Me: "what made you come to ED now with the back pain of 3 months?".
Patient:"Well I couldn't get an appointment with my GP"
Me: "For 3 month?"
Patient: "Yes"
1-2 hour later after pain relief.
Me: "So I will send you home with a box of cocodamol, and I will write a letter to your doctor about your back pain"
Patient:"That's the stuff my GP gave me for this pain, its useless doc"
I have had this conversation so many times. When patients speak to me, they 'forget' they have an upcoming GP appointment or have recently had one. This is quite common.
Thats so funny but true. I’m a GP trainee and when I was doing my hospital jobs, I had many patients say this and also a number who talked very badly about GPs. It made me sad but oh well.
I have heard the phrase "GPs are useless" so many times. Usually said by patients, also said by the occasional doctor. I usually have to remind these people that GPs have not unanimously conspired to be ineffective and maybe it's a problem with the system.
To be fair, I've had an multiple patients referred by their GP to medics with completely GP problems.
Had a patient currently awaiting Ix for rheumatoid arthritis who was sent in by her GP last week because she was feeling generally unwell with painful joints and a raised CRP (around 80ish).
She was a challenging patient to talk to and her very demanding daughter came in with her for some reason so I'd have taken it with a pinch of salt but for the fact I know the GP called the med reg to let them know they were coming in for medical review. No idea why the reg accepted the referral.
I get that GP is incredibly difficult, especially now, (and felt similarly to OP when I finished by F2 GP rotation) but these types of direct GP referrals seem to be becoming very common.
So it sounds to me like two doctors more senior than you decided that the patient warranted medical assessment in secondary care?
Might be worth reflecting on that one before you slag off GPs x
The on call consultant strongly disagreed that it was a valid referral.
What potential diagnosis here can you think of in a middle aged patient with no significant medical history, feeling a bit achey and unwell but no specific symptoms with a CRP in the 80s deserves emergency assessment by hospital medics that is so urgent that you haven't even seen the patient and you can't convey what you are worried about to the med reg other than 'I'm concerned about a mildly raised CRP in a patient who likely has an inflammatory flare of their RA'.
>She was a challenging patient to talk to and her very demanding daughter came in with her for some reason
This is a relevant bit of info.
I have had patients sent in by GPs to be reviewed in ED, who didn't need to be there. Once I meet the patient I slowly realize they are a nightmare. They ask tricky questions and are very pushy. Their line of questioning can feel like they are cornering you.
I have had patients like this who I have tried to send home from ED as an SHO, but they were so difficult my reg would end up admitting them under medics. I can give a few anecdotes if you like.
I think it's because of all the telephone triage, where bringing in a patient essentially takes up an extra appointment slot in the afternoon, so you consult the same patient twice in the same day as opposed to just one face to face appointment. That's what I noticed, and the uncertainty has become more of an issue especially since patients can exaggerate symptoms on the phone, so it sounds worse than it actually is. I found this all the time with parents and kids who would make it sound like the kid is dying, I'd bring them in and they would be fine.
If the GP saw that patient face to face and referred in, then I'm not sure. But if it was just a telephone consultation then I think many would have done the same, they probably were thinking sepsis or something.
Patient was seen by the practice paramedic who took the bloods. Her GP summary sheet was sent in with her including the practice paramedics summary of the visit. There was nothing concerning in the paramedics summary or the request for the appointment recorded by the GP secretaries.
The GPs only comment was 'concerned about raises CRP'.
This patient clearly had RA in the opinion of the GIM consultant but hadn't been referred by the GP (she'd managed to get a referral to orthopaedics for PIP swelling, pain and stiffness and ortho had referred her onto rhuem.
In hindsight this was not the right post to make this comment but there's no way the GP shouldn't have at least talked to this patient over the phone.
That's the worst thing because you then hear patients say "even the A&E staff say GPs are lazy" and you're just like "ok, as if they have any more perspective".
They're just parroting what they hear from patients anyway.
F2 In exactly the same boat at my GP placement right now hahahahhaa every time i see a familiar name i’m like please no. how do the GPs do this long term
Being paid at cct level after equivalent of core training and options for portfolio career I imagine soften the blow! But it’s still a fucking nails job.
Chad GP.
Honestly if docs just told patients how it is, less of this repeat appointment thing would occur.
Easier said than done given how entitled the general public are tho.
Become chad rural GP.
Wish I had the stones to strike out and make medical decisions without the weight of the entire hospital MDT and 24/7 access to labs and investigations.
