Doctors: Diagnosis By Phone

[Princess]

I wish I had read this thread before.

I woke up with a bad case of conjunctivitis in both eyes this morning (had it before so fairly certain of the diagnosis). I went into Boots on the way to work to get something over the counter. The pharmacist there was really helpful and after taking a look at me said it was quite severe and suggested I saw my GP. So, I called at lunchtime to be told a clinician (is that even a real job) would call me back to ask me some questions. I explained I had seen a pharmacist and was acting on his advice. The receptionist didn't care. I explained I was in meetings all afternoon and only really had my lunch hour to make personal calls. The receptionist stuck to her guns and said they'd call me back. Of course, they called whilst I was in an meeting. I called back to be told the same thing a clinician would call me back.

I gave up, went back to Boots and bought the over the counter drug. I'll try and get on my husband's doctors books tomorrow.

[Jah Lush]

I had a bad case of conjunctavitus recently and went to Boots and consulted with the pharmacist She prescribed me with some eyedrops and it soon cleared up. No need to see a doctor.

[JimSmith]

Our health outcomes are relatively cost efficent in comparison with the rest of the world, we spend only 7.7% of GDP on health(public and private) by comparison in France they spend 10.1%, in Germany 11.1% and the US 15% if we want instant access to a doctor for non emergency complaints then we need to pay alot more whether that is privately or through taxation, personally I'd rather keep it cheaper and know that with anything life threatening I'll be seen to (as happened once before).

[spadetownboy]

Princess Wrote:

-------------------------------------------------------

> I wish I had read this thread before.

>

> I woke up with a bad case of conjunctivitis in

> both eyes this morning (had it before so fairly

> certain of the diagnosis). I went into Boots on

> the way to work to get something over the counter.

> The pharmacist there was really helpful and after

> taking a look at me said it was quite severe and

> suggested I saw my GP. So, I called at lunchtime

> to be told a clinician (is that even a real job)

> would call me back to ask me some questions. I

> explained I had seen a pharmacist and was acting

> on his advice. The receptionist didn't care. I

> explained I was in meetings all afternoon and only

> really had my lunch hour to make personal calls.

> The receptionist stuck to her guns and said they'd

> call me back. Of course, they called whilst I was

> in an meeting. I called back to be told the same

> thing a clinician would call me back.

>

> I gave up, went back to Boots and bought the over

> the counter drug. I'll try and get on my

> husband's doctors books tomorrow.

and there lies the crux of the whole problem,because the nhs cant sort me out at my own convenience its their fault and that my friends is the common theme running throughout this thread, but unfortunately it doesnt work like that. a little bit more patience from the patients is called for me thinks.

[Princess]

Spadetownboy, I think that is a little unfair. I had tried to take self diagnose and prescribe rather then burden an already stretched NHS. It was only when the pharmacist (medically trained as far as I know) suggested I saw a GP I felt I should possibly make a doctors appointment.

I don't mind talking to a clinician (although I would still like to know what one is) if that's the rule. However, my job means my availability is quite limited during working hours and it was exceptionally frustrating to miss my slot and go back to square one.

I do feel, whilst I don't mind talking conjunctivitis over the phone in a completely open plan office (no quiet rooms or offices), I might be a little more reluctant to talk about more 'intimate' problems in front of my team when I get the call from the clinician!

[Ladygooner]

Just got my letter from Melbourne Clinic advising new procedure. Did you know that all patients at Melbourne Grpve are eligible for a month's free membership with Fusion Centres in Southwark? They say that you can provide feedback on their services anytime by visiting www.mgmp.co.uk. Just an extra thought I had, not sure I would want a clinician calling me back whilst I am at work to discuss my symptoms where everyone else in my open plan office can listen in.

[jollybaby]

I think I gave up trying to work out how to salvage the NHS years ago - probably when trying to assess the 30th patient of the night in the middle of a corridor with ambulances lined up in a queue outside A&E. I think one of the main problems is that there is confusion over what services GPs should be providing. There has been a huge pressure to transfer the care of patients with chronic diseases - asthma, diabetes etc to the community. Many of these patients would have previously been seen in hospital clinics,but now GPs are expected to follow them up and have strict targets with financial penalities if not met. I don't think there is anything wrong with this in principle but this surely this must impact on their ability to provide urgent care.

[bignumber5]

Sounds like a rough experience, Princess - hope your eyes clear up soon.

A clinician is, technically anyone on clinical staff - nurse, doctor etc. bit of a pointless word most of the time.

Your whole situation earmarks one of the biggest problems with GP surgerys - receptionists. Demand a butt-load of personal detail (it takes years of training to ellicit a proper medical history if you're a doctor or nurse, who knew cheap shoes and sun-damage was a suitable replacement for a professional qualification), under the impression that they can triage your needs (years of A&E nursing experience to do that safely) and generally be sodding rude into the bargain.

The receptionists at my GP (Dulwich med centre) are far better than most on the basic manners front, but still act like they're guarding a nuclear weapons depo if you call for an appointment.

