Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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what happened to the GP?
- kathrin j thomas (15 August 2003)
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Communicate - don't just 'listen'
- susanne McCabe (19 August 2003)
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Far from unique
- Mark Aszkenasy (20 August 2003)
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Re: what happened to the GP?
- Bill Kirkup (23 August 2003)
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Any role for the GP?
- Catherine A J Dixon (29 August 2003)
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Listen to the patient
- Valerie F Hartley-Brewer (8 September 2003)
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Try to make, the patient understand what is his problem.
- Ionescu Sebastian (15 September 2003)
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kathrin j thomas, GP Gelligaer Surgery, Hengoed , South WalesCF82
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Bill Kirkup is right to suggest that we may have lost something of the art of medicine in the headlong rush to embrace the science. However,he may have forgotten the people who provide over 90% of health care in the UK. GPs are very familiar with making and acting on working diagnoses without the immediate aid of high technology. GPs, of course,are using technology more and more , but we rely on clinical skills as initial decision aids. Often, we have to initiate treatment before we can get a test result. His mother obviously needed hospital treatment but I can assure Dr Kirkup that GPs rely on history-taking (and often examination) in every consultation and usually reach provisional diagnoses before thinking of investigation.This is why medical students may find they learn more clinical skills in the primary care setting. Most of our job is about "listening to the patient" and this is what makes the generalist so efficient and effective. We also prevent more premature death than any hospital specialist but we are used to being overlooked, mostly because we have few machines that go "beep" Kathrin Thomas Competing interests: None declared |
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susanne McCabe, retired cf24 3pf
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A common problem amongs GPs though is that they will reinterpret not just abbreviate what the person has said. Check with the person that you have understood what they are telling you. The number of incorrect entries on files would be significantly decreased. This is vital these days when so many alerts are being flagged up regarding child abuse or violence in families that GPs are tempted into making covert judgments without good evidence. Obviously there is a need for this at times but many people's family lives are ruined when mistakes are made by earnest and well meaning health workers. Competing interests: None declared |
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Mark Aszkenasy, Public Health Physician West Lane Hospital TS5 4EE
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Having lived with a spouse who was a diagnostic radiologist and is now a full time mother, I can confirm that Dr. Kirkup's experience is far from unique. Regular anecdotes of obvious clinical signs missed whilst awaiting radiological opinion. Reminds me of the of the apocryphal story that was current in the 1980's about a UK medical student on elective in the US. He was asked by the professor to examine the patient's abdomen. When he asked the patient if he could examine him, gently uncovered the patients belly and proceeded to go through with the routine of inspection, palpation, percussion and auscultation, he was asked "what the hell are you doing, I said examine his abdomen. Now go fetch the ultrasound machine and do it". Looks like we have well and truly caught up with our colleagues in the US now. Competing interests: None declared |
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Bill Kirkup, Regional Director of Public Health Government Office North East, Newcastle upon Tyne NE1 4TD
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Kathrin Thomas wonders if I have forgotten the GP, and it's a good point. I am a great fan of the UK primary care system, and would not normally have proceeded in this way. However, it was 'out of hours', the surgery telephone directed callers to phone a deputising service, and sadly my mother had had a less than happy experience previously with the deputising service. That's when she phoned me. I would have mentioned it, but there is a limit to how much it's possible to cram into 750 words! Competing interests: None declared |
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Catherine A J Dixon, GP Principal The surgery, 21 Stockwell Road,Knaresborough, HG5 0JY
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On reading Dr Kirkup's report I felt only sympathy for his mother and all her family but was a little surprised that her GP did not even get a mention. Certainly in our area GP's can arrange direct admission to a medical ward; avoiding a wait in a/e and sparing busy A/E staff seeing extra patients. Surely a GP that knew his mother may have listened to her (or him) and spared them some of the torment suffered. I hope that she is now recovered. Competing interests: None declared |
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Valerie F Hartley-Brewer, GP Weston and Rush Hill Surgeries, Bath BA1 3NR
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There are still doctors around who base diagnosis on clinical findings. They are known as general practitioners! A competent GP would have agreed with Dr Kirkup's diagnosis and given IV furosemide with oral follow up, thus avoiding all contact with the hospital. Competing interests: None declared |
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Ionescu Sebastian, paediatric surgeon; chief of paediatric surgery department M.S. Curie children hospital; bd. C. Brancoveanu no. 20, Bucharest - 4 Romania
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It is wonderful to read such an exposure in the BMJ. If we respect our patients, we listen to them. I am convinced we have to make them understand why we prescribe the treatment to justify any recommendation. If the patient understands the reason for our advice he will respect them. Healing means also explaining, not only prescribing. Competing interests: None declared |
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