Jane Wilson-Howarth

Blog

 
 

Give GPs a break!

Thursday, 30 March 2017
Journalists are attacking us again. A Torygraph article reported a recent study – in a Shock! Horror! Probe! headline kind of way – that some GP consultations can take as little as two minutes. For 15 years, until September, I was a Principal in general practice in Cambridge where the allotted time for a pre-booked appointment was 10 minutes, and five for booked-on-the day emergencies. This seemed to work well, as long as patients understood that there wasn’t time for multiple problems nor for long discussions on the pros and cons of new diets, vitamins and…….
If someone attended with something that was easy to diagnose with a glance down the throat (tonsillitis) or a temperature check and a ‘sounding’ of the lungs with a stethoscope (chest infection), then a providing an antibiotic prescription plus a sound bite of health education might indeed take just a couple of minutes. This would then mean that more complex problems could take longer. Whatever the system, there is always the option of booking double (20 minute) appointments and also offering a follow up a consultation a week or 10 days later, and another and another. Many people judge that such an appointment system isn’t giving patients enough time but in my experience, many people in crisis find the offer of regular appointments for a while comforting and it can help them get through the worst of it.  And with this system I believe I grew to know well those within the 2500 patients registered with me who had recurrent or persisting problems.
When I was new to general practice I would allow patients in crisis to have long, long appointments – sometimes people would stay weeping for up to 40 minutes. Usually they’d start repeating their story after less than 10 minutes – for emphasis, no doubt, perhaps unaware how carefully I’d been listening. Meanwhile I’d be thinking that by now my waiting room must be heaving with impatient patients and I’d be hoping for the rest of my consultations to be straightforward - for skin infection or cystitis, for example.
I learned to interrupt gently and tell patients to come back at the end of my surgery or later in the week. Sometimes, patients recovered amazingly quickly if just offered a few sleeping pills to allow them to draw breath and get some catch-up sleep. I’d also promise to be there for them while worrying that by offering unlimited repeat appointments I might make patients unhealthily doctor-dependent. Almost always though, long before I’ve even starting to think this patient is coming too often he/she would have started sleeping again and had begun to see some chinks of hope and they’d stopped booking to see me. With committed GPs this system works well.
One challenge is to get patients to trust us again. Sometimes I play a game with myself, wondering if I could guess the diagnosis between calling my patient from the waiting area and walking with them into my consulting room. There is a lot to be learned in the way people walk or limp, whether they look like the weight of the world is on their shoulders, whether the cough is the special waiting room tickle put on for the doctor or the hacking body-wracking cough of pneumonia, whether there is the give-away smell of cigarettes or alcohol or ketones on the breath, whether the hair is lank, whether the skin colour is good – or too good (booze or hypertension) – or pale, whether there is sweating, suggesting really bad pain, fever or a someone being about to vomit or faint. An experienced GP sees a lot, knows a lot and can do a lot for her patients.
The challenge is to get the government off our backs – and journalists to realise we are doing our best – so we continue to have the time, energy and enthusiasm to do our work rather that get bogged down with pointless bureaucratic tasks, meetings and paperwork. It is this that is driving a lot of us out of general practice. That is one of the main factors that drove me to leave.
Posted: 30/03/2017 12:22:27 by Global Administrator | with 0 comments



