Jobbing Doctor has written a post about how junior doctors do not understand General Practitioners. I am about to write a piece on how General Practitioners do not know how to refer patients properly to hospitals.
Now, I have come across many General Practitioners in my time, some very good and others who are careless and extremely bad. One general practitioner springs to mind today. I was oncall quite sometime ago at St Mary's IOW. I had taken a job at the IOW with the assumption that it would be a easy ride and a easy job. Of course, it was probably the busiest job I have ever done. It wasn't a summer holiday. Instead it was hard graft for hours. To help matters along, my PRHO [F1] had been victimised by her University and been sent to the IOW to repeat her 6 months as PRHO. She learned fast because I made her learn fast and stop moping around. There is no point pissing around when people are dying around you.
On bright and breezy Thursday morning, I landed in Accident Emergency as the SHO Medicine oncall. It was about 7.30. I saw a number of patients, all relatively simple, a few MIs, a few chest infections etc. All fairly mundane stuff. This was until I got a bleep from a General Practitioner. The posh GP said " Hello, are you the SHO Medicine oncall? I would like to send this old chap in who is fine really but has probably just developed a chest infection. He is fine, talking and I have examined him. He just needs a once over and he can return back to the care home".
One hour later, the patient attended with the GP referral letter. This particular General Practitioner clearly had not examined the patient because he was practically dead.
The GP letter stated " No oedema". I had never seen such large tree trunks as legs before. The man was practically unresponsive, the GCS did not match the one sent by the GP. The chest examination note from the GP stated " minor basal creps". Fluid was filling his lungs as we rapidly, and froth was flowing out of his mouth. The man was practically moribund. As everyone knows, in Accident and Emergency, you have to multitask, this means dragging the oxygen in, sticking the monitor on, inserting the large venflons, taking the bloods from the venflons, rapidly take some blood gases, examine the patient, order all kinds of xrays and scans immediately. Speed is of the essence because if you delay, the patient dies. Examining the patient was traumatic because the stench was bad. He had cellulitic legs that were weeping badly. His back was caked with pressure sores that had become infected. Clearly no one had taken care of him for quite a while. While I had a high amount of Oxygen being given to him, went through and examined him rapidly. My guess, Congestive Cardiac Failure, probable renal failure, probable bilateral limb cellulitis and extensive infection in his pressure sores.
IOW A and E is different in that - you do everything yourself even if you call for help. The patient was still breathing so all I had to do was stabilise him. The worst issue is despite Frusemide and everything you can think of, the patient deteriorates. Time ticks, you call your Registrar oncall.
I always breathed a sigh of relief when he appeared in circumstances that were going out of control. We managed to do a CVP line and secure a better room for proper assessment. My Registrar was flaked and just didn't know what was going on either. On further interview of the care assistant, the patient had been in a nursing home, 5 General Practitioners had seen him, none had examined him but prescribed anti biotics. The patient lay flat and continued to be breathless and was found relatively moribund this morning. We asked whether the GP examined the patient, she told us it never happened. He apparently just wrote the letter and sent him in to Accident Emergency. The patient had not communicated for days.
The blood tests came back, the patient was in severe renal failure and his blood gases where everywhere. He arrested twice before we managed to secure a Accident Emergency bed for him. We struggled for four hours in Accident Emergency to stabilise him. He was taken to ITU but died before our second Ward round. We were essentially fighting a losing battle because the 5 GPs had not communicated with each other.
The patient had been neglected by the system. He was just one of many elderly people in nursing homes or care homes who are neglected like this.
So when Jobbing Doctor tells us how great GPs are, we have to ask ourselves whether ALL GPs are great or just a select few. My experience of GPs are that many are extremely good. By the same token, a lot are fairly neglectful. They just get away with it because they always have done and their colleagues never say a thing about it. That's how medicine works or doesn't work as the case maybe.
