Doctors do like to medicate..
09 November 2012, 07:39 PM
#31
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I can do lots with back pain in 10 minutes (that is why I'm worth my money because non-doctors can't do that), whether a first presentation or follow up,
they will have far more than HPC and PMH taken. They will have a drug history and also their social history including their work and its effect on their back, and the effect of their back on their work, discussion of alternative duties. They will have a history and examination to look for red flags and discussion will be made regarding investigations to differentiate between the diagnoses and guide treatment. They will also have their health beliefs explored since these can be a major issue in back pin and if unaddressed you have a bad prognosis straight away as you haven't got the confidence of your patient. They also need their pain treated and there are only a few situations with back pain where you don't have a decent time to focus on pain control first, and if you jump to inappropriate investigations you can reinforce yellow flag behaviour. If someone can walk in to see me (just) then they may get cocodamol, diclofenac and diazepam on a first visit. Later they may get morphine, amitriptyline, gabepentin, pregabalin, MRI scan, physiotherapy, orthopaedic, neurosurgical or pain clinic referrals. If I have to go and see them and they are literally stuck in position, then they might get morphine and diclofenac injections. They want to be able to get up off the floor, and sometimes are in a position outside where if you don't get them off the floor they will become hypothermic before they can actually move due to their pain.
For those that don't like their depression drugs, they have options to try another, or reconsider whether they want them at all. Why did they go to see a doctor whose job is to diagnose and whose treatment options for depression are advice, prescription and/or referral to someone who will talk to them? When the patient insists something must be done they often don't want to be told that some DIY CBT from a website, helping themselves, better diet and exercise as well as cutting down alcohol and drugs might help and they want something NOW. So sometimes they get antidepressants on the first visit and sometimes these appear to be of benefit. The wait around here for talking therapies is better than most areas, but far too long for a distressed patient.
Depression and back pain are some of the most challenging conditions to treat because of patient behaviour and belief. They often have some fairly fixed ideas which are responsible for a large part of the problem.
they will have far more than HPC and PMH taken. They will have a drug history and also their social history including their work and its effect on their back, and the effect of their back on their work, discussion of alternative duties. They will have a history and examination to look for red flags and discussion will be made regarding investigations to differentiate between the diagnoses and guide treatment. They will also have their health beliefs explored since these can be a major issue in back pin and if unaddressed you have a bad prognosis straight away as you haven't got the confidence of your patient. They also need their pain treated and there are only a few situations with back pain where you don't have a decent time to focus on pain control first, and if you jump to inappropriate investigations you can reinforce yellow flag behaviour. If someone can walk in to see me (just) then they may get cocodamol, diclofenac and diazepam on a first visit. Later they may get morphine, amitriptyline, gabepentin, pregabalin, MRI scan, physiotherapy, orthopaedic, neurosurgical or pain clinic referrals. If I have to go and see them and they are literally stuck in position, then they might get morphine and diclofenac injections. They want to be able to get up off the floor, and sometimes are in a position outside where if you don't get them off the floor they will become hypothermic before they can actually move due to their pain.
For those that don't like their depression drugs, they have options to try another, or reconsider whether they want them at all. Why did they go to see a doctor whose job is to diagnose and whose treatment options for depression are advice, prescription and/or referral to someone who will talk to them? When the patient insists something must be done they often don't want to be told that some DIY CBT from a website, helping themselves, better diet and exercise as well as cutting down alcohol and drugs might help and they want something NOW. So sometimes they get antidepressants on the first visit and sometimes these appear to be of benefit. The wait around here for talking therapies is better than most areas, but far too long for a distressed patient.
Depression and back pain are some of the most challenging conditions to treat because of patient behaviour and belief. They often have some fairly fixed ideas which are responsible for a large part of the problem.
Last edited by john banks; 09 November 2012 at 07:41 PM.
09 November 2012, 07:59 PM
#32
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I can do lots with back pain in 10 minutes (that is why I'm worth my money because non-doctors can't do that), whether a first presentation or follow up,
they will have far more than HPC and PMH taken. They will have a drug history and also their social history including their work and its effect on their back, and the effect of their back on their work, discussion of alternative duties. They will have a history and examination to look for red flags and discussion will be made regarding investigations to differentiate between the diagnoses and guide treatment. They will also have their health beliefs explored since these can be a major issue in back pin and if unaddressed you have a bad prognosis straight away as you haven't got the confidence of your patient. They also need their pain treated and there are only a few situations with back pain where you don't have a decent time to focus on pain control first, and if you jump to inappropriate investigations you can reinforce yellow flag behaviour. If someone can walk in to see me (just) then they may get cocodamol, diclofenac and diazepam on a first visit. Later they may get morphine, amitriptyline, gabepentin, pregabalin, MRI scan, physiotherapy, orthopaedic, neurosurgical or pain clinic referrals. If I have to go and see them and they are literally stuck in position, then they might get morphine and diclofenac injections. They want to be able to get up off the floor, and sometimes are in a position outside where if you don't get them off the floor they will become hypothermic before they can actually move due to their pain.
For those that don't like their depression drugs, they have options to try another, or reconsider whether they want them at all. Why did they go to see a doctor whose job is to diagnose and whose treatment options for depression are advice, prescription and/or referral to someone who will talk to them? When the patient insists something must be done they often don't want to be told that some DIY CBT from a website, helping themselves, better diet and exercise as well as cutting down alcohol and drugs might help and they want something NOW. So sometimes they get antidepressants on the first visit and sometimes these appear to be of benefit. The wait around here for talking therapies is better than most areas, but far too long for a distressed patient.
