Do doctors misdiagnose patients? Absolutely, but in most cases it is not the fault of the doctor or anyone else for that matter. Most people who complain of headache have a headache and not a brain tumour. Most people with a pain in their leg have just that and the symptoms subside and in the absence of other symptoms, history or cause for concern sending patients to hospital is a waste of time and money and potentially dangerous. I've had patients suffering PTSD following humiliating diagnostic tests. If a patient comes in saying they have constant headaches and can't get a particular smell out of their mind, have lost time, have developed weakness somewhere or their family says they have a changed personality then a GP would refer the patient for urgent investigation. The terrible truth about general practice is that some days over half the patients you see have no reason to be in the room which justifies any medical response. Like most GPs I do not do as many night visits as I used to but the number of times I have been in a family home in the middle of the night to treat an hallucinating child with a very high fever and the answer to the question "have you tried Calpol?" was "we have run out" or "I forgot to buy some" is staggering. The main reasons people use nuclear options of turning up at A&E or calling for a doctor or, worse, an ambulance at 3AM are difficulty in gaining access to a GP quickly or astonishing stupidity of parents and carers. If people didn't make appointments just so they can moan about some aspect of their life which they already know how to resolve the stupid parents of the poor child might have been able to get through at 8:30 AM when the phones get answered and pain and anguish would be avoided all round. In that context and with so little time available there is a tendency to diagnose the obvious because that is what it is. Sometimes mistakes are made but the doctors in our practice send many people to hospital who don't think they need to go because we have spotted a symptom the patient thinks is irrelevant. If middle aged men made appointments with their GP instead of shrugging off the pain in their left arm, "heartburn", difficulty in urinating or urinating too much the, already very respectable, life expectancy in this country would improve greatly. In most countries people have nothing like the 24 hour access to appropriate healthcare that people in the UK have and, yes, things need to improve on the medical side but also on the patients' side.
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Experiences of Addiction and the Medical Profession
- Thread starter pjd555
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BecomingJulie
Bluelight Crew
And the obvious answer to that is, more front-line staff -- specifically, in this case, more GPs and practice nurses.
Whenever resources are stretched, mistakes are made. Stressed people forget things. Mistakes cause increased stress. This creates a vicious cycle; overwork beyond a certain point just makes you less productive, as you have to spend longer going back and tidying up after yourself. There's no doubt in my mind that GPs are overworked.
If it's easier to get an appointment anytime, then people will worry less about having to get one. And they won't feel so inclined to try to get an appointment with a GP just for the sake of getting an appointment. GPs will have more time to spend with each patient, not be in such a hurry to get the next "customer" through the door, and so better positioned to diagnose conditions properly.
..... Ah, but that's going to involve spending money, though, isn't it?
Whenever resources are stretched, mistakes are made. Stressed people forget things. Mistakes cause increased stress. This creates a vicious cycle; overwork beyond a certain point just makes you less productive, as you have to spend longer going back and tidying up after yourself. There's no doubt in my mind that GPs are overworked.
If it's easier to get an appointment anytime, then people will worry less about having to get one. And they won't feel so inclined to try to get an appointment with a GP just for the sake of getting an appointment. GPs will have more time to spend with each patient, not be in such a hurry to get the next "customer" through the door, and so better positioned to diagnose conditions properly.
..... Ah, but that's going to involve spending money, though, isn't it?
I am not "middle class" but have made numerous appointments about such things. I got prescribed Gaviscon eventually. It makes marginal difference at best and I still have my concerns so continue to make appointment and continue to be fobbed off. I was told I was making it up and refused a repeat prescription for said Gaviscon on the grounds of "drug seeking".
I have no doubt that some patients are a frustrating nightmare but that doesn't for one moment make it okay to be a pisspoor GP numbed to it all. If that is the case they should either take a long sabbatical and get a fuklkin grip or find another career cos this really is life and death stuff.
The terrible truth is ihat most GPs will never pause long enough to even know if this is true but will assume it was anyway. I'd add "and hope for the best" but as the worst that ever happens in the vast majority of cases is to be asked to move to another practice that's hardly the case.
BigG
Ex-Bluelighter
Sometimes people call ambulances for what appear to be stupid reasons but occasionally these stupid reasons end up having more serious consequences when we get there...
