Doctors are slaves to fashion in the same way as everyone else is.When new drugs are introduced, you get a surge of use, then a tailing off, and eventually the new drug becomes established and we all get used to it.
When it comes to new drugs, the Jobbing Doctor is a late adopter. I don't always rush into using the new agent, relying on others to try them with their patients.
Sometimes my therapeutic cautiousness means that my patients don't get the new medication as soon as they might; it does work both ways as I have rarely had to stop medication that has been withdrawn.
Take Calcium Channel blockers. They have been around for a long time now (greater than 30 years) and have not been my favourite group of blood pressure tablets. Especially the dihydropyridine group [all those drugs - there are 20 of them - that end in -ipine]. Over the last few years I have seen what seems like hundreds of patients with bad leg swelling (full of fluid), and I have often stopped the medication.
On one of my house calls today I have done it again.
I really feel that we overmedicate the elderly.
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Grrrrr.. don't get me started. Had an arguement with an examiner when doing MRCGP iMAP viva last year about putting crumblies on Ca channel blockers. My position was akin to yours but the examiner insisted no one ever got swollen legs with 5mg amlodipine :-(
Allegedly good for preventing strokes though. And don't bugger your renal function.
as a layman having watched old folk die on the "pathways" im frankly surprised that what passes for medical care is allowed
its fairly obvious to me that the decision to go on the late stage drugs and withdraw fluids is a death sentence, and no matter how bad the patients condition nobody could last more than a few days on that regime, and im far from convinced in the instances ive seen up close and personal that the nurses making that decision should be allowed to do it
shipman may have been locked up, but we seem to have widespread death by dehydration in this country
exactly how long would a healthy person last on those drugs and no fluids? a week max?
according to the papers the numbers of folk dying from dehydration has gone sky high in old folks homes, but this is just numbers of instances listed on death certificates, i wonder how many other deaths by dehydration are hidden by other stuff being listed on death certs as normally happens?
and while we are on this subject it worries me greatly that nurses can now certify a death at home for a terminally ill patient, this is dumbing down gone too far
the ethics of this worry me a lot
so i think these "fashions" in treatment need thinking again
your problem dear jobbing doctor is that you're a dinosaur combined with an ostrich.
The NHS doesn't work, your example of good care is all too frequently not the case. The NHS doesn't work because managers and politicians generally don't engage well with clinical staff and vice versa. politics and health don't mix but we have to make the best of a bad job. The whole nhs machine is too big and rusty.
The nhs worked well years ago - when the clinical staff ran the hospitals.
The nhs problems are not party political - successive governments have all shafted it.
why did the gp's acheive such great qof scores? - because we're good at what we do and we know how to care for pts well. Just think what we could do if we were able to set our own, sensible targets and demand the highest standards throughout primary and secondary care.
stop whining and support your consortium, get involved if you don't like what others are doing. the status quo sucks we need change.
BWD, but isn't the problem that it won't be the grass roots GPs doing the comissioning? If so, when? How many sessions do I have to cancel in the surgery to joina cxonsortia, havin gno partners to cover me.
I'd rather ride a rusty lumebring bike that gets me there eventually than ride something whizs bang that will ultimately kill me.
Anyway, we're in Wales so why worry?
(Apologies, you could be Welsh and working abroad in England!) :-P
"stop whining and support your consortium" - yes big business demands it.
By the way when do we start paying health charges up front to appease the likes of Humana, et al ?
http://www.guardian.co.uk/politics/2011/feb/01/david-cameron-nhs-reform
SFD sadly i'm not in my native Wales.
Several of the gps I know involved in the consortia are grassroots, they want to make a positive difference and we as partners facilitate the time they need.
I agree it's different if you're single handed but as long as you have a positive dialogue with your cluster/consortia you can still have your say. The point is we all neeed to engage to get the service we want because change will be imposed anyway. The jobbing doctor fails to acknowlege all the hours our consortia have put in to engaging with the pct and putting in place the right mangerial staff to do the day to day running of consortia. The chief difference is that in future we will be clinically led and the people doing the day to day work will be fully engaged with clinical leads. It may not be what we came into medicine to do but the service has to be efficiently managed. We have to be forward looking to manage the challenges of future health care, to ensure we provide for an increasing population and changing demographics. Is not about who can and can't have a hip replacement. Do you really want a rusty and often inadequate service for your pts and your family? We have to change.
a&e charge nurse - I refer you to lucy's comment in the why the nhs works post below the one we're commenting on.
"The chief difference is that in future we will be clinically led and the people doing the day to day work will be fully engaged with clinical leads" - then you have swallowed Lansley's bullshit hook line and sinker.
Put another way - even if you did object to these back of a fag packet reforms (as most clinical staff do) the coalition would still not take a blind bit of notice, since the primary driver behind them is not to improve clinical standards but to disburse as much of £100 billion NHS budget amongst circling corporate health providers.
Certainly, there is not one shred of evidence that patients will be any better off as a result of these changes.
Of course a £2 billion NHS reorganisation was not flagged up by the tories as part of their pre-election manifesto - you have to ask yourself why they were so coy about it if they believed it would be supported by the electorate and most NHS staff?
Any guesses as to when patients will have to start paying up front - perhaps only then the penny will finally drop about what's really happening?
A&e
I'm not advocating privatisation and have never done private work. I'm not interested in the politics - just accepting that the nation is bankrupt. Don't get me started on tax dodgers as depriving us of revenue but even if they paid up we still can't afford to carry on as we are.
My greatest concern as a doctor and a patient is the woeful state of many services and the outright neglect of areas such as mental health, care of the elderly etc.
I see this as an opportunity for us to make positive changes. What winds me up is the ranters who are more than happy to sound off but don't put forward any sensible alternative. This isn't about swallowing political spin its about facing facts - we don't live in an ideal world.
"I'm not interested in the politics" - I do not think anybody can fully understand the significance of this debate if the political context is removed.
The coalition are undermining the fundamental fabric of the NHS, and these changes are being driven by political ideology rather than any good clinical evidence.
The more we hear about them, the more the doubts grow, and not just amongst the ostro-dinosaurs.
The concerns you express over mental health and elderly care services will not mysteriously disappear once Humana, et al seize the con
I'm very interested in the politics. I'm interested in how we can spend £30 billion on an IT system that doesn't work. I'm very interested in how we adopted a system that doubled admin costs in the NHS from 6% to 13% esp as we are now doing a rerun of that system (fundholding). I'm very interested in this, because it's the reason we're bankrupt and I really don't want to hand over any more money to the people involved. And I do have solutions. Get rid of the internal market in the NHS. There is no place for it. Instead of having 300 GP consortia, let's have 152 PCTs. Etc, etc. And sorry if we rant, but I do get a bit stroppy about people pouring billions down the drain.
BWD, I really hope you are right. As it's going to be pushed through anyway I guess English GPs (oops I mean GPs working in England) will make the best possible job of it they can. I suppose ultimately I am scepitacal as none of the previous reforms seemed to have helped much despite massive sums of public cash being spent.
My hope is you will have a better service than now but I suspect only marginally so, to the extent that no one notices, but at what cost?
I've only been doing the job 12 years, and can only imagine the scepticism of older GPs like JD, who have been doing it more than twice as lon, is double mine!
Wales seems to be going in the opposite direction, meging hospital trusts and PCOs to try to get rid of the market.
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