Depression and back pain are some of the most challenging conditions to treat because of patient behaviour and belief. They often have some fairly fixed ideas which are responsible for a large part of the problem.
they will have far more than HPC and PMH taken. They will have a drug history and also their social history including their work and its effect on their back, and the effect of their back on their work, discussion of alternative duties. They will have a history and examination to look for red flags and discussion will be made regarding investigations to differentiate between the diagnoses and guide treatment. They will also have their health beliefs explored since these can be a major issue in back pin and if unaddressed you have a bad prognosis straight away as you haven't got the confidence of your patient. They also need their pain treated and there are only a few situations with back pain where you don't have a decent time to focus on pain control first, and if you jump to inappropriate investigations you can reinforce yellow flag behaviour. If someone can walk in to see me (just) then they may get cocodamol, diclofenac and diazepam on a first visit. Later they may get morphine, amitriptyline, gabepentin, pregabalin, MRI scan, physiotherapy, orthopaedic, neurosurgical or pain clinic referrals. If I have to go and see them and they are literally stuck in position, then they might get morphine and diclofenac injections. They want to be able to get up off the floor, and sometimes are in a position outside where if you don't get them off the floor they will become hypothermic before they can actually move due to their pain.
For those that don't like their depression drugs, they have options to try another, or reconsider whether they want them at all. Why did they go to see a doctor whose job is to diagnose and whose treatment options for depression are advice, prescription and/or referral to someone who will talk to them? When the patient insists something must be done they often don't want to be told that some DIY CBT from a website, helping themselves, better diet and exercise as well as cutting down alcohol and drugs might help and they want something NOW. So sometimes they get antidepressants on the first visit and sometimes these appear to be of benefit. The wait around here for talking therapies is better than most areas, but far too long for a distressed patient.
Depression and back pain are some of the most challenging conditions to treat because of patient behaviour and belief. They often have some fairly fixed ideas which are responsible for a large part of the problem.
John, I'm genuinely encouraged (not patronising you) to see such a logical and scientific approach to pain management by GPs such as yourself these days.
This is why doctors are (relatively) well paid. This stuff doesn't just come out of a book or protocol, you need to treat and follow up loads of patients over years to get a feel for what works for who.
Easy to try and second guess and slag off GPs over the internet.....
09 November 2012, 08:42 PM
#33
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I wonder if rather than the usual courses that primary and secondary care attend within their comfort zones to tot up hours for revalidation, that a day or two out a year shadowing a colleague would be mutually educational. I'd like to see some of the more recent ITU and anaesthetic techniques as well as more minimal access cardiology and surgery. I think there would be genuine encouragement all round about what is done elsewhere, as the participants would be open and confident but also ready to be challenged about their views. Do you think that would fly with secondary care and would it count towards your revalidation requirements?
09 November 2012, 08:55 PM
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id put pain releif as a near top priority initially - imagine a proffessional had left your close relative in pretty severe pain, how would you feel. its happened to me and wasnt very nice tbh.
even 80mg of inj morphine couldnt suppress the pain - its horrible to watch.
equally seeing loved ones clearley "out there face" wasnt pretty, but atleast stopped the crying and screaming. but thats probably an extreme case. id still thank a professional for adressing pain initially and then following up with a decent attempt at diagnosis and long term care plan put into place that maybe didnt rely so heavily on painkillers - if it could be avoided.
even 80mg of inj morphine couldnt suppress the pain - its horrible to watch.
equally seeing loved ones clearley "out there face" wasnt pretty, but atleast stopped the crying and screaming. but thats probably an extreme case. id still thank a professional for adressing pain initially and then following up with a decent attempt at diagnosis and long term care plan put into place that maybe didnt rely so heavily on painkillers - if it could be avoided.
09 November 2012, 10:10 PM
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You do need to get a grip and remember you are NOT a doctor. Just because you have some crappy biomedical sciences degree does not mean you can diagnose or treat patients or have any real idea about what it takes to do so.
You have neither the training, experience or suitable registration.
All very well to jibber jabber nonsense on the internet when you have never actually had the burden of responsibility for a patients well being.
Sorry my friend but you need a reality check
You have neither the training, experience or suitable registration.
All very well to jibber jabber nonsense on the internet when you have never actually had the burden of responsibility for a patients well being.
Sorry my friend but you need a reality check
FWIW, after 4 years at university I am equally as qualified as you to diagnose and treat patients, maybe more so when it comes to musculoskeletal issues. Oh, and I am professionally registered too
As for chatting jibber jabber nonsense and lacking experience, I do on call work in ITU and have indepth experience in treating neurological patients and multipatholgy patients. I also work in a outpatient setting where I often seek the advice of two spinal specialists that have forgotten more about back complaints than you will ever know. I attend weekly in service training seminars held by the said two spinal specialist to improve upon and widen my own clinical skills.
You would be amazed at the number of referrals I recieve from GP's that wouldn't know a cervical myelopathy from a cauda equina if it bit them on the ****. Long gone are the days when the general public believed doctors always know best or are infallible.
Example of how good some doctors are.
Patient X comes in to see me and their first words were "you're my last hope". They'd had a THR following a #NOF and for the last 5 months post surgery had suffered a major decline in physical function and were falling on a frequent basis. They had seen the surgeon in follow up clinic, the GP, had xrays, MRI's etc etc. No clinical explanation or reason found for the above decline. 30 minutes with me and I notice patient X is unable to fully extend his unoperated leg at the hip and knee whilst walking and in standing and their balance and proprioception is all over the place. Hmmm, all those consultations by all those miraculous doctors and not one of them noticed patient X has a 3cm leg length discrepancy. Guess what? Referred for a orthotic r/v, shoe built up on said leg to equalise bilateral leg length, some rehab, time improving confidence and reducing fear avoidance caused by numerous falls and what would you know, patient X has regained his premorbid level of function, is no longer falling, and living life indepedently.