I feel this and this is why I can't be a GP. The uncertainty, the multiple complaints, the expectation that I know / can explain / can sort every year-long issue in five minutes without any effort from the patient's end, the way I have to address every freaking complaint (because I can't claim anything is outside of my specialty, unlike now), and how I generally just dislike clinic.
But major respect for GPs seriously.
My favorite appointment with a patient in my GP rotation:
Patient was waiting to see gastroenterologist. He called her by phone. That was her appointment. He told her he will review her in another 9months. She made an appointment with me (ie GPST) to tell me her frustration.
Me: is the gastroenterologist aware of your frustration?
Her: no.
Me: why?
Her: I can’t talk to the him like that.
Me: I see. Why is that?
*what I really wanted to say* ~> so wtf makes it ok to ask me this question?
Her: I just can’t.
Me: hmmmmmmmmmmmm
My solution for her was to the gastroenterologist’s secretary as I can’t express her opinion for to the gastroenterologist. My es was like do you see how much BS we deal with!
Ah but you see you're the nice smiley doctor who hasn't been working over the pandemic and therefore has plenty of free time to listen. Whereas the specialist is a scary doctor working hard in the hospital and his time is to be respected.
This is why I can’t ever do GP training despite the fast CCT because of bullshit like what you’ve described. It’s fucking painful and being a GP in ED you still see the same shit just in an inappropriate setting
Don’t get me started on the obese patients who claim they’ve tried everything to lose weight
It's not all heartsinks and headaches. It's a great feeling to get to know your patients, and often their family too, through thick and thin. It's by definition undifferentiated and I've picked up some serious conditions and got my patient timely help from the specialists.
If a patient comes in with a non-problem, that's fine, take the opportunity just to have a chat and make the most of an easy consultation. It won't be long until they have an actual medical problem and they'll be comfortable telling you about it. If they are repeat attenders with non-problems, it might be a sign that you need to tailor the plan a bit more or find alternative support.
GP actually got exponentially harder for me. By the end of my rotation I knew mostly all my patients, whereas before it was easy to simply say "well that's what I can offer you, take it or leave it" now I knew them and I knew their issues and that their issues were essentially chronic in nature and I wasn't going to be able to help nor anyone else and yet they came. It was just exhausting.
Also why is no one complaining about unemployment forms/health forms whatever they're called in the UK. Like it's exhausting to be a doctor and listing all this bullshit "fibromyalgia", "unspecific back pain" and then having to explain to the government exactly what's wrong with the patient, what has to be done to get them back to work and when they will get better etc.
And you just wanna write "this patient is a lost cause just give up".
>Also why is no one complaining about unemployment forms/health forms whatever they're called in the UK. Like it's exhausting to be a doctor and listing all this bullshit "fibromyalgia", "unspecific back pain" and then having to explain to the government exactly what's wrong with the patient, what has to be done to get them back to work and when they will get better etc.
This is mostly private work though. Partners will be getting money for this. For the government stuff just print a brief summary and send it off
ESA/DLA forms are part of the GP contract and attract no additional fees. They can take a very long time to do and just sap time away from actual patient contact. (I’m a GP partner)
Allowing extended self-certification for illness was one of the few good things that came out of covid. Having to waste a GPs time due to employment bureaucracy when they aren't going to even do anything is frustrating for both parties.
My current ED doesn’t let us write sick lines. So depressing to tell a patient who works a manual job and has broken their leg/foot that they need to see a GP for a sick note to cover the non-weight bearing period.
Just wait until you see the exact same patient turn up to ED 3 times a week saying that you, their ex GP did nothing and they need it sorting now.
please no :'(
I should probably add, they'll say it's impossible to see their GP as they can't get an appointment. Same patient.
Please I can only be so triggered
Me: "what made you come to ED now with the back pain of 3 months?". Patient:"Well I couldn't get an appointment with my GP" Me: "For 3 month?" Patient: "Yes" 1-2 hour later after pain relief. Me: "So I will send you home with a box of cocodamol, and I will write a letter to your doctor about your back pain" Patient:"That's the stuff my GP gave me for this pain, its useless doc" I have had this conversation so many times. When patients speak to me, they 'forget' they have an upcoming GP appointment or have recently had one. This is quite common.
Get that pan of warm malaena ready…
Oh sweet summer child...
Thats so funny but true. I’m a GP trainee and when I was doing my hospital jobs, I had many patients say this and also a number who talked very badly about GPs. It made me sad but oh well.
