Roger Tisi1 rightly draws attention to the unnecessary work that GPs have to do with little evidence for benefit. Peter Perkins2 letter on dyspepsia is interesting only because it makes sustainability even more remote. While Ca125 has a place in investigation, it is of such low sensitivity and specificity3 that it cannot be routinely used in dyspepsia. When the NICE guidelines on heavy menstrual bleeding were first adopted, one PCT noted that it was spending in excess of £20K on unnecessary TSH tests!
Michael Balint4 may have had sustainability in mind when he wrote his book, The Doctor, His Patient and the Illness. How many GPs still collude anonymously with their patients and colleagues? It is so easily done and often, mistakenly, saves the consultation or helps terminate it!. But ‘collusion of anonymity’ is wasteful of resources and inimical to sustainability. Above all else it is an illusion of good medicine and perpetuates the myth of the ‘nice’ doctor.
One is also persuaded by the power of the doctor as the most potent therapeutic intervention in the consultation. GPs no longer seem to have the time to discuss risks/benefits with patients, but now need to be willing and able to reclaim their professionalism and engage more with patients. Therein lies the key to good medical practice and sustainability.
- © British Journal of General Practice 2013