And before you start gobbing off as per usual, no I am not amazing, no I am not a doctor, no I am not saying "wow, look how good I am". I am also not saying all GP's or Doctors are poor clinicians. I work with, and have worked with some amazing doctors but, doctors like everyone else on this planet are not infallible to making mistakes. You don't need a PHD in orthopaedic medicine to firstly discover, and then realize a 3cm leg length discrepancy will present clinically in the above manner or have the above impact.
So you are right, I am not a doctor, and whilst I have nothing against doctors (other than ones such as yourself), your post eluding to the fact that because I am not a doctor is therefore reason I am unqualified to either assess or treat patients and do not possess either the experience or adequate registration to do so can be shoved up your ar*e.
All in all and considering your post, I think that adds up to a rather large F**K YOU.
Last edited by need4speeduk; 09 November 2012 at 10:24 PM.
09 November 2012, 10:41 PM
#36
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You are a presumptuous jumped up tw*t and saldy a prime example of why patients have such little faith in doctors these days. Your head is so far up your own **** I'd be amazed if you could even see a patient standing in front of you.
FWIW, after 4 years at university I am equally as qualified as you to diagnose and treat patients, maybe more so when it comes to musculoskeletal issues. Oh, and I am professionally registered too
As for chatting jibber jabber nonsense and lacking experience, I do on call work in ITU and have indepth experience in treating neurological patients and multipatholgy patients. I also work in a outpatient setting where I often seek the advice of two spinal specialists that have forgotten more about back complaints than you will ever know. I attend weekly in service training seminars held by the said two spinal specialist to improve upon and widen my own clinical skills.
You would be amazed at the number of referrals I recieve from GP's that wouldn't know a cervical myelopathy from a cauda equina if it bit them on the ****. Long gone are the days when the general public believed doctors always know best or are infallible.
Example. Patient X comes in to see me and their first words were "you're my last hope". They'd had a THR following a #NOF and for the last 5 months post surgery had suffered a major decline in physical function and were falling on a frequent basis. They had seen the surgeon in follow up clinic, the GP, had xrays, MRI's etc etc. No clinical explanation or reason found for the above decline. 30 minutes with me and I notice patient X is unable to fully extend his unoperated leg at the hip and knee whilst walking and in standing and their balance and proprioception is all over the place. Hmmm, all those consultations by all those miraculous doctors and not one of them noticed patient X has a 3cm leg length discrepancy. Guess what? Referred for a orthotic r/v, shoe built up on said leg to equalise bilateral leg length, some rehab, time improving confidence and reducing fear avoidance caused by numerous falls and what would you know, patient X has regained his premorbid level of function, is no longer falling, and living life indepedently.
And before you start gobbing off as per usual, no I am not amazing, no I am not a doctor, no I am not saying "wow, look how good I am". I am also not saying all GP's or Doctors are poor clinicians. I work with, and have worked with some amazing doctors but, doctors like everyone else on this planet are not infallible to making mistakes. You don't need a PHD in orthopaedic medicine to firstly discover, and then realize a 3cm leg length discrepancy will present clinically in the above manner or have the above impact.
All in all and considering your post, I think that adds up to a rather large F**K YOU.
FWIW, after 4 years at university I am equally as qualified as you to diagnose and treat patients, maybe more so when it comes to musculoskeletal issues. Oh, and I am professionally registered too
As for chatting jibber jabber nonsense and lacking experience, I do on call work in ITU and have indepth experience in treating neurological patients and multipatholgy patients. I also work in a outpatient setting where I often seek the advice of two spinal specialists that have forgotten more about back complaints than you will ever know. I attend weekly in service training seminars held by the said two spinal specialist to improve upon and widen my own clinical skills.
You would be amazed at the number of referrals I recieve from GP's that wouldn't know a cervical myelopathy from a cauda equina if it bit them on the ****. Long gone are the days when the general public believed doctors always know best or are infallible.
Example. Patient X comes in to see me and their first words were "you're my last hope". They'd had a THR following a #NOF and for the last 5 months post surgery had suffered a major decline in physical function and were falling on a frequent basis. They had seen the surgeon in follow up clinic, the GP, had xrays, MRI's etc etc. No clinical explanation or reason found for the above decline. 30 minutes with me and I notice patient X is unable to fully extend his unoperated leg at the hip and knee whilst walking and in standing and their balance and proprioception is all over the place. Hmmm, all those consultations by all those miraculous doctors and not one of them noticed patient X has a 3cm leg length discrepancy. Guess what? Referred for a orthotic r/v, shoe built up on said leg to equalise bilateral leg length, some rehab, time improving confidence and reducing fear avoidance caused by numerous falls and what would you know, patient X has regained his premorbid level of function, is no longer falling, and living life indepedently.
And before you start gobbing off as per usual, no I am not amazing, no I am not a doctor, no I am not saying "wow, look how good I am". I am also not saying all GP's or Doctors are poor clinicians. I work with, and have worked with some amazing doctors but, doctors like everyone else on this planet are not infallible to making mistakes. You don't need a PHD in orthopaedic medicine to firstly discover, and then realize a 3cm leg length discrepancy will present clinically in the above manner or have the above impact.
All in all and considering your post, I think that adds up to a rather large F**K YOU.
See what is in bold. The answer is NO you are NOT. You are in NO way as qualified as me to see or treat patients.
You are NOT a doctor.
You do NOT hold a degree in Medicine
You have NOT completed close to ten years of higher training after that medical degree
You are NOT a member/fellow of one of the Royal Colleges
You are NOT on the specialist registrar.
You do NOT hold a CCST
I doubt whether you are even allowed to prescribe drugs are you?