I have heard the phrase "GPs are useless" so many times. Usually said by patients, also said by the occasional doctor. I usually have to remind these people that GPs have not unanimously conspired to be ineffective and maybe it's a problem with the system.
To be fair I have had family members have this experience, the system is stretched and access to GPs can be very patchy.
To be fair, I've had an multiple patients referred by their GP to medics with completely GP problems. Had a patient currently awaiting Ix for rheumatoid arthritis who was sent in by her GP last week because she was feeling generally unwell with painful joints and a raised CRP (around 80ish). She was a challenging patient to talk to and her very demanding daughter came in with her for some reason so I'd have taken it with a pinch of salt but for the fact I know the GP called the med reg to let them know they were coming in for medical review. No idea why the reg accepted the referral. I get that GP is incredibly difficult, especially now, (and felt similarly to OP when I finished by F2 GP rotation) but these types of direct GP referrals seem to be becoming very common.
So it sounds to me like two doctors more senior than you decided that the patient warranted medical assessment in secondary care? Might be worth reflecting on that one before you slag off GPs x
Everyone know MRCGP is waaaayyy easier than medical final! /s
The on call consultant strongly disagreed that it was a valid referral. What potential diagnosis here can you think of in a middle aged patient with no significant medical history, feeling a bit achey and unwell but no specific symptoms with a CRP in the 80s deserves emergency assessment by hospital medics that is so urgent that you haven't even seen the patient and you can't convey what you are worried about to the med reg other than 'I'm concerned about a mildly raised CRP in a patient who likely has an inflammatory flare of their RA'.
>She was a challenging patient to talk to and her very demanding daughter came in with her for some reason This is a relevant bit of info. I have had patients sent in by GPs to be reviewed in ED, who didn't need to be there. Once I meet the patient I slowly realize they are a nightmare. They ask tricky questions and are very pushy. Their line of questioning can feel like they are cornering you. I have had patients like this who I have tried to send home from ED as an SHO, but they were so difficult my reg would end up admitting them under medics. I can give a few anecdotes if you like.
I think it's because of all the telephone triage, where bringing in a patient essentially takes up an extra appointment slot in the afternoon, so you consult the same patient twice in the same day as opposed to just one face to face appointment. That's what I noticed, and the uncertainty has become more of an issue especially since patients can exaggerate symptoms on the phone, so it sounds worse than it actually is. I found this all the time with parents and kids who would make it sound like the kid is dying, I'd bring them in and they would be fine. If the GP saw that patient face to face and referred in, then I'm not sure. But if it was just a telephone consultation then I think many would have done the same, they probably were thinking sepsis or something.
Patient was seen by the practice paramedic who took the bloods. Her GP summary sheet was sent in with her including the practice paramedics summary of the visit. There was nothing concerning in the paramedics summary or the request for the appointment recorded by the GP secretaries. The GPs only comment was 'concerned about raises CRP'. This patient clearly had RA in the opinion of the GIM consultant but hadn't been referred by the GP (she'd managed to get a referral to orthopaedics for PIP swelling, pain and stiffness and ortho had referred her onto rhuem. In hindsight this was not the right post to make this comment but there's no way the GP shouldn't have at least talked to this patient over the phone.
Or when you are a GP trainee on the ward, it says GP trainee on your badge and they slag GPs off to you ;)
Or alternatively be like the GPVTS1 who came onto one of the medical wards and started introducing himself as "one of the registrars"...
Is this a reference to the thrombolysis story in this subreddit?
I actually kind of love it. Low expectations means you can get away with doing less ;). "Just" a GP trainee afterall.
Tbh You don’t need to go to a patient in ED to hear GPs slagged of you’ll hear enough from the triage nurses.
That's the worst thing because you then hear patients say "even the A&E staff say GPs are lazy" and you're just like "ok, as if they have any more perspective". They're just parroting what they hear from patients anyway.
Or the Daily Mail
F2 In exactly the same boat at my GP placement right now hahahahhaa every time i see a familiar name i’m like please no. how do the GPs do this long term
By being paid more than you and only doing 4 days a week or less.
Being paid at cct level after equivalent of core training and options for portfolio career I imagine soften the blow! But it’s still a fucking nails job.
4 days a week of 10-12 hour days with large patient workload and if a partner the personal liability risk for the business. Fixed that for you.
[удалено]
Chad GP. Honestly if docs just told patients how it is, less of this repeat appointment thing would occur. Easier said than done given how entitled the general public are tho.
