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>> As a general practitioner, I have often wondered why some patients immediately attempt to consult their GP about minor ailments of short duration. Typical d

>> As a general practitioner, I have often wondered why some patients immediately attempt to consult their GP about minor ailments of short duration. Typical dismissive attitude of most GPs in the UK to make you feel guilty for consulting them. Having sick children can be worrying and minor ailments can actually be more serious in a child, so it's hard to know when to ride it out and when to seek a second opinion.

jackvalentine 9y ago
The same doctors then fight extremely hard against the expansion of the roles of registered nurses to tend to these minor ailments that they’re too good to treat.
- J-dawg 9y ago
  I haven't heard of this before, can you expand on this?
  - jackvalentine 9y ago
    It's kinda late, but to bring it back in a bit my experience is with AU - the government in my state wants to use nurses to do low-level healthcare stuff and General Practitioners (doctors who do family medicine, not a specialization) are pushing back because they say the funding doesn't stack up, and people need to be driven in to GP offices to ensure lifecycle heathcare. Some people think they're rentseeking, some people think they have a point. I obviously have my opinion but I won't push it on you.
- kalleboo 9y ago
  That sounds like a US thing, does that happen in the UK as well?
  - jackvalentine 9y ago
    My experience is in AU. Every state is a bit different though.
- MistahKoala 9y ago
  Amusingly, in the UK it's nurses who have been resisting the professionalisation and expansion of ancillary roles. Despite broadening their scope of specialism and responsibility over the past couple of decades, a specialist nurse friend tells me that they're quite stubborn as a profession, with other roles (e.g. technicians and assistant practitioners) overtaking parts of the job that nurses could have taken.
  - jackvalentine 9y ago
    > Amusingly, in the UK it's nurses who have been resisting the professionalisation and expansion of ancillary roles. What's the reason behind this - government wants them to do more work without more pay? An innate sense that they're doing exactly the right job and why change it?
    - MistahKoala 9y ago
      Oops, missed your question until just now. The impression I got from my friend/colleague is that nursing in the NHS is an innately conservative and rigid culture (as it is in other areas of healthcare), which goes to the heart of nursing's governing body in setting policy. Whilst nursing has expanded the scope of roles available in recent years (taking on prescribing responsibilities and increased specialisation), it perhaps might not have been at quite the pace or breadth as circumstances require. Consequently, some of the supporting roles that are more flexible, like technicians and healthcare assistants, have started to take on more routine tasks like simple obs and assessment; this makes sense because in most cases, taking blood, measuring lung function and hearing etc. are easy to do - the actual assessment and signing off of work is still done by a (more expensive and better utilised elsewhere) clinician.
Blazespinnaker 9y ago
Our gp encourages children visits. When you look at return on healthcare investment for children in terms of years of life left, it makes sense. Plus kids don’t self report very well, you need a doctor to diagnose.
J-dawg 9y ago
I've noticed this dismissive attitude as well, and I'm a generally healthy adult who goes to the GP very rarely. People go to the doctor because they don't know what's going on with their body and they are worried. They don't know that it's a minor ailment until an expert tells them. I hate this trend for shaming people just for being worried (which of course can be a sign of a mental health condition in itself). I think the difficulty here is that doctors do have to deal with hugely ignorant people on a daily basis. The fact that many people apparently haven't grasped that antibiotics don't do anything for viral infections is testament to this. (Seriously - there was recently a national NHS ad campaign about this).
psergeant 9y ago
> make you feel guilty for consulting them While they shouldn’t be making you feel guilty per-se, they’re gatekeepers for the public, finite resource of NHS care, and help stop healthcare spending spiralling out of control.
- switch007 9y ago
  How much is too much to spend on healthcare?
- J-dawg 9y ago
  This to me seems like one of the fundamental problems with the NHS. (Compulsory caveat: we're very lucky to have it and it's way better than the American system, etc etc) But the primary care side of things basically has to be a bit shit for the whole thing to work. Because demand for healthcare is so elastic. Almost every single one of us has those little niggles, aches and pains and things that we ought to get checked out. If we could get a GP appointment at 24 hours notice, and be guaranteed an un-rushed meeting with a sympathetic and friendly doctor, demand would skyrocket. The system has to limit demand by never getting too good. There isn't really a private alternative because, in the UK, NHS GPs are the gatekeepers of everything. You need a referral letter from an NHS GP to see a specialist on your own private medical insurance. There are some companies with private GPs but they're extremely expensive, presumably because there isn't much competitive pressure. So the system finds an equilibrium, where it's frustrating but tolerable. Not quite good enough, but not quite bad enough that it's worth paying for a private GP.
  - jon-wood 9y ago