For example last Friday we got a Red.1 call to a "catastrophic haemorrhage " which turned out to be a bloke with a nose bleed (not even a bad one). Anyway after going through the motions and doing some baseline obs we noticed he was pale and clammy with sats of 82 a BP that was all over the place and a 12 lead that showed massive ST elevation... After realising the obvious and debating tye best way to get the bloke out of his tiny flat and down the stairs (he was massive) he stopped breathing and went into cardiac arrest. Things just went down hill from there really but very long story short he had a shockable rhythm still and came back but the moral of the story being that had we just fucked him off as a time waster hed be dead now
Everyone has the right to free healthcare at the point of contact in this country and the answer to the increasing pressures on the NHS is a tough one and is frankly beyond me.
111 was meant to have helped as we're things like pharmacy first but truthfully they haven't and in the case of 111 that has only made things worse.
For example last Friday we got a Red.1 call to a "catastrophic haemorrhage " which turned out to be a bloke with a nose bleed (not even a bad one). Anyway after going through the motions and doing some baseline obs we noticed he was pale and clammy with sats of 82 a BP that was all over the place and a 12 lead that showed massive ST elevation... After realising the obvious and debating tye best way to get the bloke out of his tiny flat and down the stairs (he was massive) he stopped breathing and went into cardiac arrest. Things just went down hill from there really but very long story short he had a shockable rhythm still and came back but the moral of the story being that had we just fucked him off as a time waster hed be dead now
Everyone has the right to free healthcare at the point of contact in this country and the answer to the increasing pressures on the NHS is a tough one and is frankly beyond me.
111 was meant to have helped as we're things like pharmacy first but truthfully they haven't and in the case of 111 that has only made things worse.
BecomingJulie
Bluelight Crew
Well, the 111 system was doomed from the get-go. Non-medically-trained staff working from a flowchart with lots of endpoints saying Speak to someone who understands this is the sort of thing that appeals to the sort of manager who doesn't understand the first thing about the job. Real life is way more complicated than that, unfortunately.
BigG
Ex-Bluelighter
Basically what happens Julie is that they're call centre staff with no medical training whatsoever who just read something called "treatment pathways" from a screen and as you say it directs then via a kind of flowchart to ask different questions (this leads to them inevitably asking the caller questions such as "are you currently conscious " or other stupid things).
There is usually one paramedic or nurse in the room to give further advice but basically if the questions lead then to a dead end.. Which they invariably do then the call handler simply says either call an ambulance or go to A&E which was exactly what the service was designed to prevent.
Plus now some callers know which answers to give to certain questions that will inevitably lead to the operator recommending dialing 999 for an emergency paramedic crewed ambulance. When we get there the situation is often far from an emergency and a massive waste of what are very limited resources.
Care at the chemist (or pharmacy first depending where you live) was a slightly better thought out and successful scheme in that people with minor ailments can get certain drugs prescribed to them by a pharmacist. Pharmacists are very knowledgeable people. Maybe not at medical intervention and stuff but in terms of medicine knowledge they're more clued up than the majority of doctors actually.
The last time i called for an abulance was yonks ago and was because a mate 'Blue Jim' (cos he was always od'ing)had done it again but by time it arrived - within 5-10 minutes he was ok but the para said they would much rather we called 999 even if we were unsure of the situation as the line between life and death is very slim.
keeping
Bluelight Crew
Slim Jim
One Thousand Words
Bluelighter
Fat junkies have cleverer nicknames
BigG
Ex-Bluelighter
That's right blondim mate...we'd far rather be called to a false alarm than someone not call one and die.
You did the right thing mate and should be proud of your actions.....I'm proud of you for doing that too...you probably saved your mates life...very well done bro
Eveleivibe
Ex-Bluelighter
Where I am, the emergency services n AnE is stretched n they're urging people to consoder before contacting an ambulance. Apparently people are ringing ambulances over studded toe, flu n silly things that they could see their GP over. Its extremely busy.....
Evey
Evey
BecomingJulie
Bluelight Crew
I know. I even get the thinking behind it.
Call centres staffed by phone drones with little training beyond "discover which expert to ask and direct the person there" are fine when people are enquiring about non-life-threatening matters. But a person with experience in a field learns to read situations and pick up on clues.
Twice this week I have managed to correctly find other people's programming errors without proper diagnostics. Firstly a PHP script with a version mismatch (it relied on a feature which turned out to have been insecure and whose behaviour has changed in modern versions). And secondly, a CGI script in I don't know what language because I never even saw the code, with a misspelled variable name -- meaning it was trying to store something one place in memory and then retrieve it from somewhere else.
