Prompt service is what you expect in a cafeteria — but now those at the top of the NHS want to see instant service in healthcare, too.
The political consensus today is about speed. The focus of all the new drives, especially in general practice, has been for people to see medics faster.
As part of this, surgeries have been merging in a bid to make them more ‘efficient’ — and it’s this that was behind the roll-out last week of the scheme for patients to see a GP over the internet, rather than in person.
Prompt service is what you expect in a cafeteria — but now those at the top of the NHS want to see instant service in healthcare, too
The thinking is that everyone should be seen on the day, and this is where considerable resources have been focused.
Of course, I understand this. We live increasingly frenetic lifestyles and having to wait to see a doctor is frustrating.
But I do wonder if we’re not missing something about the real value of general practice. In our rush for everyone to be seen within five minutes of developing a cough, I think we are failing to really appreciate one of the most important aspects of medicine: the doctor-patient relationship and continuity of care.
There was a fascinating study published this week that illustrated this eloquently.
The political consensus today is about speed. The focus of all the new drives, especially in general practice, has been for people to see medics faster
Researchers found that among older patients, those who were unable to see the same GP were more than twice as likely to end up in hospital compared to those who regularly saw the same one.
It is thought this is because patients have to repeat their medical history, which wastes valuable time and means symptoms of serious illness go undetected.
A few years back, I developed acne and rosacea out of the blue and went to the GP a number of times. Each time I saw a different doctor. Each time they asked the same question and suggested the same things, which I then had to explain I’d already tried.
It was incredibly frustrating, and it struck me that if I, as a fairly articulate doctor, experienced it like this, what must it be like for someone less able or older, without a medical background?
One of the great things about general practice is that a doctor gets to know you over years. It gives them a unique understanding and perspective.
Those who benefit from this most — people with mental health problems, the elderly and those with chronic or complex conditions — are all too often ignored anyway, and they’re the ones who have the most to lose from a lack of continuity of care.
In fact, research has also shown that continuity of care can cut hospital admissions.
At its best, general practice is about far more than just medical knowledge. It is about continuity and consistency; about medicine within a community delivered by people who are experts in that community, who know the people they serve and are able to see a patient holistically.
As part of this, surgeries have been merging in a bid to make them more ‘efficient’ — and it’s this that was behind the roll-out last week of the scheme for patients to see a GP over the internet, rather than in person
This simply doesn’t happen with a doctor that you see for the first time — and for just ten minutes. But this kind of value is hard to capture. It doesn’t fit nicely on a pie chart that NHS bosses can monitor and evaluate.
It’s far easier instead to look at hard outcomes, such as the number of days that patients have to wait to see a GP. This kind of data is easier to monitor and so the NHS big-wigs love it — but it diminishes general practice to a bland, inhuman interaction.
When I worked in geriatrics, we would often get referrals from GPs who couldn’t give a clear reason for the referral, except they ‘just knew’ something was wrong with the patient.
The thinking is that everyone should be seen on the day, and this is where considerable resources have been focused. Of course, I understand this. We live increasingly frenetic lifestyles and having to wait to see a doctor is frustrating
Time and again, these referrals turned out to be serious conditions such as cancer, yet there were no clear symptoms that would have indicated this. It was simply that the GP had a hunch based on a deep connection with the patient.
Just the other day, I received a call from a GP who had known one of my patients for nearly 30 years. He apologised for bothering me but said he’d seen her about some unrelated physical health problem and was convinced that something wasn’t right. He couldn’t put his finger on it, he said, but she didn’t seem herself.
I got her into my clinic and she confessed she was stockpiling medication with a view to killing herself on the anniversary of her mother’s death.
For me, that human connection between a GP and their patient is priceless. Yet in the rush for everyone to be seen quicker and quicker, it’s something that we are at real risk of losing.
Google must stop this tide of smut
There’s no doubt that the internet has brought many great things — but it’s also brought with it the ubiquity of pornography, and I worry about what this is doing to our young.