If I'm feeling pissy when I have to phone the GP's, I go OTT on medical jargon when they start digging for info, then when they admit that they have no idea what I'm talking about, I politely (seriously...) explain that that is why I would like to see a doctor.

I can see that the receptionists are likely working on instructions from the GPs, but it sticks another obstacle between patient and doctor and that's not ideal.

[Scruffy Mummy]

Excuse me but didn't GP's recently get a lush ?100,000 per year pay deal???? And for that we get a returned phone call - not a proper appointment? Weren't these GP's supposed to invest in their surgeries? Surely they could invest in a few more staff? Or evening appointments.

I'm sorry but it's not good enough. Call me crazy but hey, I'd like to have a doctor's appointment at a time that I can make it!! Most of us work - and get a darn sight less than ?100,000 a year thank you very much and we can't just sit around all day waiting for a clinican to call us back!

[Scruffy Mummy]

Oh, and I had what I thought was conjunctivitis a year ago - and went to the chemist who gave me the usual drops. It cleared up abit but it turned out it was something called blertiris - a different condition which required different treatment. So you can't always self-diagnose. AND, if you have small children - how realistic is it to be able to take the call when you are in the playground or when they are having an all mighty tantrum? And there might be some things you don't want to discuss in front of your children - maybe you don't want to worry them or it's an intimate problem. GOSH - I am so annoyed. If my surgery brings this in, I will be livid.

[Burbage]

There seems to be some confusion over what GPs are expected to do. It turns out there's a website that can show you, approximately here:

http://www.qof.ic.nhs.uk/search.asp

Apart from the thrill of being able to compare meaningless numbers about your own GP with any number of GPs you have nothing to do with, it provides a sobering breakdown of what GPs are 'assessed and rewarded' for.

As you can see, once they've made a diagnosis, they've got to chase you up and give you leaflets and stuff or they lose points. In addition, there are some intriguing combinations - assessing depression, for example, only scores points if the patient already has high blood pressure or heart problems. All together, it looks like an incentive for them not to do any diagnosing if they can help it and, if they can't help it, to prey only on the afflicted. I'm sure it's not quite as bad as that, but it doesn't look too sane at first glance.

The government has been making noises about putting GPs into polyclinics - and if they'll be anything like the walk-in centres, I'd be in favour. Efficient, competent service on a wide range of things (including first aid), without trips to A&E or points for lectures and leaflets. However, as practices are supposed to be run as hard-nosed businesses, I wouldn't be surprised if they ended up being rented out for estate agents or coffee shops, with just a token quack in a booth. Perhaps this tele-doctoring is a step in that direction.

[david_carnell]

Scruffy Mummy Wrote:

-------------------------------------------------------

> I'm sorry but it's not good enough. Call me crazy

> but hey, I'd like to have a doctor's appointment

> at a time that I can make it!! Most of us work -

> and get a darn sight less than ?100,000 a year

> thank you very much and we can't just sit around

> all day waiting for a clinican to call us back!

Really? I don't want to sound rude but this sort of statement is part of the problem. You have a medical problem that you deem important enough to go to the doctors with and yet demand that you are seen when it's convenient to you?!

You have to take time off work to get a sofa delivered (hyperbole) but you think your health isn't that important and therefore doctors should work around your schedule? A bit more flexibility is needed methinks.

[Cassius]

But not all of us can take personal phone calls at any time of day - so we ring the doctor to make an appointment when it is possible to call.

Back to the sofa analogy - we chose to get sofa delivered - we do NOT chose to be ill.

[david_carnell]

It's not the call time I object to (although I presume we all have mobiles now) but the idea we can "demand" and appointment when it suits us. When would that be for the vast number of people? After 6pm when we all get back from work I would think. It's really not feasible is it?

If you are sick enough to go to a doctor I think you should be glad you get a same-day appointment in most cases and it's gratis. Free. And yet Doctors who work long hours, are highly qualified, do on-call shifts, get abused by patients and shafted by government are seen as the bad guys because you don't get an appointment when you want it or you have to wait 15 mins because they're running behind. Madness.

[Scruffy Mummy]

I don't have a problem with scheduling an appointment and organising my work or childcare around that appointment. I would expect that as a matter of course.

What I have a problem with is the idea that I wouldn't be able to make an appointment - that I should just sit around all day and await a phone call!!! Of course - if I have something I think is life-threatening/urgent - like a heart attack or seizure I would drop everything and go to the hospital or doctor's surgery - that's not in doubt!

But if it's one of the many nebelous/minorish-but-maybe-complaints, I would like to be able to make an appointment. If I have to have a telephone session, then I would like to have a telephone appointment - so I can ensure that a) I am avaiable and b) in a place where I can take the call. If, I have to wait in for the gas person to come to fix the boiler, I would know in advacnce and re-schedule committments. The gas company also give you some choice of days and times for them to call. It wouldn't matter if my kid is around or not - they can still come and repair my boiler.