Are you allowed to admit a patient to hospital?
Do you have patients either in the community or in hospital that have you as the lead physician/surgeon? Of course NOT.
How on earth can you be deranged enough to consider that you are as qualified as me to diagnose and treat patients???
You actually don't have patients ffs, they are NOT your patients as you are NOT the lead clinician for them.
As I said it's all very well trying to talk the talk criticising the treatment of a doctor saying that opioids are not indicated but you can't walk the walk.
You have no training in pain management do you? I presume you aren't even allowed to to prescribe opioids.
Seriously mate take a reality check
Last edited by Dingdongler; 09 November 2012 at 10:43 PM.
09 November 2012, 10:50 PM
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WOW.
You really do have an unbelievable overinflated opinion of yourself and your profession.
You little man, are no more important than a porter, a nurse, a physio, a domestic, a radiographer, a pharmacist, or anyone else.
I think it is you who needs a reality check.
You really do have an unbelievable overinflated opinion of yourself and your profession.
You little man, are no more important than a porter, a nurse, a physio, a domestic, a radiographer, a pharmacist, or anyone else.
I think it is you who needs a reality check.
Last edited by need4speeduk; 10 November 2012 at 12:12 AM.
09 November 2012, 10:51 PM
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If I was asked in a medical exam to compare a cervical myelopathy with a cauda equina I would decline to complete the examination as I would not want to be a part of an organisation that mixed up a diagnosis and a piece of anatomy in its question.
You do come across a bit disgruntled. On the basis of what legislation does 4 years at university make you equally as qualified as a doctor to diagnose and treat patients compared to a consultant anaesthetist with registration under the Medical Act 1983 and further with certificate of completion of specialist training and final clinical responsibility for a patient? Can you give epidural or spinal anaesthesia like our friend Dingdongler is qualified to do so? Do you think he knows about the cauda equina just a little?
As a matter of interest, how do you measure leg length? I usually measure from the ASIS to the floor. Genuine question BTW. I may be a thick GP, but I did spend some time in an orthotics department so perhaps I'm more aware of these issues than some.
You do come across a bit disgruntled. On the basis of what legislation does 4 years at university make you equally as qualified as a doctor to diagnose and treat patients compared to a consultant anaesthetist with registration under the Medical Act 1983 and further with certificate of completion of specialist training and final clinical responsibility for a patient? Can you give epidural or spinal anaesthesia like our friend Dingdongler is qualified to do so? Do you think he knows about the cauda equina just a little?
As a matter of interest, how do you measure leg length? I usually measure from the ASIS to the floor. Genuine question BTW. I may be a thick GP, but I did spend some time in an orthotics department so perhaps I'm more aware of these issues than some.
09 November 2012, 10:56 PM
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See what is in bold. The answer is NO you are NOT. You are in NO way as qualified as me to see or treat patients.
You are NOT a doctor.
You do NOT hold a degree in Medicine
You have NOT completed close to ten years of higher training after that medical degree
You are NOT a member/fellow of one of the Royal Colleges
You are NOT on the specialist registrar.
You do NOT hold a CCST
You are NOT a doctor.
You do NOT hold a degree in Medicine
You have NOT completed close to ten years of higher training after that medical degree
You are NOT a member/fellow of one of the Royal Colleges
You are NOT on the specialist registrar.
You do NOT hold a CCST
I am also NOT a deluded, arrogant, egotistical Pr*t.
So I guess that's one more claim you can add to your trophy cabinet.
Last edited by need4speeduk; 10 November 2012 at 12:19 AM.
09 November 2012, 11:10 PM
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If I was asked in a medical exam to compare a cervical myelopathy with a cauda equina I would decline to complete the examination as I would not want to be a part of an organisation that mixed up a diagnosis and a piece of anatomy in its question.
You do come across a bit disgruntled. On the basis of what legislation does 4 years at university make you equally as qualified as a doctor to diagnose and treat patients compared to a consultant anaesthetist with registration under the Medical Act 1983 and further with certificate of completion of specialist training and final clinical responsibility for a patient? Can you give epidural or spinal anaesthesia like our friend Dingdongler is qualified to do so? Do you think he knows about the cauda equina just a little?
As a matter of interest, how do you measure leg length? I usually measure from the ASIS to the floor. Genuine question BTW. I may be a thick GP, but I did spend some time in an orthotics department so perhaps I'm more aware of these issues than some.
You do come across a bit disgruntled. On the basis of what legislation does 4 years at university make you equally as qualified as a doctor to diagnose and treat patients compared to a consultant anaesthetist with registration under the Medical Act 1983 and further with certificate of completion of specialist training and final clinical responsibility for a patient? Can you give epidural or spinal anaesthesia like our friend Dingdongler is qualified to do so? Do you think he knows about the cauda equina just a little?
As a matter of interest, how do you measure leg length? I usually measure from the ASIS to the floor. Genuine question BTW. I may be a thick GP, but I did spend some time in an orthotics department so perhaps I'm more aware of these issues than some.
In no way are my posts directed towards yourself, or any other healthcare professional, be they a consultant, a GP, and so on.
They are directed at the idiot who in all honesty, I'd be embarrassed to have the misfortune to call a colleague or be in the same profession with.
As I have said, I work with and have worked with some amazing doctors, be they a Consultant, registra, house officer, GP, whatever. I have total respect for all professions, be they porters or Consulatants and I treat them all with the same respect. No profession/person is any more important than another. Take one cog out of the wheel and it will all fall apart. We are a team.
What I do not respect is people like idiot here who has a totally overinflated and unrealistic opinion of his own importance.
As for measuring leg length, I tend to measure from the greater Trochanter to the center portion of lateral malleolous.
