Monday, July 15, 2024

The Good Doctor says: “Do yourself a favour!”

Do Yourself a Favour!

CHRISTMAS is a time when family and friends get together. So it was for Carol and me. We hosted a family, a GP and his wife with their children. We had known them since university. Inevitably our minds turned to work. Yes even at Christmas! The topic was QOF, which stands for Quality Outcome Framework. This is the NHS’ way of ensuring that GPs do the right things for patients with long term conditions such as diabetes, asthma, epilepsy heart disease etc etc..

Ray related a story that has gone round in my mind since. He called one of his female patients to tell her how concerned he was that despite her multiple serious problems, she had not asked for her prescription or come for a review for almost two years. His receptionists and nurses had phoned her, written to her and texted her. But she had not responded. Before he could finish his sentence, she gave him a torrent of complaints about his surgery. He listened politely for a few minutes, then interrupted. “Mrs X I am merely phoning to tell you how concerned I am about your health. You have diabetes, hypertension (blood pressure 220/115 mmHg) and atrial fibrillation. If you do not take your medication you are at risk of dying from a stroke or a heart attack anytime.” The lady replied “ I know that . I am not stupid. I am 51 year old not 15”. To which he replied “ In that case why don’t you act your age and start taking responsibility for your health, instead of blaming others all the time. It is 7:30 pm and I could be at home watching Manchester United. Instead I have taken the trouble to phone you out of concern about your health. Do you think your reaction is normal for a responsible adult?.” She apparently calmed down a little, only soon to revert to her complaining mode.

QOF

People with long term conditions need routine checks with a frequency dependent on how well controlled their condition is. For this to happen, contact needs to occur between patients and GPs/ GP staff. Despite the chronicity of such conditions, and despite GPs “educating” patients to come forward of their own accord every year, a significant proportion do not do so, but wait for doctors to chase them. This results in numerous phone calls, texts, letters, failures to attend, followed by more letters, phone calls and texts. All of this constitutes a drain on GP resources, and means that time which should be spent on caring for patients is spent on chasing irresponsible people.

Empowerment

In its purist form, this means giving power to someone in order to enable them to achieve a target. NICE guideline (Feb 2012) about patient experience in the NHS, talks about “empowering all patients and the public”. Referring to the NHS constitution, it states: “The constitution provided clear signposting to the rights and responsibilities for patients, public and staff”.

We empower patients by giving them information, and opportunities to improve their health. This includes sacrifices on the part of GPs who start early and finish late. Access to general practice has never been better. The media loves to report bad news stories about how difficult patients find it to get appointments with GPs. Yet no one mentions that the demand on appointments has doubled in the last 10 years, with no concomitant increase in the number of GPs. GPs have only managed to cope by increasing their work rate and expanding work to fill more of their private lives.

Responsibility

Seldom do we hear about public responsibility. In the third world, patients do better with fewer resources. Patients seem to be more self-reliant. Some of them walk miles to attend a clinic, and they are very grateful. In the UK it seems the more we avail patients of resources the more wasteful and demanding the public becomes. The commonest excuses I hear for failure to attend are: I have no transport, or I was too busy, or I was too ill!!

The media often talk about holding professionals to account. GPs have so many layers of scrutiny, it is becoming ridiculous. We have the QOF, appraisals/revalidation, and CQC. Yet politicians seem to have neither the political nor the moral courage to hold the public accountable. How do we measure public responsibility? My colleague’s experience is not unique. It is a common and regular experience in general practice that when one goes the extra mile to help patients improve their health, one is met with a puerile response and often with an abusive reaction. Frequently, one is made to feel that when people take their medications or have their tests, they are doing their GP a favour! The same people, who cannot be bothered to look after themselves, can spend hours complaining about what the NHS has not done for them. This is not the behavior of responsible mature members of a developed society.

Patients who have suffered from a condition for 20 years, who know what they need to do, and who will only do the right thing if they are nagged and pursued by a professional, do not need empowerment. They need a kick up the back side. And who is going to deliver that kick?

In my opinion the government should do so through education, advertising and some meaningful action, such as a DNA fee, that is a penalty for failing to attend an appointment. We also need to redefine the role of patient groups to become a two way conduit. Patient groups need to be given the resources to influence patient behavior for the better.

Irresponsible behavior costs the nation dearly. It merits only one kind of power, the power of the law. Only the law will stop irresponsible members of the public from wasting NHS resources and being abusive to NHS staff.

So if you are like Mrs X, do yourself a favour and grow up.

You might live a longer and more fulfilled life.

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