Tuesday, 8 January 2013

Doctor, Doctor!

Before I begin - I am not a doctor. I never have been, and I never will be. I do not speak for doctors as a whole, nor any doctor in particular. Everything in this blog post is simply my own outside opinion. I might be wrong, but it is what it is. I thank you very much.


Yesterday I had to pop down to my local medical practice. It is a squalid, grey, unappealing building in a particularly dubious area of town, and I certainly don't make a habit of going. I had to go yesterday however because like the IDIOT I am, I had lost my repeat prescription - I must have chucked it out by mistake when having a post-Xmas clear out - so I had to saunter on down to fill out a form so I could get my next batch of medication before the stuff I have at the moment runs out and I turn into a werewolf.

Whilst I was filling out the form however, something caught my eye. Lying on the desk was a pile of leaflets, roughly A3 size, bearing the slogan "DOCTOR FIRST IS COMING TO *INSERT TOWN NAME HERE* MEDICAL PRACTICE!". This intrigued me, so I picked up the top copy, folded it and stuffed it into my bag, promptly forgetting all about it until a few hours later when I was on the train going to the dentists. As the train rolled along the tracks, I read the leaflet and it concerned me a little, so I thought I'd write about it here. Again, I don't speak on behalf of doctors. This new system might be magnificent, but I'm unsure. The literature is in bold, my thoughts in this normal font....


We are very pleased to announce that in February 2013, the Practice will be moving to the Doctor First appointment system. This leaflet will tell you what it means for you as a patient, and how you will be able to access Doctors quickly and easily in the New Year!

It can be a bit of a nightmare getting into the doctors, particularly at this time of year when the Norovirus is flying around and elderly people are struggling etc. To put this into context - I've never met my registered doctor. In fact, I wouldn't know him if I walked past him on the street. I know his name, and I know he's at my local medical practice, but I've never met him. Every time I've been fortunate enough to get an appointment in good time, I've had to be assigned to a doctor - any doctor. You hope you get lucky and get a decent one, basically. Now that's not necessarily a huge deal - they're all qualified - but I do find it a bit bemusing that the guy I put down on forms as my doctor is someone I've never actually met. So a new appointment system? Interesting. Let's read more.

What is Doctor First? 

Have you ever tried to get an appointment with a Doctor and been told that there are none available?


Doctor First is an appointment system that will make this a thing of the past! With Doctor First you will ALWAYS be able to access a Doctor on the same day!

That's a very, very bold claim. How do they plan to do this, exactly?

With Doctor First you'll receive the healthcare you need when you need it! Doctor First puts Doctors in control of appointments in order to put our patients needs first!

OK - alarm bells already.

I (and everyone else) go to a doctor for a reason - we are poorly in some way and we need a bit of help, whether it's depression or a broken arm, high blood pressure or schizophrenia. We go to doctors because they're medically qualified, right? They know how to help when it comes to this stuff - they know more than you or I do. As such, I want my doctors to be doing this - helping poorly people, whether that's at their surgery or via home visits. What I'm not sure I want them doing is the stuff that the people on reception do - booking people in for appointments and general other admin duties. Anyway, let's carry on.

How will I get an appointment when I need one? 

With Doctor First, being able to access a Doctor is easy. Contact the surgery in the usual way and advise the receptionist that you would like an appointment with a Doctor. The receptionist will ask for a brief description of the problem and a telephone number on which the Doctor can contact you. The receptionist will put you on a list for the Doctor of your choice, where possible. The Doctor will contact you by telephone that day. The Doctor may be able to give telephone advice without needing to see you. However, if after assessing you, the Doctor feels you need to see an appropriate healthcare professional, he/she will book you an appointment for that day.

I see the logic here - if nothing else, this cuts down on the people walking into the surgery and seeing the doctor. But...

Firstly, are we not just transferring the doctor's time, rather than freeing it up? What changes here - the doctor doesn't talk to you face to face, instead he talks to you over the phone. No time has been saved there, unless this initiative is designed to let doctors fob you off, to put it bluntly. And then how does that help the patient? Do doctors even want to spend their time talking on the phone to people?

Secondly, talking on the phone if you're a patient? Telling a receptionist about your problem? I'm very fortunate in that I've never had genital warts, touch wood, but if I ever do get them I'm not sure I'd want to tell a non-qualified receptionist about them, thanks very much. It'd be hard enough to talk to a doctor about it. Like lots of people I'm not a huge fan of talking on the phone about anything, let alone private health problems. This to me seems like cutting corners, with the rather ambitious promise that you'll "ALWAYS" get your doctors attention on the same day the sweetener to convince patients that this is a good idea.

The back page of the leaflet is essentially more of the same, so I'm not going to copy it all down for you. One bit in particular did stand out though...

Our receptionists will ask you only for brief details of your problem, so that it can be put on the list which the Doctor will see when he calls you back. This brief information will allow the Doctor to prioritise patients effectively.

I have a problem with "prioritise patients". Here are five ailments that I've just thought up off the top of my head:

Glandular fever
Depression which has led to suicidal thoughts/self-harming
Irritable bowel syndrome

Now. Who do you phone first? Who do you phone last?

Earlier on I argued that you should leave the medical stuff to the doctors, and I stand by that. If anyone is qualified to rank those five ailments in order of seriousness/priority, it's probably a GP. Do we want them to, though? Never mind "What gets priority?" - should there be a "priority" at all? The cynical side of me thinks that if we go down this road, in 10 years time the questions the receptionist will ask you will include your postcode, your occupation and whether you can pay by card or not. Remember, this is a Tory government - privatisation is always just a shot away.

On paper, "Doctor First" seems brilliant, but I'm unconvinced. I can see a future where doctors have to juggle their medical expertise with their admin/diary planning skills, and that could become an issue. Doctors are people too - they get stressed, unhappy and down just like we do - and I worry that they'll hate this system which has been burdened upon and that their morale will drop. I hope not, but I guess we'll have to see.

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