Why are so many GP's rubbish?
Discussion
So many times in business this has happened to my staff - today is the latest (and a typical) example:
A staff member came to see me to say that she's been getting panic attacks at night while in bed and she's been feeling somewhat depressed. She explains that it relates to some personal problems with her Mum and Sister - and nothing to do with work. She says she's off to see her GP about the problem.
The upshot is, the GP signs her off work for a week. No medication, no counselling just "don't go to work for a week Mrs X, and see how you feel in seven days".
So she's off work for a day but then comes back into work. She says to me, "well I felt worse at home - at least at work I can have my mind on other things, so I thought I'd come back and I'm glad that I did". I said, "good on you, that shows real character and common sense, and, by the way, thank you".
My points are these:
1) The person has not had their problem in any way resolved. She was with the GP for two minutes, who simply spouted the same rubbish he spouts for all such cases. He didn't refer her to any specialist counsellors or discuss any appropriate medication. As such, she's still ill. The GP has failed in his job.
2) The advice that this, so called, professional gave her made her worse not better. Once again, he failed in his job.
3) Clearly the GP believes that her employer should have pay for his incompetence by having to deal with lost production and increased costs (paying a temp). So, all of a sudden, I'm shelling out to pay for his poor/lazy conduct.
4) I asked myself this question: If every time a GP signed someone off from work, without addressing the real problem, they were forced to have a £1 per hour reduction in their salary - would they be so quick to do it? I suspect not, but they sure as hell expect everyone else to pay for their incompetence.
A staff member came to see me to say that she's been getting panic attacks at night while in bed and she's been feeling somewhat depressed. She explains that it relates to some personal problems with her Mum and Sister - and nothing to do with work. She says she's off to see her GP about the problem.
The upshot is, the GP signs her off work for a week. No medication, no counselling just "don't go to work for a week Mrs X, and see how you feel in seven days".
So she's off work for a day but then comes back into work. She says to me, "well I felt worse at home - at least at work I can have my mind on other things, so I thought I'd come back and I'm glad that I did". I said, "good on you, that shows real character and common sense, and, by the way, thank you".
My points are these:
1) The person has not had their problem in any way resolved. She was with the GP for two minutes, who simply spouted the same rubbish he spouts for all such cases. He didn't refer her to any specialist counsellors or discuss any appropriate medication. As such, she's still ill. The GP has failed in his job.
2) The advice that this, so called, professional gave her made her worse not better. Once again, he failed in his job.
3) Clearly the GP believes that her employer should have pay for his incompetence by having to deal with lost production and increased costs (paying a temp). So, all of a sudden, I'm shelling out to pay for his poor/lazy conduct.
4) I asked myself this question: If every time a GP signed someone off from work, without addressing the real problem, they were forced to have a £1 per hour reduction in their salary - would they be so quick to do it? I suspect not, but they sure as hell expect everyone else to pay for their incompetence.
Jaglover said:
It may not be his fault
There may be a long waiting list to see counsellors and thy won't want to hand out anti-depressants like smarties.
By that rationale, every time there's a queue to see a specialist they would be denied the opportunity to join the queue. That doesn't make any sense.
So at the very least he should put her on the waiting list rather than do nothing.
Also, why sign her off work when it makes her worse and costs me a fair few quid?
The GP actually only has to address 2 questions :-
1) Is this person fit to work? Yes / No
2) Is there someone (a specialist) who I can refer this person to to improve their condition / illness? Yes / No
The first one seems to have been answered as you've agreed that she is ill. The second question is more difficult because the truth is that mental health services in this country are extremely stretched with very long waiting times. Thus in the majority of cases a period of time off work can be more effective that giving someone the stigma of suffering from mental illness. If this doesn't work then I would expect the GP to make a referral to a specialist but she probably wouldn't be seen for quite a while (min 3 months).
Remember that a GP is a generalist not a specialist who job is to act as a gatekeeper to access specialist services. However this assumes that the specialist services exist and can deal with a problem adequately. If services don't exist then the GP is in a no win situation.
1) Is this person fit to work? Yes / No
2) Is there someone (a specialist) who I can refer this person to to improve their condition / illness? Yes / No
The first one seems to have been answered as you've agreed that she is ill. The second question is more difficult because the truth is that mental health services in this country are extremely stretched with very long waiting times. Thus in the majority of cases a period of time off work can be more effective that giving someone the stigma of suffering from mental illness. If this doesn't work then I would expect the GP to make a referral to a specialist but she probably wouldn't be seen for quite a while (min 3 months).
Remember that a GP is a generalist not a specialist who job is to act as a gatekeeper to access specialist services. However this assumes that the specialist services exist and can deal with a problem adequately. If services don't exist then the GP is in a no win situation.
srebbe64 said:
It may not be his fault
There may be a long waiting list to see counsellors and thy won't want to hand out anti-depressants like smarties.
By that rationale, every time there's a queue to see a specialist they would be denied the opportunity to join the queue. That doesn't make any sense.
So at the very least he should put her on the waiting list rather than do nothing.
Also, why sign her off work when it makes her worse and costs me a fair few quid?
Well he doesn't give a crap about costing you money, he sees a ton of people each day with a vague set of symptomns given by an unreliable patient who probably doesn't know what tell the doc anyway.
He probably thinks she overreacting/hypochondriac etc when its probably just stress and thinks a few days off will sort her out, if it doesn't then he might think about sending her to a specialist.
Maybe she wasn't clear or assertive enough in explaining the problem to the GP?
srebbe64 said:
1) The person has not had their problem in any way resolved. She was with the GP for two minutes, who simply spouted the same rubbish he spouts for all such cases. He didn't refer her to any specialist counsellors or discuss any appropriate medication. As such, she's still ill. The GP has failed in his job.