    > There isn't really a private alternative because, in the UK, NHS GPs are the gatekeepers of everything. I think this is slowly shifting. I have private medical cover via my employer and one of the things included in that is access to video chats with GPs via a mobile app - obviously they can't diagnose everything without being physically present, but they can do referrals for things where its obviously needed. There are a few services popping which offer this sort of thing for a one off fee for each appointment as well.
Doctor_Fegg 9y ago
Not at all my experience: both my GP and our kid's GP (the infant specialist) are welcoming, and the medical centre staff are pretty efficient at triaging patients so those that clearly don't need to be seen by a GP can be helped by a nurse or redirected to the pharmacy.
SilkRoadie 9y ago
I experience the same thing in the UK. I rarely go to the doctor. Perhaps once a year if that. If I go it is because something hasn't gotten better after a number of weeks, I am unsure about something or genuinely uncomfortable. The doctor is usually dismissive unless something is hanging off. My partner was hospitalized for pneumonia. That was despite seeing a doctor 4 times. Each time the doctor was dismissive about the problems she was having. It was only when she struggled to get out of bed that a doctor said it was time to go to hospital. This has happened for similar issues attending different doctors for issues such as fatigue (turned out to be low iron levels after an operation) and wrist pain (turned out to be RSI which required multiple cortisone injections and prolonged time off work.) This attitude makes you not want to attend the doctor unless you become critically ill.
gutnor 9y ago
The GP in the UK thinks that having weeks of waiting period for a GP appointment is normal. So, of course, they triage and prioritise and Peppa Pig level of care is seen as terrible use of constrained resources. On another forum, I got a UK GP upset that my country suggest people over 40 to see a GP once a year for a checkup. What a waste of resource it seemed to him, he could not believe it. Well the truth is that in most of the European countries, seeing a GP is simply a non-issue. Even in my in law family village, 70 km away from the nearest city, population reaching 100 inhabitant there is a GP 3 full days a week, free. 8 km from there, there is a 24/7 walk-in centre. I never experienced "you have to wait for weeks to get an appointment" or the "go through the list of common ailment and their cure for 2 weeks before requesting a GP appointment". You are sick, you go to the GP open consultation, he will see you within the hour. Or you call and he will come in the afternoon. That's what GP visit mean in other EU countries. Before coming to the UK I never had to go to the A&E. Now, I'm really sad to say because it is a terrible waste, but that's my primary care centre (after self medication). My GP has a month waiting list, 2+ weeks if I'm happy to go to a GP that has never heard of me. I don't think the NHS realise just how far they have been bled out over the years. They rely on statistic and forgot anything about the side concern. Sure maybe seeing a GP once a year when you are asymptomatic 40 year old does not have an immediate ROI. What they lost sight of is the indirect ROI, like GP knowing his patient ? Or even patient knowing his GP ? That has been proven recently that simply trusting your GP increase the efficiency of medication. Note that A&E has been tremendous. They really helped us understand what to be worried about with small babies and children. But there is nothing (thankfully) they did that a GP in my home country would not have done.
DanBC 9y ago
> so it's hard to know when to ride it out and when to seek a second opinion. Your GP isn't the first port of call though. People can ask a pharmacist, speak to NHS 111 or read NHS Choices.
- jon-wood 9y ago
  Pharmacists can be great, but my experience of NHS 111 has always been awful. Anytime I've spoken to them the script has basically covered checking whether I have Ebola, whether I'm conscious, whether I'm bleeding to death, and then they've told me to go and see a doctor.
MistahKoala 9y ago
In the context of an (albeit semi-satirical) article in a medical journal, it's a legitimate question to ask and not at all 'dismissive'. The economics of a healthcare system requires such things to be asked. From the perspective of a GP, they might find it troubling that, despite continual patient education efforts, patients persist in seeking GP consultations for symptoms of minor ailments rather than opting for a nurse (or even a chemist). Patients can usually be seen by nurses sooner and for longer consultations, with the ability to prescribe and triage for further diagnosis/consultation. My own idea for why this happens (in a UK context, at least) is that nursing's reputation for basic healthcare skills persists amongst the public, as well as a notion that nurses may be acting 'above their station' in diagnosing and treating patients. The popular idea of nursing as providing basic care and observation is something that tends to be done by healthcare assistants these days. The role of specialist nurses - including nurse practitioners - in recent times should allay such legitimate concerns, but it might be the case that they are encumbered with a low-visibility public presence or status. Another idea that occurs is that it seems to have been part of patient culture for patients to arrange appointments with a family GP when seeking assessment and treatment - a norm passed down through family generations? Changing it or introducing new norms within families' relationships with primary care providers may be a particularly tricky challenge to overcome.

jackvalentine 9y ago

The same doctors then fight extremely hard against the expansion of the roles of registered nurses to tend to these minor ailments that they’re too good to treat.