Stephen Cottrell, the Bishop of Chelmsford, said this week that online pornography gives boys a ‘warped’ attitude’ to women.
How right he is. Studies have found that 90 per cent of boys aged 11 to 16 have viewed hardcore pornography. (I suspect the other 10 per cent were lying.)
There’s no doubt that the internet has brought many great things — but it’s also brought with it the ubiquity of pornography, and I worry about what this is doing to our young
There are still large swathes of the adult population for whom pornography is Emmanuelle wearing a negligee in soft focus after eating fondue; a bit nudge-nudge. This is so far from today’s pornography that I almost can’t bear to shatter the illusion.
The issue is the violence, with women routinely portrayed in degrading and abusive situations. I think many parents are unaware of exactly what their children are being exposed to — and what it’s doing to them.
Brain scans show that the prefrontal cortex — the part linked to reasoning — is the last part of the brain to fully develop. Pornography presents behaviours and attitudes as normal; but while most adults understand such images as a fantasy, not a blueprint for human relations, teenagers struggle with this.
Stephen Cottrell, the Bishop of Chelmsford, said this week that online pornography gives boys a ‘warped’ attitude’ to women. How right he is. Studies have found that 90 per cent of boys aged 11 to 16 have viewed hardcore pornography. (I suspect the other 10 per cent were lying.)
We owe it to them to curtail this tide of filth, and the people who should take responsibility for this are the internet giants.
For too long they’ve thrown their hands in the air and said they can’t police the internet as it’s too complex. Well, I just don’t buy that. If the likes of Google put as much effort into tackling minors viewing pornography as they did avoiding paying tax, you know there’d have been a solution a long time ago.
Grandparents, please don’t give up the day job!
Grandparents: please step away from your grandchildren. Put down the toddler. According to a study this week, you are giving them cancer.
Yes, apparently grandparents are killing their grandchildren with kindness because they are over-feeding them on sweets and snacks. This, the researchers argue, condemns them to a life of obesity and illness.
I think this is offensive bunkum. And I’m sure if they weren’t so busy looking after their grandchildren, playing in the garden with them and cooking them proper meals, grandparents would have been up in arms.
Apparently grandparents are killing their grandchildren with kindness because they are over-feeding them on sweets and snacks. This, the researchers argue, condemns them to a life of obesity and illness
Research has found that 44 per cent of children are now regularly cared for by grandparents, with children spending on average ten hours a week with them.
In many cases, grandparents are the ones who are most aware of what’s happening with children. While parents are out at work, it’s the grandparents doing the school pick-ups and helping with homework.
When couples divorce, it’s often grandparents who provide a sense of safety and constancy. From a psychological perspective, this is so important: we know the damage that divorce can bring on young people who don’t have a secure base.
Forty per cent of adults report struggling with stress. Smartphones and the expectation of always being available are being blamed
It’s not easy being a grandparent. You have to walk a delicate line between being an authority figure for the child, being their friend and confidant, but not stepping on the toes of the parent.
The unconditional love that I had from mine has sustained me well into adulthood. They were my absolute champions. They gave me a sense of identity and connection to my past — and a unique warmness from knowing they would do anything for me.
Yes, they gave me sweets and biscuits but they also taught me how to fly a kite and kick a ball and took me to adventure playgrounds. My nan even taught me to unicycle. I did more exercise with them on one day than I would do in a whole week at home.
A weekend with my grandparents was an exhausting experience full of love and fun and laughter. So please, grandparents, don’t listen to these sour-faced researchers. Just keep doing what you’re doing.
Forty per cent of adults report struggling with stress. Smartphones and the expectation of always being available are being blamed.
I have great sympathy with this. About a year ago, my smartphone stopped receiving emails — so for months I could only check them at home at the end of the day. The first thing I noticed was how often I’d been checking emails. Also, by the time I replied, most ‘crises’ had resolved without my involvement. My phone is fixed but I now have a strict policy. While I’ll read emails as they come in, I answer them at the end of the day. It’s amazing how liberating not being at everyone’s beck and call can be.