Sunday, 25 April 2010


I have realised that we don’t have a National Health Service. We have a regional one. Its only since I’ve been a locum and worked in 3 different counties that I’ve realised this. What do I mean? Well let’s take admitting a patient into hospital for a start. Each hospital has its own rules for admitting a patient. Some have a GP hotline, some have a switchboard may or may not answer and when they do they can’t find the doctor you are looking for, and some have their own team who negotiate on your behalf with the admitting doctor. I don’t get it. How hard can it be to have a common admission pathway to hospital? Very hard it seems. In the end you get fed up trying to work out what’s going on and the patient gets bounced to A+E with a letter.
What about paperwork? Each hospital has its own paperwork to be filled in, different colour schemes and boxes to be ticked. Is it too much to ask to have one set of universal notes? They would look the same for every hospital and could be easily read through, filled in and relevant section found? Far too sensible. Each hospital has to have its own identity so someone somewhere in an office can justify their salary. Universal notes would save on stationary costs, improve patient care (as everyone knows where everything is) and you could even audit things easier if you were so inclined. Hell, if every hospital stuck to this you could even begin to attempt to computerise it. There could even be a standardised admission letter that GPs could use so the admitting doctor could read our ineligible scrawls.
Mind you I can’t be too critical of different hospital records seeing as I have had to train in 5 different electronic record systems to be a GP locum. Some of the systems I’ve used a truly rubbish, God only knows why the GPs use them.
I could rant about postcode lotteries for health care but everyone knows about those. I’m talking about what goes on behind the scenes. Nurses needing to retrain when they move hospitals because one hospitals certificate aren’t valid in another hospital. New doctors not having the faintest idea how to fill in requests for tests as every hospital does it differently. TTO forms that vary from place to place with varying information filled in. Getting everyone to agree on all this would be a nightmare. But then that’s where politicians come in, so we can blame them if it all goes wrong.
I read that it’s the ambition of Labour and Conservative that every hospital becomes a Foundation trust (worked well for Mid Staffordshire?). With this of course it would mean a rebranding of each hospital. New signs, new letterheads, new everything. That will not be cheap, and surely some of that money could be better spent ensuring the smooth running of the hospitals and the staff that work there. You might even improve patient care, but that’s not my main concern, I just want an easy life.

Shit Life Syndrome

I think I have discovered a new syndrome, well I say new but really its been around for as long as politicians have lied. I had a patient see me the other day who was feeling down in the dumps. Being a kind & caring GP I patiently sat and listened to her tell me her life story of how she has no money, no job, an abusive boyfriend, a young baby to feed and how its all making her feel a bit, well, shit. Believe it or not but I don’t have a magic pill that can fix this, I asked her why she came to the GPs but she wasn’t sure, she didn’t know what else to do. She has a syndrome that I am seeing more and more nowadays. It consists of low mood caused by adverse life circumstances. Otherwise known as “Shit-life Syndrome”.
Depending on where you work you’ll probably see a few of these cases. They are easy to recognise. About 5minutes into their history you mind will start to wander, perhaps thinking about what you are going to have for lunch or how that bid for an ivory back scratcher is going on ebay. Several minutes later your mind will wander back the patient who will still be telling you about all the terrible things that are going on in their life. There isn’t really much you can do, you ponder that if your life was going as shit as theirs you’d feel pretty depressed too. What about counselling? “Nah, tried that before doc and it was rubbish” (Waiting list is vast anyway). Ok then, what about antidepressants? Won’t change a thing but will make the drug companies happy.
I know! Exercise, going for nice walks, going out with your friends? Gyms too expensive, have you seen where I live doctor, and I’ve not got money to go out are the 3 rapid replies. This patient has “shit life syndrome”, nothing you can do for them other than listen. Maybe sign the odd ‘fit-note’ so they can get a bit of extra cash to help pay for the 50 inch flat screen telly every feels they have to own.

What’s the solution? Perhaps society needs to concentrate less on accumulating wealth and more on accumulating happiness? But we live in a consumer-drive society with an economy in nosedive so this isn’t going to happen anytime soon. Oh well, lets just cut benefits, raise taxes and penalise anyone else who happens to have shit-life syndrome (aka the Daily Mail solution)