J-dawg 9y ago
I haven't heard of this before, can you expand on this?
- jackvalentine 9y ago
  It's kinda late, but to bring it back in a bit my experience is with AU - the government in my state wants to use nurses to do low-level healthcare stuff and General Practitioners (doctors who do family medicine, not a specialization) are pushing back because they say the funding doesn't stack up, and people need to be driven in to GP offices to ensure lifecycle heathcare. Some people think they're rentseeking, some people think they have a point. I obviously have my opinion but I won't push it on you.
kalleboo 9y ago
That sounds like a US thing, does that happen in the UK as well?
- jackvalentine 9y ago
  My experience is in AU. Every state is a bit different though.
MistahKoala 9y ago
Amusingly, in the UK it's nurses who have been resisting the professionalisation and expansion of ancillary roles. Despite broadening their scope of specialism and responsibility over the past couple of decades, a specialist nurse friend tells me that they're quite stubborn as a profession, with other roles (e.g. technicians and assistant practitioners) overtaking parts of the job that nurses could have taken.
- jackvalentine 9y ago
  > Amusingly, in the UK it's nurses who have been resisting the professionalisation and expansion of ancillary roles. What's the reason behind this - government wants them to do more work without more pay? An innate sense that they're doing exactly the right job and why change it?
  - MistahKoala 9y ago
    Oops, missed your question until just now. The impression I got from my friend/colleague is that nursing in the NHS is an innately conservative and rigid culture (as it is in other areas of healthcare), which goes to the heart of nursing's governing body in setting policy. Whilst nursing has expanded the scope of roles available in recent years (taking on prescribing responsibilities and increased specialisation), it perhaps might not have been at quite the pace or breadth as circumstances require. Consequently, some of the supporting roles that are more flexible, like technicians and healthcare assistants, have started to take on more routine tasks like simple obs and assessment; this makes sense because in most cases, taking blood, measuring lung function and hearing etc. are easy to do - the actual assessment and signing off of work is still done by a (more expensive and better utilised elsewhere) clinician.

Blazespinnaker 9y ago

Our gp encourages children visits. When you look at return on healthcare investment for children in terms of years of life left, it makes sense. Plus kids don’t self report very well, you need a doctor to diagnose.

J-dawg 9y ago

I've noticed this dismissive attitude as well, and I'm a generally healthy adult who goes to the GP very rarely. People go to the doctor because they don't know what's going on with their body and they are worried. They don't know that it's a minor ailment until an expert tells them. I hate this trend for shaming people just for being worried (which of course can be a sign of a mental health condition in itself). I think the difficulty here is that doctors do have to deal with hugely ignorant people on a daily basis. The fact that many people apparently haven't grasped that antibiotics don't do anything for viral infections is testament to this. (Seriously - there was recently a national NHS ad campaign about this).

psergeant 9y ago

> make you feel guilty for consulting them While they shouldn’t be making you feel guilty per-se, they’re gatekeepers for the public, finite resource of NHS care, and help stop healthcare spending spiralling out of control.

switch007 9y ago
How much is too much to spend on healthcare?
J-dawg 9y ago
This to me seems like one of the fundamental problems with the NHS. (Compulsory caveat: we're very lucky to have it and it's way better than the American system, etc etc) But the primary care side of things basically has to be a bit shit for the whole thing to work. Because demand for healthcare is so elastic. Almost every single one of us has those little niggles, aches and pains and things that we ought to get checked out. If we could get a GP appointment at 24 hours notice, and be guaranteed an un-rushed meeting with a sympathetic and friendly doctor, demand would skyrocket. The system has to limit demand by never getting too good. There isn't really a private alternative because, in the UK, NHS GPs are the gatekeepers of everything. You need a referral letter from an NHS GP to see a specialist on your own private medical insurance. There are some companies with private GPs but they're extremely expensive, presumably because there isn't much competitive pressure. So the system finds an equilibrium, where it's frustrating but tolerable. Not quite good enough, but not quite bad enough that it's worth paying for a private GP.
- jon-wood 9y ago
  > There isn't really a private alternative because, in the UK, NHS GPs are the gatekeepers of everything. I think this is slowly shifting. I have private medical cover via my employer and one of the things included in that is access to video chats with GPs via a mobile app - obviously they can't diagnose everything without being physically present, but they can do referrals for things where its obviously needed. There are a few services popping which offer this sort of thing for a one off fee for each appointment as well.