Last edited by need4speeduk; 09 November 2012 at 11:12 PM.
09 November 2012, 11:25 PM
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I don't think he is self important. Some consultants are, but many more come across that way as they rightly take a very serious view of their final clinical responsibilities for patients and are confident in how they lead their teams.
How often do you visit an undiagnosed acute back pain out of hours and administer medication, controlled drugs or not? What qualifications do you have to do so? Do you have experience of the dynamic of walking around a housing estate (not in this case perhaps!) at 3am with a bag of opiates and wondering about the patient's hidden motives and undeclared history to manipulate you? Do you not think the GP would love the luxury of an undistressed patient and an hour in a well lit examination room during daylight hours with no urgent unscheduled demands on his time? Do you think the out of hours GP service would be safely staffed if he did this? What about the patient who has collapsed that he is going to see next? Or the one after that that is dying of cancer at home?
If the answer is never and none to all this, then how can you comment on the medical treatment the original poster's wife received?
I suspect this is what Dingdongler was getting at in a more direct manner by effectively stating that you are an unqualified yet critical bystander in the situation of the original poster. However you see it, that it not cog like behaviour such as you would like to promote which will result in you being treated like a noctor.
How often do you visit an undiagnosed acute back pain out of hours and administer medication, controlled drugs or not? What qualifications do you have to do so? Do you have experience of the dynamic of walking around a housing estate (not in this case perhaps!) at 3am with a bag of opiates and wondering about the patient's hidden motives and undeclared history to manipulate you? Do you not think the GP would love the luxury of an undistressed patient and an hour in a well lit examination room during daylight hours with no urgent unscheduled demands on his time? Do you think the out of hours GP service would be safely staffed if he did this? What about the patient who has collapsed that he is going to see next? Or the one after that that is dying of cancer at home?
If the answer is never and none to all this, then how can you comment on the medical treatment the original poster's wife received?
I suspect this is what Dingdongler was getting at in a more direct manner by effectively stating that you are an unqualified yet critical bystander in the situation of the original poster. However you see it, that it not cog like behaviour such as you would like to promote which will result in you being treated like a noctor.
10 November 2012, 12:05 AM
#43
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I suspect this is what Dingdongler was getting at in a more direct manner by effectively stating that you are an unqualified yet critical bystander in the situation of the original poster. However you see it, that it not cog like behaviour such as you would like to promote which will result in you being treated like a noctor.
We are ALL prone to mistakes. It's part of being human. Just because you are a doctor, and maybe an amazing doctor, does not make you infallible. Personally I think the use of oramorph on an initial visit for back pain is not indicated unless you have tried other means of pain relief first. Just my personal opinion.
10 November 2012, 04:06 AM
#44
You were not the person who was at the scene and you are neither qualified to make that decision, nor carry it out.
It is a sad day when one medical professional sees fit to undermine the reputation of another using the internet.
My personal opinion doesn't count for anything, but if I were in the OP's position, I would not be unhappy with the actions of the Doctor in dealing with this emergency - and I must profess to being no great fan of the medical profession/NHS.
10 November 2012, 07:43 AM
#45
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NFS, you may think I'm some sort of jumped up egomaniac but I am not. I do however take my job very seriously and take great exception to people second guessing the profession as a whole. Especially people who are NOT qualified to do so. Basically where anybody who happens to work in a hospital (or can use google) thinks they are experts.
That is not to say we as a body or individuals do not make mistakes, of course we do, sometimes horrendous ones. When we do then we should be criticised and the appropriate action taken. Should are actions and decisions be continually questioned? YES they should, to ensure the best treatment for our patients. But this should be done in a robust and appropriate way, it doesn't mean everybody can have a go.
Read this quote from JB
How often do you visit an undiagnosed acute back pain out of hours and administer medication, controlled drugs or not? What qualifications do you have to do so? Do you have experience of the dynamic of walking around a housing estate (not in this case perhaps!) at 3am with a bag of opiates and wondering about the patient's hidden motives and undeclared history to manipulate you? Do you not think the GP would love the luxury of an undistressed patient and an hour in a well lit examination room during daylight hours with no urgent unscheduled demands on his time? Do you think the out of hours GP service would be safely staffed if he did this? What about the patient who has collapsed that he is going to see next? Or the one after that that is dying of cancer at home
It's exactly this sort of experience that you do NOT have and will never have. Tbh I don't have it either as I'm not a GP. My experience has come from 20 years of seeing patients not just in the cold light of day but at all sorts of times, in all sorts of circumstances, of all sorts of ages from neonates to the elderly.
This has come from sometimes working 80hrs/week and rotating between about twenty hospitals so experience would be amplified by seeing different population groups and how things may be done differently in different institutions. And then working abroad for a period of time to see if anything different could be learned there.
This is how you get to a position where you can (hopefully) have the breadth of experience, knowledge and skill to make the right decisions for your patients. Even then we can't always as the human body is a very complex machine and no two people or their response to disease is the same.
The bottom line is that you are NOT qualified to second guess clinicians, especially the GP in the op. Just because you work in a hospital and interact with patients doesn't mean you have the the qualifications, breadth of experience, skill or knowledge to do so.
Am I saying doctors shouldn't be questioned and scrutinised? Of course not, but that doesn't mean everybody can play at being a clinician when they never carry the can.
As I pointed out earlier you aren't even allowed to prescribe any of drugs we've been talking about. How can you possibly state their use was inappropriate when you aren't even allowed to use them??
That is not to say we as a body or individuals do not make mistakes, of course we do, sometimes horrendous ones. When we do then we should be criticised and the appropriate action taken. Should are actions and decisions be continually questioned? YES they should, to ensure the best treatment for our patients. But this should be done in a robust and appropriate way, it doesn't mean everybody can have a go.