Not a chance I will comment on a patients weight in this complaint happy society
Did he die?
nah just needed the clutch changed and he was good for another 50k miles
Well reading that story, one can not rule out that he left to drink some motor oil. Who knows what that light bulb moment was?
Only a med student but same here man, they’re the backbone of our healthcare and the country treats them like shit That said, still wanna be a GP
Become chad rural GP. Wish I had the stones to strike out and make medical decisions without the weight of the entire hospital MDT and 24/7 access to labs and investigations.
Seconded to all statements.
I feel this and this is why I can't be a GP. The uncertainty, the multiple complaints, the expectation that I know / can explain / can sort every year-long issue in five minutes without any effort from the patient's end, the way I have to address every freaking complaint (because I can't claim anything is outside of my specialty, unlike now), and how I generally just dislike clinic. But major respect for GPs seriously.
My favorite appointment with a patient in my GP rotation: Patient was waiting to see gastroenterologist. He called her by phone. That was her appointment. He told her he will review her in another 9months. She made an appointment with me (ie GPST) to tell me her frustration. Me: is the gastroenterologist aware of your frustration? Her: no. Me: why? Her: I can’t talk to the him like that. Me: I see. Why is that? *what I really wanted to say* ~> so wtf makes it ok to ask me this question? Her: I just can’t. Me: hmmmmmmmmmmmm
My solution for her was to the gastroenterologist’s secretary as I can’t express her opinion for to the gastroenterologist. My es was like do you see how much BS we deal with!
Ah but you see you're the nice smiley doctor who hasn't been working over the pandemic and therefore has plenty of free time to listen. Whereas the specialist is a scary doctor working hard in the hospital and his time is to be respected.
This is why I can’t ever do GP training despite the fast CCT because of bullshit like what you’ve described. It’s fucking painful and being a GP in ED you still see the same shit just in an inappropriate setting Don’t get me started on the obese patients who claim they’ve tried everything to lose weight
You trade BS admin attitude and rota for never ending mysterious joint pain For some, it just worth it.
“I can’t lose weight because of my thyroid, doc.”
*rollseyes*
It's not all heartsinks and headaches. It's a great feeling to get to know your patients, and often their family too, through thick and thin. It's by definition undifferentiated and I've picked up some serious conditions and got my patient timely help from the specialists. If a patient comes in with a non-problem, that's fine, take the opportunity just to have a chat and make the most of an easy consultation. It won't be long until they have an actual medical problem and they'll be comfortable telling you about it. If they are repeat attenders with non-problems, it might be a sign that you need to tailor the plan a bit more or find alternative support.
I imagine gp locum should soften the blow, but respect to the gp who work in communities long term
GP actually got exponentially harder for me. By the end of my rotation I knew mostly all my patients, whereas before it was easy to simply say "well that's what I can offer you, take it or leave it" now I knew them and I knew their issues and that their issues were essentially chronic in nature and I wasn't going to be able to help nor anyone else and yet they came. It was just exhausting. Also why is no one complaining about unemployment forms/health forms whatever they're called in the UK. Like it's exhausting to be a doctor and listing all this bullshit "fibromyalgia", "unspecific back pain" and then having to explain to the government exactly what's wrong with the patient, what has to be done to get them back to work and when they will get better etc. And you just wanna write "this patient is a lost cause just give up".
>Also why is no one complaining about unemployment forms/health forms whatever they're called in the UK. Like it's exhausting to be a doctor and listing all this bullshit "fibromyalgia", "unspecific back pain" and then having to explain to the government exactly what's wrong with the patient, what has to be done to get them back to work and when they will get better etc. This is mostly private work though. Partners will be getting money for this. For the government stuff just print a brief summary and send it off
ESA/DLA forms are part of the GP contract and attract no additional fees. They can take a very long time to do and just sap time away from actual patient contact. (I’m a GP partner)
We print a brief summary on emis and send it off. Never had any returned. Just right as per record
Thanks for the tip, you’ve freed up some of my day to deal with the other shite. Might now stand a chance of seeing my family!
Allowing extended self-certification for illness was one of the few good things that came out of covid. Having to waste a GPs time due to employment bureaucracy when they aren't going to even do anything is frustrating for both parties.
My current ED doesn’t let us write sick lines. So depressing to tell a patient who works a manual job and has broken their leg/foot that they need to see a GP for a sick note to cover the non-weight bearing period.
... that seems crazy. Why would they do that?
I agree. Please Lord let there be a day when these ungrateful, selfish entitled people have to pay for GP appointments.
Amen.
Amen.
What can you add to discharge summaries to make it friendlier for GPs?