Doctor_Fegg 9y ago

Not at all my experience: both my GP and our kid's GP (the infant specialist) are welcoming, and the medical centre staff are pretty efficient at triaging patients so those that clearly don't need to be seen by a GP can be helped by a nurse or redirected to the pharmacy.

SilkRoadie 9y ago

I experience the same thing in the UK. I rarely go to the doctor. Perhaps once a year if that. If I go it is because something hasn't gotten better after a number of weeks, I am unsure about something or genuinely uncomfortable. The doctor is usually dismissive unless something is hanging off. My partner was hospitalized for pneumonia. That was despite seeing a doctor 4 times. Each time the doctor was dismissive about the problems she was having. It was only when she struggled to get out of bed that a doctor said it was time to go to hospital. This has happened for similar issues attending different doctors for issues such as fatigue (turned out to be low iron levels after an operation) and wrist pain (turned out to be RSI which required multiple cortisone injections and prolonged time off work.) This attitude makes you not want to attend the doctor unless you become critically ill.

gutnor 9y ago

The GP in the UK thinks that having weeks of waiting period for a GP appointment is normal. So, of course, they triage and prioritise and Peppa Pig level of care is seen as terrible use of constrained resources. On another forum, I got a UK GP upset that my country suggest people over 40 to see a GP once a year for a checkup. What a waste of resource it seemed to him, he could not believe it. Well the truth is that in most of the European countries, seeing a GP is simply a non-issue. Even in my in law family village, 70 km away from the nearest city, population reaching 100 inhabitant there is a GP 3 full days a week, free. 8 km from there, there is a 24/7 walk-in centre. I never experienced "you have to wait for weeks to get an appointment" or the "go through the list of common ailment and their cure for 2 weeks before requesting a GP appointment". You are sick, you go to the GP open consultation, he will see you within the hour. Or you call and he will come in the afternoon. That's what GP visit mean in other EU countries. Before coming to the UK I never had to go to the A&E. Now, I'm really sad to say because it is a terrible waste, but that's my primary care centre (after self medication). My GP has a month waiting list, 2+ weeks if I'm happy to go to a GP that has never heard of me. I don't think the NHS realise just how far they have been bled out over the years. They rely on statistic and forgot anything about the side concern. Sure maybe seeing a GP once a year when you are asymptomatic 40 year old does not have an immediate ROI. What they lost sight of is the indirect ROI, like GP knowing his patient ? Or even patient knowing his GP ? That has been proven recently that simply trusting your GP increase the efficiency of medication. Note that A&E has been tremendous. They really helped us understand what to be worried about with small babies and children. But there is nothing (thankfully) they did that a GP in my home country would not have done.

DanBC 9y ago

> so it's hard to know when to ride it out and when to seek a second opinion. Your GP isn't the first port of call though. People can ask a pharmacist, speak to NHS 111 or read NHS Choices.

jon-wood 9y ago
Pharmacists can be great, but my experience of NHS 111 has always been awful. Anytime I've spoken to them the script has basically covered checking whether I have Ebola, whether I'm conscious, whether I'm bleeding to death, and then they've told me to go and see a doctor.

MistahKoala 9y ago

In the context of an (albeit semi-satirical) article in a medical journal, it's a legitimate question to ask and not at all 'dismissive'. The economics of a healthcare system requires such things to be asked. From the perspective of a GP, they might find it troubling that, despite continual patient education efforts, patients persist in seeking GP consultations for symptoms of minor ailments rather than opting for a nurse (or even a chemist). Patients can usually be seen by nurses sooner and for longer consultations, with the ability to prescribe and triage for further diagnosis/consultation. My own idea for why this happens (in a UK context, at least) is that nursing's reputation for basic healthcare skills persists amongst the public, as well as a notion that nurses may be acting 'above their station' in diagnosing and treating patients. The popular idea of nursing as providing basic care and observation is something that tends to be done by healthcare assistants these days. The role of specialist nurses - including nurse practitioners - in recent times should allay such legitimate concerns, but it might be the case that they are encumbered with a low-visibility public presence or status. Another idea that occurs is that it seems to have been part of patient culture for patients to arrange appointments with a family GP when seeking assessment and treatment - a norm passed down through family generations? Changing it or introducing new norms within families' relationships with primary care providers may be a particularly tricky challenge to overcome.