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
> Custom EMIS LV Software.
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