Read this quote from JB
How often do you visit an undiagnosed acute back pain out of hours and administer medication, controlled drugs or not? What qualifications do you have to do so? Do you have experience of the dynamic of walking around a housing estate (not in this case perhaps!) at 3am with a bag of opiates and wondering about the patient's hidden motives and undeclared history to manipulate you? Do you not think the GP would love the luxury of an undistressed patient and an hour in a well lit examination room during daylight hours with no urgent unscheduled demands on his time? Do you think the out of hours GP service would be safely staffed if he did this? What about the patient who has collapsed that he is going to see next? Or the one after that that is dying of cancer at home
It's exactly this sort of experience that you do NOT have and will never have. Tbh I don't have it either as I'm not a GP. My experience has come from 20 years of seeing patients not just in the cold light of day but at all sorts of times, in all sorts of circumstances, of all sorts of ages from neonates to the elderly.
This has come from sometimes working 80hrs/week and rotating between about twenty hospitals so experience would be amplified by seeing different population groups and how things may be done differently in different institutions. And then working abroad for a period of time to see if anything different could be learned there.
This is how you get to a position where you can (hopefully) have the breadth of experience, knowledge and skill to make the right decisions for your patients. Even then we can't always as the human body is a very complex machine and no two people or their response to disease is the same.
The bottom line is that you are NOT qualified to second guess clinicians, especially the GP in the op. Just because you work in a hospital and interact with patients doesn't mean you have the the qualifications, breadth of experience, skill or knowledge to do so.
Am I saying doctors shouldn't be questioned and scrutinised? Of course not, but that doesn't mean everybody can play at being a clinician when they never carry the can.
As I pointed out earlier you aren't even allowed to prescribe any of drugs we've been talking about. How can you possibly state their use was inappropriate when you aren't even allowed to use them??
10 November 2012, 08:25 AM
#47
In my humble opinion, when you take on a role that involves providing care and giving medical support based on your opinion, you open yourself up to continuous judgement. Everyone has a right to an opinion and everyone else has the right to decided which opinion they believe.
In my (sadly) ever growing opinion, doctors and specialists appear to genuinely not care about the repercussions of either not treating or prescribing drugs with life changing side effects just to get a patient out of the room.
I base this on myself, my sister, watching my mother die and my father suffer.
Dingle in our brief encounters you have come across as very knowledgeable, offering the more scientific approach but I don't feel you actually consider how important the questions posed to you are and without knowing you I base this solely on you projected forum image, you do come across as an arrogant know it all, no offence intended, just being honest.
In my (sadly) ever growing opinion, doctors and specialists appear to genuinely not care about the repercussions of either not treating or prescribing drugs with life changing side effects just to get a patient out of the room.
I base this on myself, my sister, watching my mother die and my father suffer.
Dingle in our brief encounters you have come across as very knowledgeable, offering the more scientific approach but I don't feel you actually consider how important the questions posed to you are and without knowing you I base this solely on you projected forum image, you do come across as an arrogant know it all, no offence intended, just being honest.
Last edited by pimmo2000; 10 November 2012 at 08:26 AM.
10 November 2012, 09:13 AM
#48
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NFS, I am less interested in your personal opinion than I am on the evidence base or guidelines behind your opinion. Your comments about time with the patient do not demonstrate an appreciation of the reality of general practice and balancing acute pain management with longer term management and safe prioritisation regarding how to see patients in a much shorter time than you are used to. That is not the same as cutting patients short and mismanaging them. I would be interested to hear what you would have prescribed to the original poster's wife and how you would then have returned to them hourly to find you had started too low on the analgesic ladder and not followed guidelines or been humane in your treatment plan.
Let us hear the evidence rather than noctorism.
I am requesting evidence because to disagree with the treating GP's prescribing and two other doctors, one from the specialty whose core business is treating pain, you need something better than your opinion as a non prescriber. You also may wish to consider that your clinical and professional responsibility is not that of the responsible clinician who is a GP or consultant. Consider the cost of your professional indemnity and the risk of the decisions you take and compare them with a prescriber.
Let us hear the evidence rather than noctorism.
I am requesting evidence because to disagree with the treating GP's prescribing and two other doctors, one from the specialty whose core business is treating pain, you need something better than your opinion as a non prescriber. You also may wish to consider that your clinical and professional responsibility is not that of the responsible clinician who is a GP or consultant. Consider the cost of your professional indemnity and the risk of the decisions you take and compare them with a prescriber.
Last edited by john banks; 10 November 2012 at 09:36 AM.
10 November 2012, 09:53 AM
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As you keep stating, I am not a doctor and therefore am not qualified to prescribe or administer drugs and it would now also appear that because I am not a doctor I neither know their use or effect.
I haven't been to college/uni and taken a automechanics course either. Does that mean I am not qualified or capable of diagnosing and fixing a problem that arises with my car?
I give up tbh. All hail the Doctor. Apparently the only member of the NHS that has time constraints, follows guidelines & evidence based practice, responsibility for their patient, and knows what they are doing.
I haven't been to college/uni and taken a automechanics course either. Does that mean I am not qualified or capable of diagnosing and fixing a problem that arises with my car?
I give up tbh. All hail the Doctor. Apparently the only member of the NHS that has time constraints, follows guidelines & evidence based practice, responsibility for their patient, and knows what they are doing.
10 November 2012, 02:36 PM
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Prescribing and responsible clinician status are protected by statute (as you agree you are not a doctor) whereas fixing a problem on your own car is not. I would consider the opinion of someone not qualified to prescribe if backed up by evidence, but you have criticised without providing credentials or evidence against using opiates first line in severe acute back pain.
