Thursday 16 July 2009


I've good GPs in my corner. Sensible folk, with too much to do and not enough time to do it in, genuinely devoting themselves to their patients' care. I know this because not only do I write to them, a lot, and receive letters from them, a lot, but patients talk about them.

When we meet I habitually explain who I am and why we're meeting, which invariably involves a comment that Dr X felt Blah was going on and we could meet up to think that through, is that a fair comment, what's the truth of it, what're your thoughts on what's going on? The patient then can chatter about either the matter they've been referred with, or the GPs framing of it.

Sometimes it's helpful because they can talk through a another person, such as "The GP says I'm losing my memory, but I'm not, I'm fine," which then can lead on to why would the GP/spouse/daughter reckon your memory's not so good, and so on.

The last way I know anything of the GPs is through meeting them. Rarely I meet them formally, in monthly training they do, if I'm doing teaching with them. Sometimes I meet them in their surgery, popping in after I've seen one of their patients, just to talk it through with them. More frequently I see them in practice meetings when a nurse and I'll meet with the GPs, practice manager and their nursing staff to talk through both operational/service stuff as well as clinical stuff (such as updates on management of different conditions, since without that patients were sometimes getting inaccurate and unhelpful details).

The written contact, formal contact, informal popping in, episodic practice visits and patient dialogue means I get a fair feel for different GPs in my corner. Mostly, they're very good indeed. Some are fantastic.

But it gets me thinking. Who are the good doctors? Which GP would I want for my kith and kin?

And that's where I come a little unstuck. I want a good doctor to generate a service that is accessible. To have no waiting list, at all. I want them to see folk where ever they may be, that's appropriate. I want them to have a motivated, passionate team of relevant disciplines working with them, to work with the doctor to orchestrate exceptional care (synergy, not parallel working). I want few prescriptive protocols since I want care for each patient to be person centred, individual, appropriate care. I want the doctor to have capacity in their service, so all health needs they determine can then be met by their service. I want the doctors/their team to be friendly and work helpfully and collaboratively with others in Primary and Secondary Care. I want the doctor to temper policy and guidance with huge doses of common sense.

And at that stage it kind of struck me, what I want in a good doctor is really what I'd be wanting from myself. Burst my bubble there, as it really is an act of supreme narcissism to think like that. Which helpfully has got me looking at colleagues who work differently, or construct a different service, to try and see the positive in what they're doing.

Plenty of ways to skin a cat, eh?


ditzydoctor said...

dear shrink, i was thinking of the same!
looking at my colleagues, i was wondering: just who would i want to look after my mum and dad when they get old?
and it hit me that i couldn't really find one COMPLETE person

i guess i'll have to lower my expectations! :)

Maggie said...

I'd be very happy if you were looking at me (hopefully don't need yet) or my parents (now deceased).

Parental GP refused to discuss anything with me (only child, daughter) or my husband (who they both appointed joint executor to their wills, along with their solicitor) due to "patient confidentiality".

While I do understand patient confidentiality, I think this/these GPs went a bit over the top. I was expected to sort it all out when it came to puting them in so called Nursing Homes, GPs did nothing to help, plus one of them refused to vist in the Nursing Home (too far, but not that much too far given their long association in my view).

I really value your posts, and am really chuffed when I see you've updated on Bloglines. You are an island of sanity in the looniness that is the NHS "care" for the elderly!

Please keep writing!

Best wishes from rather grey and damp Liverpool,