It's quite a different matter - trying to have a sensible conversation about a health issue with a lively toddler jumping up and down or having a tantrum. I can imagine the scence now 'Yes, doctor - I'm a bit worried about... put that down, stop it now!...sorry about that, yes, where was I? oh, I have this lump... no don't throw that down the loo...'

Being able to have a scheduled appointment with your GP (not an A&E doctor) really doesn't seem like alot to ask especially considering that GP's have an annual salary of ?100,000!!

[david_carnell]

I see. Yes that seems reasonable. If it is merely the phone call you want at a specific time I think that's fine. I can appreciate it can be difficlt to fulfill though. It would have to be a window of time rather than a specific to allow for delays and rambling numptys who doctors can't get rid of.

I don't think GPs salaries have much to do with things though.

[Scruffy Mummy]

The reason I keep mentioning the salary is because the GP's pay deal was meant, as I understand it, to also cover doctors investing in their surgeries - i.e. extended hours, more staff, etc. Yet, many (not surprisingly) have done this. So it just annoys me when I hear stories like this - because it annoys me that the government has agreed a nice pay package and we the public haven't really seen the benefit.

[Brendan]

david_carnell Wrote:

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> If you are sick enough to go to a doctor I think

> you should be glad you get a same-day appointment

> in most cases and it's gratis. Free.

Since when is it free?

[SeanMacGabhann]

Since ever isn't it? I don't know anyone who has paid

[Brendan]

Free at the point of delivery. Very different to free.

[david_carnell]

Who pays to see a doctor? Those who go private I suppose. Not at your GP centre though.

Pescriptions cost a set fee though. In some cases this is above the over-the-counter price and most doctors will recommend buying the drug this way - in most cases you save a lot of money. Those on low incomes, students, pensioners etc get reduced or free pescriptions.

[Brendan]

We pay for it. I don?t like this idea that ?It is free? because it seems to suggest that ?therefore you can?t complain.? I have every right to demand an explanation as to how and why my tax money is being spent. This goes for all public services.

[KalamityKel]

On a positive side to the Melbourne Practice I am glad they've finally decided to extend surgery hours AND offer a session on Saturday's. For those who warrant a physical appointment (I assume deemed necessary by the doctor) and who find getting time off work difficult this is a God send. Also, for things like repeat prescriptions that require a check up at the same time it can be difficult to do when your work day is 9-5 with an hours journey either way meaning you care unable to get to the docs under the previous surgery times. Yes I appreciate if your health really matters to you then you should drop everything but not everyone in the world can (without risk of losing your job and all that)

With regards to telephone appointments yes I can see it useful for the more simple condition but have my doubts on the accuracy of diagnosis. On many occassions I have come across stories, not in particular from the Melbourne practise GPs advising the most strangest and also "stupid" suggestions for dealing with children - one example being my very poorly nephew at the time - suffering a severe case of tonsilitus and a mean tummy bug, being constently violently ill for over 2 weeks (he was practically wasting away to nothing) and seriously dehydrated was advised by the doctor to try porridge oats in his bottle and lots of toast and the classic line "if he doesnt improve come back to us in a week". Now not only did this seem cruel as he couldnt swallow anything solid but also pointless and demonstrated the doctors lack of knowledge of the child - he's well past bottle years AND had already been to the docs to seek advice on many ocassions already! Luckily the mother had more sense and wasnt happy wiv the suggestion and took him A&E where they were shocked by the doctors advice.

Another example I can think of personally was a couple of years ago with the Melbourne Practice, I had a very bad case of tonsilitus myself. I had been feeling off for a good few weeks before hand and suffered from a heavy cough. I had tried to get an appoinment in the earlier stages of illness but had difficulties finding a time (having to book 2 weeks in advance!) and when I did manage an appointment they kept me waiting over 2 hours before telling me they forgot to book me in. By which point I had to cancel. Things got worse for me where I lost my voice - great for trying to use the telephone to make an appointment. I had to get someone else to make the call for me. The receptionist was very unhelpful saying all emergency appointments were taken for that day and I'd have to call back in a few days. By this point I had had enough and went to the surgery myself and "demanded" to be seen. I waited an hour and was finally seen by a doctor who was quite concerned with my condition after peering down my throat and saw my tonsils attaching themselves to other bits in me throat (apologies I'm not too clued up on medical bits and bobs) and asked me why I hadn't come sooner as now I was at the stage where hospital might be necessary. Explaining the whole thing she was very muched shocked by the whole thing but said as a locum she didn't have much power in the surgery and could only apologise. Obviously I recovered well.

My point here is how can a doctor properly assess something like that over the phone? The UK has the reputation of hypercondriacs and it is all to easy for Doctors to assume a condition isn't as bad as it sounds from the person complaining. Is this not inviting more serious health issues to arise?

[SeanMacGabhann]

blimey Kel - longest KK post ever??

[KalamityKel]

impressed? :p