Mark Trowell typed:
> the biggest problem I find is reducing dependency in a hard core of
> patients. Trying to wean patients off the routine of monthly/3
> monthly/six monthly repeat consultations.
me 2
I'm sure my personal experience is shared by many on the list, in that,
I would estimate, 80% of my workload is generated by 5% of the list.
And most of these 5% aren't very poorly and in desperate need of medical
attention. Mostly, the situation has arisen that they see me reguarly,
for a variety of reasons.
Some of them, I don't mind seeing, and, obviously, I am to blame (at
least partly) for the way that the situation *has* arisen.
My life would be lot easier if these 5% just "disappeared", but that
isn't going to happen. I won't be following in the footsteps of my
erstwhile "colleague" from Hyde (the GP who has *ALLEGEDLY* murdered a
few patients for monetary gain).
As has been well publicised on this list, *my* solution to the morale
problem was to reduce my NHS committment, and keep reducing that
committment, until the stress levels began to drop. I now to half a
session every other Tuesday.
No, I do the equivalent of 6-7 clinical sessions a week, which keep a
certain of money in the coffers, though not enough bearing in mind the
huge drain that my heroin addiction causes... er, no, I meant the huge
drain my children, nursery fees, private school fees, petrol-guzzling
monster car repayments, etc, etc, (I hardly need repeat them here as you
will all no doubt be intimately familiar with them), Extra monies must
be obtained from other sources - journalism, medico-legal work,
independent tribunal service are the main ones. This tops of my income
to just over the average intended net remunertaion (only just) but the
stress levels involved in earning this are a lot lower than they were
when I was doing 9+ clinical sessions a week and (in the early days) 3-4
nights a week on call.
The point has been made that there will be financial consequences of the
increaesing number of women in GP. This is "a good thing" for many
reasons, but it does mean that a higher proportion of GPs will be
non-main-breadwinners in the househould and they may therefore care less
about the gradually eroding financial value - in the gummint's eyes - of
GPs in general.
Male traditional senior partner types (uesed to live and die) for the
practice. Everything was coordinated by them to make the practice as
efficient (in all senses) as possible. No, so many GPs have other
professional fee-earning interests.
I read on this list of GPs doing things I would never do. A Recent
example, spending hours checking through accounts for IOS fees. We see
what we caculated and see what the HA says, if there's broad
aggreement, leave it. Haggling over a couple of hundred pounds will soon
be a waste of my time. It might not be a waste of the practice manager's
time but, with respect, I don't think he has the required skills.
I'm sure there's a cliche about "someone getting the whatever they
deserve". Never been truer than it has been in GP. I worked with someone
once who was abrupt, never listened, wouldn't prescribe antibitocs,
would order addicts out of his room without thinking. Most of the
patients disliked him. Or I should day that most of the patients who
liked me, didn't liek him. Which should tell you just as much about me
as it did about him. What were the differences between us? Patient
satisfaction surveys would show a swing to me, but what about scientific
measurments. Did I cure more people than him? Did I reduce morbididity
than him? I doubt it. On the contrary, very possibly. The point being
that the patients liked me and I (must have) liked them. But he was the
one who buggered off to the golf course at 11.30am while I was in
surgery an hour later, taking calls from patients who couldn't get into
see me in the morning, and doing all the rest of the stuff my mode of
working generated but which my partner's mode of working did not.
Who's going to be the first to have an MI? Who's going to be the first
to take antidepressants?
So, I cut down my sessions. I can't change the way I work, because I
believe it's linked inextricably with my personality, and I believe even
more firmly that I cannot change that.
This seemed the most logical step and, so far, it seems to be working.
Many of the signs of stress have disappeared, or are improving. Sleeping
better. More tolerant of children's behaviousr at home (though not a lot
- but this may be more to do with the kids thab I. Better relationship
with wife. IBS which appeared for the first time about 12-18 months ago
(when things were at their worst) has largely settled.
[fx: sings] "Things are getting better!"
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