Saturday, 23 June 2007
Be sure before you drop your pants
This description of a GP's consultation with a patient is reproduced below, many thanks to the original author for his permission:
"Had an interesting consultation this morning. Paraphrased version:
"Hi, Doc. You got the fax from Urology? Can I ask who signed it?"
"Errrr... Mr Illegible Scrawl. Why?"
"When you referred me urgently to Urology, did you think I'd be seen by a Consultant? I thought I would be - especially as you thought I'd got prostate cancer."
"I got a bit suspicious about the doctor in clinic. He introduced himself as 'Fred', knew something about my cancer but really didn't seem to know anything when I mentioned being treated for mt blood dyscrasia and wasn't remotely interested in that. And he did what you did in the way of examining my prostate, looked at a blood test, then said he'd send you a fax and I should see you tomorrow for treatment"
"When I pressed him a bit and asked whether I should call him 'Doctor' or 'Mister', he replied I should just call him 'Fred'. Then he said he couldn't prescribe any treatment for me, I'd have to see my GP for that."
"When he eventually dismissed me, I made some enquiries from the clinic staff and found out he's something called a nurse specialist. So I've not even seen a junior urologist, let alone the consultant, and they've told me to come and get some treatment for my cancer from you. It was a bit of a waste of time sending me down there if you can't get a proper specialist opinion anymore. I wonder how many less enquiring patients think they have seen a consultant when they come out of there?"
This is not a rare problem either. Patients are being tricked by non-medically qualified staff who pose as proper doctors, in this case the nurse specialist strangely forgot to mention his actual title and this was certainly misleading the patient. When does 'misleading' result in the patent's consent to be treated becoming null and void? There is also the small issue of these nurse specialists managing patients without discussing cases with the medically trained specialists, resulting in the nurse specialist ordering GPs to start their requested treatment. What happens when this is the wrong treatment, does the GP carry the can as the one who is signing the prescription? A worrying situation to find oneself in really for any doctor. Who is going to carry the can when these nurse 'specialists' mismanage a patient's cancer?
Patients are being conned around the country. There are so many stories of this kind of deception that I cannot repeat them all here; but there are nurse consultants (whatever that's meant to mean) in A/E who call themselves 'consultants' only and there are podiatrists who pose as properly trained surgeons. The Witch doctor has already written expertly on this nonsensical drive to call everyone by a vague meaningless name; is this the government's way of pretending that this shoddy dangerous service is good enough for patients?
There are the protocol adoring outreach nurses who prescribe rapid IV fluids for everyone with low urine output, irrelevant of their rip roaring heart or liver failure. There are the acute pain nurses who perform simple arithmetic to convert one painkiller to another, while anything more complicated than this is left to the Consultant Anaesthetist. There are the A/E ENPs who spend hours seeing uncomplicated patients, while the doctors crack on through the majority of the workload. There are the specialist nurses in Dermatology who take hours to see patients with simple problems, only for the Consultant to come and do the job in two minutes. There are the community matrons who spend most of their time with a select bunch of patients, trying to prevent their hospitalisation; however evidence shows that their patients come into hospital just as often as they used to. There are the psychiatric specialist nurses who spend hours seeing each patient in order to produce their life history typed out on A4; it's just a shame they are seemingly incapable of producing a proper psychiatric history and mental state examination, their scribing often resembles an OK magazine feature and not a trained professionals work. There are more examples of this wasteful empowerment program, but I think I have made the point.
This is not a safe or cost effective way in which to reform the NHS. There is definitely a place for experienced nurses to become specialists in particular areas of their nursing expertise, however empowering inadequately trained nurses so that they can have a crack at being doctors is unfair on patients and a big waste of money. I am sure I will hear all the same old arguments coming out in defence of these quacks, but the tiredness of these defences is becoming more and more obvious.
There are going to be thousands of unemployed highly skilled junior doctors this August, while thousands of inefficient nurse practitioners are swanning around seeing patients at their leisure. Junior doctors have medical degrees and are trained to a much higher level, meaning that they have the potential to become independently practising consultants at the end of their training. Nurse practitioners may become nurse 'consultants' but what does this really mean, is it really safe to assume that the unknowledgeable can be continually promoted to positions of increasing responsibility without any rigorous tests of their knowledge and skills? As a result the sustainable consultant led service is being put in jeopardy and a generation of talent is going to be wasted as medical standards plummet into an abyss of incompetence.
In this New Labour fantasy land, proper examinations and standards are cast aside in favour of a system that allows the untrained to pick and choose what they fancy having a stab at. New Labour's logic allows the individual 'quacktitioner' to be so magically gifted that they can instinctively stay within their 'competence' zone at all times. It's a shame that the ignorami in control don't realise that it takes years of proper training and experience to be able to safely practicise medicine independently, and even then it's a very tricky business indeed.
I am sure there will soon be a day when the advanced nurse practitioner in primary care can refer a patient to their nurse practitioner colleague in the cancer clinic, who can then refer the patient to the surgical nurse practitioner for the operation. The doctor will probably be the one changing the patient's sheets and scrubbing the ward floor by then, the doctor will probably also get struck off when the surgical nurse practitioner stumbles blindly into the patient's aorta with a scalpel, because they never studied anatomy beyond 'Jack and Gill' level. This will be called progress.