So you were there in the Consultation, were you? You timed it with a stop watch too. You also saw whether the GP organised a referral to appropriate secondary care/counselling, whilst you were there? And clearly you are the arbiter of the GPs working practice too?
srebbe64 said:
2) The advice that this, so called, professional gave her made her worse not better. Once again, he failed in his job.
Again, so you were in the room with a dictaphone and recorded the exact words of the GP? Or your patient recorded his/her words, verbatim, and played them back to you, and with your extensive knowledge of psychiatry and counselling, you judged this advice to be inappropriate?
srebbe64 said:
3) Clearly the GP believes that her employer should have pay for his incompetence by having to deal with lost production and increased costs (paying a temp). So, all of a sudden, I'm shelling out to pay for his poor/lazy conduct.
Perhaps the GP was thinking about the patient, rather than her employer (funny concept, a doctor worried about their patients eh?) Perhaps the GP felt the patient needed time away from work, or other potential stressors, to try alleviate any excess stress. Of course the GP didn't know he was bowing to a greater mind, when he was dealing with one of your employees.....
srebbe64 said:
4) I asked myself this question: If every time a GP signed someone off from work, without addressing the real problem, they were forced to have a £1 per hour reduction in their salary - would they be so quick to do it? I suspect not, but they sure as hell expect everyone else to pay for their incompetence.
This last statement takes the p*ss in the most infuriatingly idiotic way. Do you honestly think GPs just sit behind a desk and sign people off work, as they can't be bothered to deal with problems? Do you really think that? I suggest you go and sit in with a GP for a day, just one day, and you wont come out with stuff like this. I'd like to know what Julian or any of the other PHer GPs have to think about this post.
srebbe64 said:
So many times in business this has happened to my staff - today is the latest (and a typical) example:
A staff member came to see me to say that she's been getting panic attacks at night while in bed and she's been feeling somewhat depressed. She explains that it relates to some personal problems with her Mum and Sister - and nothing to do with work. She says she's off to see her GP about the problem.
The upshot is, the GP signs her off work for a week. No medication, no counselling just "don't go to work for a week Mrs X, and see how you feel in seven days".
So she's off work for a day but then comes back into work. She says to me, "well I felt worse at home - at least at work I can have my mind on other things, so I thought I'd come back and I'm glad that I did". I said, "good on you, that shows real character and common sense, and, by the way, thank you".
My points are these:
1) The person has not had their problem in any way resolved. She was with the GP for two minutes, who simply spouted the same rubbish he spouts for all such cases. He didn't refer her to any specialist counsellors or discuss any appropriate medication. As such, she's still ill. The GP has failed in his job.
2) The advice that this, so called, professional gave her made her worse not better. Once again, he failed in his job.
3) Clearly the GP believes that her employer should have pay for his incompetence by having to deal with lost production and increased costs (paying a temp). So, all of a sudden, I'm shelling out to pay for his poor/lazy conduct.
4) I asked myself this question: If every time a GP signed someone off from work, without addressing the real problem, they were forced to have a £1 per hour reduction in their salary - would they be so quick to do it? I suspect not, but they sure as hell expect everyone else to pay for their incompetence.
Im involved with a GP at the moment and have heard alot of what goes on in consulations.. I think you are being most unfair, one day a gp will spot something in you or yours that will save a loved ones life.
GPs have a short time in which to asess a patient and they consider a huge range of factors when deciding upon a course of action, often in cases that your worker described to you the best approach would surely be to try the least invasive of remedies... some time off. Before prescribing some anti-depressants or getting her into counseilling which would take a while to arrange. If your worker needs more help in a few weeks time the doc will make further arrangements.
I think the post is a bit unfair to GP's - they won't just jump to prescribing anti-depressants for various quite sound reasons, the underlying causes and remedies for stress/depression may not be immediately apparent.
I have always had a very good service from my GP - certainly in terms of advice and care. My major issue with them though is that they are insufficiently "customer facing" in terms of access and opening hours .:
( they are closed at wknds and are also shut for 2 hours(!) at lunchtime , and its VERY difficult to book an appointment - issues which REALLY need addressing in the NHS - but a totally separate issue to standard of care )
I have always had a very good service from my GP - certainly in terms of advice and care. My major issue with them though is that they are insufficiently "customer facing" in terms of access and opening hours .:
( they are closed at wknds and are also shut for 2 hours(!) at lunchtime , and its VERY difficult to book an appointment - issues which REALLY need addressing in the NHS - but a totally separate issue to standard of care )
scoobz said:
Profit before people again Srebbe? Why am I not suprised. BTW I am sure twitcam could have taken her place for a week (as you seem to think so highly of him). You should snap him up while he still knows everything.
Brilliant.
Where's your answer there srebbe?
I'll tell you what my answer is, I plan to pay for her to have private counselling. Being as the doctor wouldn't give her more than a few seconds of his time (her words not mine) and she has a real and growing need. Unfortunately, in this country to get anything approaching decent medical care you have to go private.
scoobz said:
hold on a minute...
you were complaining about paying people when off sick and then docking their pay when they were off and yet your willing to pay for councilling for her?
excuse me if I call bullshit on that one...
even if GP's are shit...
I was never going to dock her pay - how did you get that idea?
srebbe64 said:
4) I asked myself this question: If every time a GP signed someone off from work, without addressing the real problem, they were forced to have a £1 per hour reduction in their salary - would they be so quick to do it? I suspect not, but they sure as hell expect everyone else to pay for their incompetence.
did you mean the GP got his pay docked? because that doesn't make sense.
If you did, carry on as you were.
I still call bullshit
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