Where did I say that only doctors have time constraints? I was discussing it in response to your assertion that a proper initial assessment and management of back pain could not be done in 10 minutes, yet it seems that the good doctor got to the point and relieved the patient's pain using training and legal rights and responsibilities that you do not possess. Your criticism is therefore ill founded, and we haven't even started on the evidence yet. Unless you provide it I would invite you to retract your criticism.
I await to be astonished by what you can google on this one, or you may as well gracefully give up as you say and persist in your ignorance of appropriate acute pain relief. Presently you're coming across like one of those horrendous midwives (most are not like this I will add) who like to "protect" their patients from the doctor and use calling in the obstetrician as a threat to manipulate the patient rather than putting the needs of the patient as their first concern. There are situations where only potent pharmaceuticals will do.
Where did I say that only doctors have time constraints? I was discussing it in response to your assertion that a proper initial assessment and management of back pain could not be done in 10 minutes, yet it seems that the good doctor got to the point and relieved the patient's pain using training and legal rights and responsibilities that you do not possess. Your criticism is therefore ill founded, and we haven't even started on the evidence yet. Unless you provide it I would invite you to retract your criticism.
I await to be astonished by what you can google on this one, or you may as well gracefully give up as you say and persist in your ignorance of appropriate acute pain relief. Presently you're coming across like one of those horrendous midwives (most are not like this I will add) who like to "protect" their patients from the doctor and use calling in the obstetrician as a threat to manipulate the patient rather than putting the needs of the patient as their first concern. There are situations where only potent pharmaceuticals will do.
Last edited by john banks; 10 November 2012 at 02:41 PM.
10 November 2012, 05:02 PM
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We have established I am not a doctor and therefore do not hold the qualification to prescribe mediations. You don't have to keep harping on about that one single fact.
To all and sundry, I hereby take back my observation about the use of said medication and bow to the superior knowledge, qualifications and clinical skills of all doctors.
Happy now?
One final thing before I crawl off with my tail between my legs.
You say there is a lot you can do for back pain in 10 mintues, be it an initial presentation or follow up appointment.
Would you be kind enough to please tell me (so I don't have to use google) how in 10 minutes you take a concise HPC, PMH, DH, & SH, then perform a complete and accurate objective assessment which then allows you to deduce whether the cause of said back pain is myogenic, arthrogenic, neurogenic, or otherwise, and then administer the correct and appropriate treatment and put in place a long term plan?
I only ask because I am not able to do so and you obviously are (that is why you are worth your money because non-doctors can't do that) and it would therefore benefit my clinical practice to learn from someone as undoubtably talented as yourself.
To all and sundry, I hereby take back my observation about the use of said medication and bow to the superior knowledge, qualifications and clinical skills of all doctors.
Happy now?
One final thing before I crawl off with my tail between my legs.
You say there is a lot you can do for back pain in 10 mintues, be it an initial presentation or follow up appointment.
Would you be kind enough to please tell me (so I don't have to use google) how in 10 minutes you take a concise HPC, PMH, DH, & SH, then perform a complete and accurate objective assessment which then allows you to deduce whether the cause of said back pain is myogenic, arthrogenic, neurogenic, or otherwise, and then administer the correct and appropriate treatment and put in place a long term plan?
I only ask because I am not able to do so and you obviously are (that is why you are worth your money because non-doctors can't do that) and it would therefore benefit my clinical practice to learn from someone as undoubtably talented as yourself.
10 November 2012, 07:17 PM
#52
This thread has completely gotten out of hand.
Matt there is nothing to be gained from a protracted disagreement. It's just providing popcorn fodder for the users of this forum. I will add you do know your stuff, the help you gave me still yields benefit now months later.
In the same vein Dingdongler and John Banks both know their beans. Dingdongler has has helped me in the past and always offers assistance where he can to others users of this forum. It is a priviledge for us Scoobynetters to have people with such knowledge and skill on board. Don't let a petty squabble sour your good characters
.
Matt there is nothing to be gained from a protracted disagreement. It's just providing popcorn fodder for the users of this forum. I will add you do know your stuff, the help you gave me still yields benefit now months later.
In the same vein Dingdongler and John Banks both know their beans. Dingdongler has has helped me in the past and always offers assistance where he can to others users of this forum. It is a priviledge for us Scoobynetters to have people with such knowledge and skill on board. Don't let a petty squabble sour your good characters
.
10 November 2012, 08:11 PM
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For my own patients, I usually know the PMH (so I know if they have had previous documented malignancy, osteoporosis, trauma, previous back pain, operations, eating disorder, opiate addiction, renal tract stones, pneumonia, pancreatitis, aortic aneurysm, pulmonary embolism, peptic ulcer disease, polymyalgia rheumatica, inflammatory arthitis, osteoarthritis etc), DH (I need to find out what they have had OTC for this episode, remembering if they have been prescribed oral steroids), SH so regarding the pain I take a history that takes about 4 minutes to find out the site, duration, nature, severity, radiation, exacerbating/relieving features and check for red flags (weight loss, fever, bladder/sexual dysfunction, weakness) plus features above, I already know their age and whether this is a new episode and their recent history) whilst being alert to yellow flag behaviour. I spend about 3 minutes on an examination (assuming low back pain here which is by far the majority) checking the temperature, looking at the back, palpating the back for deformity and tenderness, check range of movement, up on the couch, straight leg raising, knee reflexes, plantars, big toe power, saddle sensation and **** tone if indicated from history (rarely), relevant abdo/chest/other examination. The last 3 minutes involve prescription with check on interactions and contraindications/allergies, with advice on how to use and likely side effects (such as sedation, constipation, dry mouth, nausea, addiction/short term use indication), advice to make a review appointment, and telling the patient to make an appointment for bloods if relevant. Sometimes a sick line too. If I have to organise an MRI scan or same day hospital referral on the first visit (rare) I will run late. If I discover aspects that are not straight forward I will run late. If I have to give an opiate injection it is usually on a visit rather than a visitor to the surgery as they are well enough not to need one. The vast majority will not get a strong opiate on the first visit.
