Wednesday, July 23, 2008

News today

Several front page-type news stories today.

The main one is the release of a report by the Chief Medical Officer, Sir Liam Donaldson, on revlaidation of doctors. In principle, I think is a "good thing". But I am a little worried about the details, because that is where the Devil is. And, in my (not so) humble opinion, Donaldson has failed the profession several times in recent years, the most reprehensible episode involving his lack of accountability for the MTAS/MMC debacle.

What I would support is an annual exercise to check that we are keeping up to date that is more robust than the current system.

What I would have difficulty supporting is anything which involves excessive paper chasing. We GPs are already "answerable" to a couple of dozen different organisations and quangoes, from the PCT, to the Health Care Commission to the GMC, never mind the fact that people can also take us to Court, separately and additionally to all the other ways they can have a go at us.

And I'm not even going to mention the abomination that is Iwantgreatcare... (bugger, I did, didn't I?)

The next story is about GPs prescribing antibiotics: again, I'm in two minds about this one.

I don't prescribe antibiotics at the drop of a hat, and guidance will add to the credibility of my already rather paternalistic and uncomrpomising argument when a patient is insistent that they need "something or I'll get pneumonia" ("You'll need them when you have pneumonia, at the moment you don't.")

On the other hand, the premise that GP prescribing is part of the problem with the rise and rise of the so-called superbugs such as MRSA doesn't have a lot going for it. Dr Grumble and the Jobbing Doctor have already blogged about this failry recently, so I won't bore you further (though I do commend their blogs to you, go and have a read). Suffice to say that the Government should be looking elsewhere for solutions, rather than looking for scapegoats.

Finally, this story: I (and my colleagues) am (are) missing the diagnosis in patients presenting with HIV. Apparently there should be more widespread testing (well, I can't argue with that). But I should also be considering it in anyone presenting with a flu-like illness.

Do these people have any idea whatsoever how many people I see with just that story every week? Even in a good week its half a dozen or more. In a bad week it'll be in the fifties or sixties.

There are 7000 new case of HIV diagnosed every year. That compares to almost 114,000 deaths form heart disease, over 33,000 deaths from lung cancer and a prevalence of diagnosed diabetes of almost 4% of the population (not counting those patients who we don't know about yet).

This suggestion by the National Aids Trust, while laudable, is another example of Ivory Tower speak: they may be experts in their field, but they are patently not experts in mine. It would make much more sense to me to be dishing out free condoms and promoting safe sexual practices.

Finally, I am grateful to the Jobbing Doctor (good grief, 2 mentions in one post. I'm not stalking you, JD, don't panic...) for bringing to my attention something that isn't my fault.


The Shrink said...

We ran out of fairtrade organic coffee in our office this morning. That's your fault, that is ;-)

Russell Brown said...

Mea culpa...