that if I think it needs a dental opinion
then I will not blindly treat and therefore they would be better off
spending the time trying to track down the dentist.

I keep the emergency dental phone No. in our cottage hosp casualty- but
it is usually a fruitless exercise.
-- 
Jelly Bean

                        'When you get fed up surfing....
                                        .....go find some waves'


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