Now, I have come across many General Practitioners in my time, some very good and others who are careless and extremely bad. One general practitioner springs to mind today. I was oncall quite sometime ago at St Mary's IOW. I had taken a job at the IOW with the assumption that it would be a easy ride and a easy job. Of course, it was probably the busiest job I have ever done. It wasn't a summer holiday. Instead it was hard graft for hours. To help matters along, my PRHO [F1] had been victimised by her University and been sent to the IOW to repeat her 6 months as PRHO. She learned fast because I made her learn fast and stop moping around. There is no point pissing around when people are dying around you.
On bright and breezy Thursday morning, I landed in Accident Emergency as the SHO Medicine oncall. It was about 7.30. I saw a number of patients, all relatively simple, a few MIs, a few chest infections etc. All fairly mundane stuff. This was until I got a bleep from a General Practitioner. The posh GP said " Hello, are you the SHO Medicine oncall? I would like to send this old chap in who is fine really but has probably just developed a chest infection. He is fine, talking and I have examined him. He just needs a once over and he can return back to the care home".
One hour later, the patient attended with the GP referral letter. This particular General Practitioner clearly had not examined the patient because he was practically dead.
The GP letter stated " No oedema". I had never seen such large tree trunks as legs before. The man was practically unresponsive, the GCS did not match the one sent by the GP. The chest examination note from the GP stated " minor basal creps". Fluid was filling his lungs as we rapidly, and froth was flowing out of his mouth. The man was practically moribund. As everyone knows, in Accident and Emergency, you have to multitask, this means dragging the oxygen in, sticking the monitor on, inserting the large venflons, taking the bloods from the venflons, rapidly take some blood gases, examine the patient, order all kinds of xrays and scans immediately. Speed is of the essence because if you delay, the patient dies. Examining the patient was traumatic because the stench was bad. He had cellulitic legs that were weeping badly. His back was caked with pressure sores that had become infected. Clearly no one had taken care of him for quite a while. While I had a high amount of Oxygen being given to him, went through and examined him rapidly. My guess, Congestive Cardiac Failure, probable renal failure, probable bilateral limb cellulitis and extensive infection in his pressure sores.
IOW A and E is different in that - you do everything yourself even if you call for help. The patient was still breathing so all I had to do was stabilise him. The worst issue is despite Frusemide and everything you can think of, the patient deteriorates. Time ticks, you call your Registrar oncall.
Now my Registrar at IOW was quite fantastic, he was just very busy. We got on well as a team.
Dr Speedy as we called him, arrived late because he was stretched everywhere. He had five bleeps plastered all over him. He handed me two of them and said " You can deal with any further Reg calls from the wards and the cardiac arrests because I have no running energy left". Dr Speedy had sweat coming down his forehead and he was worried about the state of our current patient who was not responding to any treatment.
Dr Speedy as we called him, arrived late because he was stretched everywhere. He had five bleeps plastered all over him. He handed me two of them and said " You can deal with any further Reg calls from the wards and the cardiac arrests because I have no running energy left". Dr Speedy had sweat coming down his forehead and he was worried about the state of our current patient who was not responding to any treatment.
I always breathed a sigh of relief when he appeared in circumstances that were going out of control. We managed to do a CVP line and secure a better room for proper assessment. My Registrar was flaked and just didn't know what was going on either. On further interview of the care assistant, the patient had been in a nursing home, 5 General Practitioners had seen him, none had examined him but prescribed anti biotics. The patient lay flat and continued to be breathless and was found relatively moribund this morning. We asked whether the GP examined the patient, she told us it never happened. He apparently just wrote the letter and sent him in to Accident Emergency. The patient had not communicated for days.
The blood tests came back, the patient was in severe renal failure and his blood gases where everywhere. He arrested twice before we managed to secure a Accident Emergency bed for him. We struggled for four hours in Accident Emergency to stabilise him. He was taken to ITU but died before our second Ward round. We were essentially fighting a losing battle because the 5 GPs had not communicated with each other.
The patient had been neglected by the system. He was just one of many elderly people in nursing homes or care homes who are neglected like this.
So when Jobbing Doctor tells us how great GPs are, we have to ask ourselves whether ALL GPs are great or just a select few. My experience of GPs are that many are extremely good. By the same token, a lot are fairly neglectful. They just get away with it because they always have done and their colleagues never say a thing about it. That's how medicine works or doesn't work as the case maybe.
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