During that time we could pay a deputising service to look after our patients, and if the deputising service mishandled our patients, even then the overall responsibility was left with us.
This was a pretty onerous responsibility, and I had to do one night in 4, and one weekend in 4 in rota with my partners.
In 2004, the Government offered us the opportunity to rescind this 24 hour care: I was anxious about the motivation behind this, and voted against it. It went through. We know, of course, that this was the first significant plank in the privatisation project which had been started in around 1990, and now moving towards its inevitable conclusion - the break up of the NHS.
I missed this aspect of my work, but was pleased to be only working an 11 hour day for 5 days a week. This Stakhanovite workload was an improvement on what went previously.
The GP maternity units were closed down, by ministerial fiat, following the Cumberlidge report (conclusion decided before report written or evidence taken).
We do not have 24 hour responsibility any more - and the decline in standards of Out-of-Hours services is clear for all to see.
I will not let everything go, however, and if any of my patients elect to die at home, I will give them my mobile phone number, and will attend at night and at weekends, if needed. This has happened this week as I was caring for a 57 year old patient who was dying. You don't need to do anything too active, but just be there for the patient and the family.
It is called "old fashioned doctoring".
It is what we do.
6 comments:
You are obviously a fine doctor JD and it is sad that "old fashioned doctoring" is slowly disappearing.
I am certain that you have been an excellent role model for and taught your trainee GPs well, and hopefully they will follow in your footsteps.
Anna :o]
My family doctor's (GP's) practice in America has recently been 'taken-over' by a company that promises to manage the practice's financial affairs. This company is also 'handling' one of the two hospitals in the area.
Recently, I was hospitalized with complications from an enlarged prostate. I went to the hospital not affiliated with this company.
My family doctor was not allowed to visit me in the hospital (it's standard practice for GP's to attend their patients in hospital here) because of his contract with the company concerned, and had to arrange for a 'stand-in' to cover for him. For which, of course, I was charged.
Total cost for one overnight stay, a catscan, and various medications: $8,900.
Insurance (costing on average $1,200 per month) picked up most of it, but with co-pays and non-covered charges I was still billed over $1,000.
And the British complain about their National Health Service.
"You don't need to do anything too active, but just be there for the patient and the family.
It is called "old fashioned doctoring".
It is what we do. "
and thank you for it, JD. When my uncle was dying at home at age 60 last year, his (now-retired) GP was also there. When he wasn't, he wasn't far, but on the other end of the line if needby. Sometimes, it's all patients & their families need.
I don't disagree with anything you say, but as a potential GP trainee, I would like to point out that I for one am quite glad we don't do that any more.
I absolutely agree that out of hours need to be improved and patients would like us to be there 24/7. However, I have a life. I have a husband, and one day I will have children, and I would like to see those children now and again, and I am not ashamed to say that I believe having a life and looking after my family is more important than providing absolutely optimum (i.e. 24/7) care to my patients. I believe I can still be a good doctor without working every hour of the day. In fact, since having a life enables me to be a sane human being, I will be a better doctor this way. I also believe that doctors are people too, and better for it, and we should recognise that people all need time off.
I care about patients, but I care about myself and my family too, and those two things should not be incompatible.
I am possibly being naive, but we'll see.
Whilst i sympathise and take your point on board Emma, RJ's post sounds horrifying. I think it's taking matters to the other extreme when the regular GP is not even allowed to visit a sick patient. Although you'd want a life of your own outside working hours- surely you wouldn't want the choice to be taken away from you either if you wanted to be there for a patient under special or unusual circumstances?
Neelu
Absolutely, RJ's situation sounds dreadful and I would love to hope that would not happen in the UK. It's ridiculous for a doctor not to be allowed even to visit a patient and I can't see a single sensible reason for it. GPs in the UK don't make a habit of visiting their patients in hospital, as far as I can see, unless it's someone they've known a long time I guess, but if they chose to do it, I don't see why they shouldn't.
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