Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
Advertisement
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
Advertisement
British Journal of General Practice

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
The Back Pages

Choice remarks

James Willis
British Journal of General Practice 2008; 58 (553): 592. DOI: https://doi.org/10.3399/bjgp08X319891
James Willis
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info
  • eLetters
  • PDF
Loading

‘I've been a bit rough,’ said my brave friend when I arrived. I suppose I should call her an elderly friend, at 85, but actually she isn't elderly at all. ‘I had to call the ambulance on Friday.’

The ambulance?'

‘Well, my catheter blocked again so I rang the ‘Twilight Nurse’ and, can you believe, she was in (she named a town)! So, if I was in pain, which of course I was, she said I'd have to ring the ambulance.’

I had only a vague idea where the town she mentioned was but she said she sometimes drove there and it took her 45 minutes. (I have checked this now with Google Maps — ‘18.6 miles — about 41 minutes’)

Anyway, as luck would have it the block had begun to clear just as the ambulance arrived. She apologised to the crewman and he was extremely nice as he came in to complete his forms. He was used to it, he said, they got a dozen calls for blocked catheters every day. Not that it would have been ‘in his remit’ to do anything other than take her to casualty.

‘Not in his REMIT!’ my friend spat out in disgust, ‘even though I've got all the equipment, and the instructions! I could have done it MYSELF, if I could see what I was doing!’

‘So,’ she continued, ‘that would have been another hour,’ (it has been a long, long saga and she knows about this better than anyone), ‘and then the nurses in casualty wouldn't have been allowed to do anything either, and they would have had to wait, with me in agony, until the urological nurse came on at 9 O'clock.’

Which story reminded me of another: I had been on duty for the Saturday and Sunday of a bank holiday weekend when I got a call at that dreaded hour just before hand-over on the Monday morning. My family were all ready for our eagerly-awaited day-out, not quite at the stage of tapping their feet at the door.

The call was to a village about 4 miles away and although it sounded like a catheter on the phone I took a silly chance and went straight there without calling at the health centre for a catheter pack first. And of course I got it wrong and had to go back for the pack and then go all the way back out again to do it.

The actual deed, it has to be said, was accomplished in far less time than it took the aforementioned amiable but impotent ambulance man to complete his paperwork, although it has remained, until now, essentially unrecorded.

These two stories are separated by not much more than a decade but they exemplify a fundamental change, which I believe is all to do with Responsibility.

Before the political/managerial takeover of clinical responsibility which began on 1 April 1990, all aspects of the medical care of our patients were our legitimate concern. We would not have tolerated a travesty in which huge areas of the country were madly crisscrossed by solitary frontline workers, whose non-clinical seniors worked office hours and progressively hemmed in their modus operandi with ever-more-restrictive ‘remits’. We would have seen the manifest instability of the current situation, with its prospect of ambulance and casualty services inevitably putting up barriers like everyone else, as a problem we had to address. It was that overriding responsibility to our patients, that ultimate independence from officialdom, that immunity from absurdly irrelevant political slogans such as the current preoccupation with ‘choice’, which defined our role as doctors.

Sitting here, writing in amazing comfort 3 days after a laparoscopic herniorrhaphy, I am highly conscious of the technical excellence of the modern NHS; the treatment I have had could scarcely have been bettered anywhere in the world. And the friend I mentioned earlier has, I happen to know, a particularly excellent and personally-engaged GP. But there remain issues in the NHS which are profoundly worrying, and if we should ever choose to see them as not part of our professional responsibility, it may be that we should also choose a name for ourselves which is not doctor.

  • © British Journal of General Practice, 2008.
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 58 (553)
British Journal of General Practice
Vol. 58, Issue 553
August 2008
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Choice remarks
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Choice remarks
James Willis
British Journal of General Practice 2008; 58 (553): 592. DOI: 10.3399/bjgp08X319891

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Choice remarks
James Willis
British Journal of General Practice 2008; 58 (553): 592. DOI: 10.3399/bjgp08X319891
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
  • Info
  • eLetters
  • PDF

More in this TOC Section

  • Who Is My Patient?
  • Working with vulnerable families in deprived areas
  • What is the collective noun for a group of patients?
Show more The Back Pages

Related Articles

Cited By...

Advertisement

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers
  • RCGP e-Portfolio

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7679
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2021 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242