Pulse May 2019 issue - Page 54

54 Copperfield I take exception to pointless chronic disease checks W hile the new contract has made me physically sick, and while the meetings it has engendered have left me psychotically homicidal, and while this ‘GP-led opportunity’ (not my words) has led me to think this might be an opportunity to retire, there is one positive. You’d need an electron microscope to see it, though. It’s the reduction in the number of recalls we’re expected to send out before we can exception-report patients from the QOF. Just to explain, we now only have to send review refuseniks two, rather than three, QOF begging letters. You may have missed this, probably because you were wading through the 20-plus pages of QOF-update notes. Big deal, right? Well no, obviously not. But also, yes, a bit. Because it’s the teensiest positive step towards addressing a significant problem, even if it doesn’t make it clear what that problem is. So I will. Here goes: it’s the fact that we doctors overvalue medicine. We spend all our lives immersed in it. We live, breathe, eat, sleep and (if we ever get a toilet break) defaecate medicine. It is our very being. As GPs, seeing patients on a relentless treadmill of 10-minute appointments through endless days, we assume there is no other life and nothing else matters. Yet to the patient, that 10-minute appointment barely registers. Pulse May 2019 It’s just a tiny blip in their everyday existence, with whatever we advise or prescribe soon forgotten as real life crowds back in. This difference in perspective – between the GP’s raison d’être and the patient’s couldn’t- give-a-toss – is most noticeable in chronic disease management. We set up expensive, complex and time-consuming call, recall and re-recall systems to ensure all our diabetics, hypertensives, asthmatics, chronnie bronnies et al are invited, chased, harried and processed. After all, judging by the DNA and compliance rates, patients don’t seem to realise, do they, that we’ve got tests to do, drugs to prescribe, lives to save and QOF boxes to tick? It’s almost as if they’ve got better things to do than allow their lives to be defined or dominated by their ‘illness’. So perhaps we GPs should start to get real by recalibrating our view of the actual or perceived value of chronic disease management. Maybe we should acknowledge that this constant inviting, badgering, prescribing and guilting is fulfilling our needs more than the patient’s. Perhaps we think we’re being professional. Or medicolegally sound. Or vocationally driven. Or maybe we’re tick-box obsessed. Or blinded, by overwork, It’s as if they have better things to do than to the fact that all this proactive care probably allow their lives to be achieves far less for defined by their illness each individual than we allow ourselves to think, if we ever have time to think. Or maybe we’re simply justifying our own existence. Then we wonder why we’re so busy. So for all sorts of reasons, and not least for the patients, let’s ease up on the proactive care. That reduction to two invites is a start, but is nowhere near enough. In my world, we wouldn’t be writing to patients pressurising them into chronic disease checks. Those who want them would be writing to us. Dr Tony Copperfield is a GP in Essex Read more Copperfields’s blogs online at pulsetoday.co.uk/copperfield or follow him on Twitter @DocCopperfield