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The function of achieving a timely and accurate diagnosis should really be viewed as a specialty in itself IMO However the disappearance of the consultant general physician is part of the wider malaise in UK healthcare which is an almost total failure to measure and publicise clinical outcomes (and consequently no alignment of incentives for drs and hospitals to achieve good ones). If hospitals were obliged to publicise their success (or otherwise) in promptly achieving the correct diagnosis there would be considerable evolutionary pressure applied to the frequently observed "well whatever it is it's not gynae/cardiac/whatever" attitude. They might very well decide that an MDT approach to the conundrums would be useful, and having demonstrated their clear expertise, local GPs and patients might well reward such expertise with an increase flow of patients further reinforcing the virtuous circle. OOH when payment/reward is aligned to "more contacts = more profit" evolutionary pressure might lead to a system of batting the patient around multiple specialists, no true lead consultant, no hurry, repeated admissions to unsupported juniors as the patient gets sicker, ooops they died after 6 months of fannying around, but they had multiple mets so never mind it wasnt us who killed them . The fundamental problem is that "payment by results", isn't. 2009/9/9 Paul Bromley <[log in to unmask]>: > Had a chap in the last few days where I really have no idea what is going on > and he has so many complaints I cannot see the wood for the trees. (Many may > say that I often have no clue about waht is going on!!). In the dim and > distant past one could refer to a general physician who would get their > teeth into things. These days unless you direct carefully, they bounce back > with 'not our territory'. > > Do others miss the 'generalist??'. What do you do in this situation?? i have > suggested to this patinet that he goes privatly in the first instance - > first to see a Neurologist and then to possibly see a rheumatologist as he > has complaints that you could say were linked to either > speciality.Neurologists do seem to think outside of their box more than > others - or is it just my experience here?? > > -- > Best Wishes > > Paul Bromley > > www.informatiks.com > Custom EMIS LV Software. > vuE | GPLabels | GPDocs | eGFRChecker >