Both mistakes I have made enough times myself, so I know full well what sort of symptoms they were likely to cause (crashes at the same stage each time, and fails to pass on the contents of a text entry box, respectively).
What went wrong with the 111 system is that the patients learned to game the system, by giving carefully-crafted answers to the set questions so as to reach a desirable finalisation. Whoever dreamed it up made the fatal mistake of not asking themselves, What if the person on the other end of this thing is smarter than me?
It was never, ever going to be a decent substitute for a network of medical centres staffed by at least a triage nurse 24 hours a day, 7 days a week, 52 weeks a year. An experienced nurse might well get an idea what might be wrong with the patient just from watching them enter the building.
Call centres staffed by phone drones with little training beyond "discover which expert to ask and direct the person there" are fine when people are enquiring about non-life-threatening matters. But a person with experience in a field learns to read situations and pick up on clues.
Twice this week I have managed to correctly find other people's programming errors without proper diagnostics. Firstly a PHP script with a version mismatch (it relied on a feature which turned out to have been insecure and whose behaviour has changed in modern versions). And secondly, a CGI script in I don't know what language because I never even saw the code, with a misspelled variable name -- meaning it was trying to store something one place in memory and then retrieve it from somewhere else.
Both mistakes I have made enough times myself, so I know full well what sort of symptoms they were likely to cause (crashes at the same stage each time, and fails to pass on the contents of a text entry box, respectively).
What went wrong with the 111 system is that the patients learned to game the system, by giving carefully-crafted answers to the set questions so as to reach a desirable finalisation. Whoever dreamed it up made the fatal mistake of not asking themselves, What if the person on the other end of this thing is smarter than me?
It was never, ever going to be a decent substitute for a network of medical centres staffed by at least a triage nurse 24 hours a day, 7 days a week, 52 weeks a year. An experienced nurse might well get an idea what might be wrong with the patient just from watching them enter the building.
curious_24
Bluelighter
But what would actually be gained by "gaming the system"? If the caller was dead-set on an ambulance or a visit to A&E, surely they'd just go ahead and skip 111 altogether?
BecomingJulie
Bluelight Crew
A false sense of legitimacy.
F.U.B.A.R.
Bluelight Crew
Yes most people with a headache just have a headache, but my bro in law was repeatedly going to his GP with excruciating headaches, double vision and loss of balance. It wasn't until he'd collapsed at work that the doc conceded that there might be something seriously wrong. An extreme case I know, but I think GPs should be more willing to admit that they can't possibly know everything and in those cases refer the patient to a specialist.
Eveleivibe
Ex-Bluelighter
My work pays for people to do basic life saving skills. CPR, heinlich(sp) blood loss etc - I have done it for the last 10 years or so and it has definitly saved one person (C.A) and a coulple of od's. If you can get on a course you should, it gives you confidence if someone drops from an epiletic fit or any of the above.
23-02-2011 22:20
Dr clive froggat, but, he seems to be on the these are poor addict angle, watched his stuff today, so many "functioning addicts" who are now not functioning, and more screwed up because of this erratic supply, and eratic behaviour caused by the lack of smack
^^^^ his ws the bloke at the meeting who's DOC ws omnopom
Dr clive froggat, but, he seems to be on the these are poor addict angle, watched his stuff today, so many "functioning addicts" who are now not functioning, and more screwed up because of this erratic supply, and eratic behaviour caused by the lack of smack
^^^^ his ws the bloke at the meeting who's DOC ws omnopom
keeping
Bluelight Crew
i recall once - after my first etizolam w.d seizure - in ER with my girlfriend explaining to the attending doctor how just how deep in the hole i was, vis a vis 30mgs etiz a day.
he just sort of sauntered over to me, took out an ampoule of what i think was midazolam, and said 'you've tried the rest, now try the best!'
best sleep ever. he even came to see me the next morning and chatted to me about tattoos and obviously the dangers of benzodiazepines.
he just sort of sauntered over to me, took out an ampoule of what i think was midazolam, and said 'you've tried the rest, now try the best!'
best sleep ever. he even came to see me the next morning and chatted to me about tattoos and obviously the dangers of benzodiazepines.
THECATINTHEHAT
Bluelighter
- Joined
- Oct 17, 2005
- Messages
- 8,186
nice!!!