    Pontifications
    Travel
    Wildlife
    Writing
    May 2021(2)
    April 2021(3)
    March 2021(4)
    October 2020(1)
    August 2020(2)
    July 2020(1)
    June 2020(1)
    May 2020(1)
    April 2020(4)
    March 2020(4)
    January 2020(1)
    October 2019(2)
    June 2019(2)
    April 2019(2)
    March 2019(9)
    January 2019(2)
    October 2018(3)
    August 2018(3)
    June 2018(4)
    May 2018(5)
    April 2018(3)
    March 2018(1)
    January 2018(4)
    October 2017(4)
    August 2017(3)
    July 2017(2)
    June 2017(2)
    May 2017(1)
    April 2017(1)
    March 2017(4)
    January 2017(1)
    October 2016(7)
    August 2016(2)
    July 2016(1)
    June 2016(1)
    January 2016(3)
    October 2015(1)
    August 2015(1)
    July 2015(1)
    May 2015(2)
    April 2015(2)
    March 2015(2)
    January 2015(3)
    October 2014(4)
    July 2014(1)
    June 2014(4)
    May 2014(1)
    April 2014(1)
    January 2014(4)
    October 2013(1)
#righttobreathe / 100 word story / 100-word story / 50 Camels / 50 Camels and She's Yours / A Glimpse of Eternal Snows / A Wide Woman on a Narrow Boat / Aberdeen / Abuja / accidents / Active Fairness System / Adam Reta / adventure stories / advertising / affairs / age concern / air pollution / air quality / Akwanga / alcoholism / Alicia Ostriker / Americanisms / Amharic / animal reservoirs / ANM / Annapurna / antelope / anthology / Arrivals / Asad / audacity / audible / audio musical project / audiobook / author / Author from Hull / author interview / author reading / author-to-author / Auxiliary Nurse Midwife / Baglung / Bagmati / Bajaj / Bajaj Pulsar / Bajura / banknotes / BBC Radio Cambridgeshire / bear precautions / Benjamin Langley / Bertrand Russell / Bethlehem Attfield / Bhotang / bicycle / bike trip / birdlife / birds / black bear / black kites / black pine forest / Blitz / Bloodshot Books / Blue sheep / book launch / border guards / Boreal Wildlife Centre / Brad Travel Guides / Bradt / Bradt Travel Guides / Brahmin / breakfast / bridge / brown bear / buckwheat / buckwheat bird / buffalo cart / Building Back Better / BuildingBackBetter / bulbul / camaraderie / Cambridge / Cambridge writers / Cambridgeshire / camping hazards / canals / carcinogens / caste / catastrophe / cave diving / celtic / chaite-dhan / Chandragiri / Chele / childbirth / children's books / Chirang / Chisapaani / Chisapani / Chobhar / Chobhar Hill / Chough / city cycling / civet / climate change / clinics / cold desert / colourful hat / comfort / coming of age / coronavirus / Covid / covid vaccine / COVID vaccines / Covid-19 / cows / creating characters / cycling / cyclist / daisy chain / dal bhat / dangerous wildlife / dawn / dawn chorus / Dead Branches / demonstration / Department of Roads / desert / development / development work / Devon / Dhading / Dhading besi / Dhangadhi airport / Dhaulagiri / Dhee / dhulomandu / doctor memoir / Dolpa / Dolpo / domestic violence / Dr. Katrina Butterworth / dragon / dragons / Drakmar / drinking water / droppings / Dunai / dust / early marriage / earthquake / earthquake alarm / earthquake damage / earthquake today / earthquakes / East Anglia / eco-resort / eco-tourism / Edinburgh / efficacy / elbow sneezing / embankments / emergency / England / English journey / English language / environmental crisis / Eräkeskus / eternal snows / Ethiopia / ethnic cleansing / evacuation / evocative smells / Ewell / expat / exploitation / Fagu Purnima / Falgun / feelgood read / Fens / festival / festival of colour / festivals in March / fiction / Finland / fire-tailed sunbird / fishing / fishtail / flash fiction / flash literature / flash prose / flood protection / floods / 'folk / football / footbridge / footpath / for / forest / forest fires / friends / Gai Tihar / gaming / Ganesh himal / Gangetic Plain / garden / garment / Ghami / Ghemi / ghoral / giant crab spider / giving birth / global warming / goodread / goral / gorge / Gorkha / gossip / GP writer / grandad / Greece / grey-headed canary-flycatcher / haiku / handwashing / hand-washing station / hangry / happiness / happyness / hare / Hatibhan / hawkmoth / health assistant / Heffers / Heffers bookshop / Hell's Grannies / Henningham Family Press / himal / Himalaya / Himalayan Black Bear / Himalayan Goral / Himalayan griffon vulture / Himalayan Hostages / Himalayan Kidnap / Himalayan serow / Himalayan Sunrise / Himalayan woolly hare / Himalayas / himals / Hindu festival / Hindu kingdom / Holi / Holi Purnima / holocaust / home delivery / honey buzzard / hoopoe / horror / hot springs / Hotel Deep of Worldtop / Hotel Peace Palace / house crows / how long to write a book? / human kind / human spirit / idyllic childhood / Indonesia / Indra Jatra / infidelity / inspiration / inspiring fiction for children / Ireland / irrigation / Is She Dead in Your Dreams? / jackal / Janajibika Hotel / Jane Wilson-Howarth / Jews / Joe Wilson / Jomosom / Jomsom / joy / jungle / Jungle book / Juphal / Kaag Beni / Kag Beni / Kali Gandaki / Kali Gandaki gorge / Kalopani / Kalunki / Karnali River / Kashigaon / Kashigoan / Kathmandu / Kathmandu Valley / Katrina Butterworth / kestrel / khana / Khartoum / kickstart / kidnap / kindness / Kipling / Kipling's jungle / kites / Kolkata / Krishna / Kumari / Kurds / Kurentar / Kusma / labour / ladoos / lama / Lamjung himal / lammergeier / lammergeyer / landscape / landslide / landslides / language / language gaffs / Large Indian civet / largest tribuary of the Ganges / Laxmi Puja / leave no one behind / leave no-one behind / LeaveNooneBehind / letter-writing / life lessons / Livelihoods / living goddess / lockdown / lockdown project / LoMantang / Lombok / London pigeon / loneliness / Lord Ganesh / Lord Krishna / loss and recovery / love / Lukhu river / Machhapuchare / Makwanpur / Manbu / mani wall / married life / Martinselkosen / Mary Kingsley / masala tea / maskmandu / masks / maternal mortality / Maya and the Dragon / medical emergency / medical evacuation / medical memoir / medical Students / Melamchi / memoir / memoirist / memory / Michael Rosenberg / microfiction / middle grade readers / Middle Hills / mineral water bottles / Monsoon / morning mist / Moth Snowstorm / motorbike / motorbike trip / motorbikes / motorcycle / MottMacDonald / mountain medicine / mountains / mouse hare / mouse-hare / Muktinath / Mukwanpur / mulberries / Mustang / nag puja / narrator / narrow boat / National Reconstruction Authority / nature / Naubisi / neighbours / Nepal / Nepal Communitere / Nepal road trip / Nepal roadtrip / Nepal Valley / Nepal wildlife / Nepali / Nepali food / Nepali tea / Nepali Times / Nepali topi / Nepali wildlife / Nigeria / Nigiri himal / nilgai / Nilgiri / Nilgiri South / non-fiction / Nonsuch Palace / Nonsuch Park / Northumberland / novel / nuthatch / Nuwakot / obstetrics / onions / on-line newspaper / orb spider / ox-cart / Oxford / Oxford vaccine / pandemic / pangolin / parenting / Passer montanus / passing places / passive pleasure / Patan / Patan Durbar / Patan Durbar Square / payer / People in Need charity / percussion / Pfizer vaccine / PHASE / PHASE Nepal / PHASENepal / Phewa Tal / Philippines / Phoksundo / phonetics / photoktm2016 / pigeons / pika / pike / pilgrims / plastic waste / pleasure / PM 2.5 / poem / poetry / Pokhara / Police My Friend / pollution / polytunnel / pony trekking / post earthquake recovery / Potatoes / powder / pregnancy / Pridhamsleigh Cavern / publishing / puja / Pul Chowk / Pulsar / Pungmo / Purnima / Purnima programme / Pyncnonotus cafer / Qatar / rabies / Rajapur / Rajapur bazaar / Rajapur Island / Rajapur market / Rajapur town / rat snake / reading / reading aloud / Real Fairness for Real men / reconstructed dialogue / recording / Red Dawn Rising / red-vented bulbul / refugee camp / refugees / relief work / Remover of obstacles / Requiem / rhododendron / rice / ricefields / Richard Mabey / Ringmo / risk takers / river crossing / river island / river-crossing / road trip / roadtrip / Rock Doves / rock shelters / Roe Deer / Royal Enfield Riders Club / Royle's pika / rubbish / Rufus-breasted Niltava / rupees / Russian border / rustling / rustlings / safety / Sally Haiselden / samosa / Sappros / Sarengkot / sarus cranes / scorpion / screening / Second World War / Seeta Siriwardena / self-harm / senses / serow / Setopati / Shadow Spark Publishing / Shangri La / Shangri-la / Shanti bazaar / Shey-Phoksundo National Park / Shivapuri / Shivapuri Nagajung National Park / Shivapuri National Park / Shivapuri Village / Shivapuri Village Resort / short fiction / short story / shrikes / silk / Simon Howarth / Sindhupalchowk / Sinhala / Sinhalese / Six degrees of Separation / skipper butterflies / skippers / snow leopard / Snowfed Waters / social isolation / solid waste / solid waste disposal / Soti / South Sudan / sparrows / Speaking Tiger / species leap / spider venom / Spiny babblers / spotted owlet / squirrel / Sri Lanka / Sri Lankan author / Stephanie Green / stink bug / stolpersteine / street art / street dogs / Subsistence agriculture / Sudan / Suli Gad Khola / Suli Gad river / Summit Air / sunbird / sunrise / Surrey / suspended bridge / Sussex / Suttee / t / Tahr / tales / tar tattoo / tato pani / Tatopani / TBS Kathmandu / tea / tea shop / teacher / teashop / Teku / Teku Hospital / Teku infectious diseases hospital / terai / Thamel / Thankot / Tharu / Tharu people / The Book Warren / The British School Kathmandu / The Lonely Cat / Thessaloniki / time / To be blessed / totobobo / traffic / traffic jam / traffic rules / traffic uncles / transHimalaya / transHimalayan / translation / travel / travel anthology / travel narrative / travel writing / traveling with children / travelling with children / tree sparrows / trekking / Tribhuvan International Airport / trust / Tsirang / Twin Otter / Uganda / UK / UK aid / UK aid in Nepal / UKAid / unplanned pregnancy / Upper Mustang / urban cycling / urban life / urban pollution / urban water supply / vaccinating / vaccination / vaccine / Valley / vampires / vegetarian / velvet-fronted nuthatch / Viiksimontie / Village dogs / village life / volunteering / vulture / Wai / Wanderlust / water supplies / water tankers / West Sussex / western Nepal / white lies / WHO / widower / wild goat / wild places / wildlife / wildlife stories / William Matthews / winter madness / winter Wheat / Witchford / women of a certain age / Women Travellers / words / wordsmith / World Book Day / World Book Day 2020 / World Cup 1990 / World Environment Day / world's deepest gorge / writer / writers group / writer's life / writing / writing about writing / writing characters / writing exercise / writing for children / writing group / writing habits / writing prompts / xenophobia / year fives / yeti / young mother / young motherhood / Your Child Abroad / zoonoses