On the follow up visit the response to treatment and side effects are checked, a further relevant examination especially if they were too sore to do it properly the first time. Further investigations depending on duration may merit an open access MRI, referral to physio, second line meds line amitriptyline, gabapentin, pregablin, stronger opiates etc as well as more detailed discussion about impact on work.
This is a genuine representation of what happens in a ten minute appointment and is typical of a busy GP that knows what they are doing and is not afraid to get down to business, you tend not to waste time when you've been a med reg in a busy DGH up all night with your consultant at home and 20-30 admissions a day for you and your house officer to sort out plus calls from A/E and ill in patients needing review, plus even our quiet practice goes mental near Xmas and I have personally seen 30 patients in one morning with one complaint that I didn't call a lady back within the hour of her call and no **** ups as a result. The same applies to new chest pain, new depression, new diabetes, new asthma. It is all automatic now and very efficient indeed, I have standard ways of recording what I do on my computerised notes that I and my colleagues understand, so record taking doesn't take long. Patient feedback is excellent and I get 10 times as many cards of thanks than I do complaints, I have a nice bunch of patients and there is great mutual respect.
Perhaps you can see what you might take out of my 10 minute new back pain and put in instead, I've refined the process pretty well, have the advantage of knowing whole families and their circumstances for years, and have maybe about 10 back pain consultations a week.
I'm a bit disappointed you haven't engaged in why you think opiates can be a first line treatment in severe acute back pain when the above aspects that I have discussed are considered.
On the follow up visit the response to treatment and side effects are checked, a further relevant examination especially if they were too sore to do it properly the first time. Further investigations depending on duration may merit an open access MRI, referral to physio, second line meds line amitriptyline, gabapentin, pregablin, stronger opiates etc as well as more detailed discussion about impact on work.
This is a genuine representation of what happens in a ten minute appointment and is typical of a busy GP that knows what they are doing and is not afraid to get down to business, you tend not to waste time when you've been a med reg in a busy DGH up all night with your consultant at home and 20-30 admissions a day for you and your house officer to sort out plus calls from A/E and ill in patients needing review, plus even our quiet practice goes mental near Xmas and I have personally seen 30 patients in one morning with one complaint that I didn't call a lady back within the hour of her call and no **** ups as a result. The same applies to new chest pain, new depression, new diabetes, new asthma. It is all automatic now and very efficient indeed, I have standard ways of recording what I do on my computerised notes that I and my colleagues understand, so record taking doesn't take long. Patient feedback is excellent and I get 10 times as many cards of thanks than I do complaints, I have a nice bunch of patients and there is great mutual respect.
Perhaps you can see what you might take out of my 10 minute new back pain and put in instead, I've refined the process pretty well, have the advantage of knowing whole families and their circumstances for years, and have maybe about 10 back pain consultations a week.
I'm a bit disappointed you haven't engaged in why you think opiates can be a first line treatment in severe acute back pain when the above aspects that I have discussed are considered.
Last edited by john banks; 10 November 2012 at 08:17 PM.
11 November 2012, 02:34 AM
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Says it all really doesnt it. And yes, I know you guys have ridiculous time pressures and targets to meet, none of which are your fault.
4 minutes on a subjective Ax, 3 minutes on a objective Ax, 3 minutes prescribing meds.
I'm sorry but there is no way you can conduct an accurate assessment of a new acute episode of back pain in 7 minutes. No way at all. As I said, I work with two spinal specialists, two, that deal with nothing but backs day in day out. One is a physiotherapist extended scope practitioner, the other is a DOCTOR who was a rheumatologist that got frustrated at the level of care being given and went back to uni and studied osteopathy. With all their years of experience and expertise, and believe my they are good, not once have I sat in shadowing them and seen them Ax a new patient in less than 30 minutes. In 7 minutes you CANNOT take a accurate Hx and objectively Ax a back. Do you even know how to test for and decipher whether the pain is being cause by a herniated disc, a facet joint, at which level, on which side, by muscle imbalance, which muscle, where it originates or inserts, it's actions, whether they are in pelvic tilt, posterior or anterior, whether its due to SIJ dusfunction etc etc etc etc. Absolutely not a chance in hell you can do just the above in 7 minutes let alone the rest.
Perhaps this is why many GP's miss something as simple as a leg length discrepancy. You said earlier you measured from ASIS to the floor. How is something this simple going to be accurate measuring like this? What if the person has a pelvic imbalance? Have SIJ dysfunction, are e-verting or inverting on one side? How can that be accurate? Seriously. Yet you can accurately and correctly Ax a new back in 7 minutes.
"The vast majority will not get a strong opiate on the first visit"
Exactamuno. This person was fine the previous day, went to bed fine, woke up with back pain. No mechanism of injury etc.
Have you never gone to bed one night and woke up in the morning with a stiff and painful neck you are unable to rotate? Do you go in and give yourself the same cocktail of meds? I'd hazzard a guess at not. Personally, and that is all it is, I would have thought a anti-inflamatory and softer analgesia would be have been appropriate as a first line Tx rather than jumping straight in with Oramorph. You may disagree.
"It is all automatic now and very efficient indeed"
Maybe that's the problem. No two patients are alike or present in the same way. Yes certain things have common presentations/symptoms but no one cap fits all. Spinal stenosis has a common presetation/pattern, as does a disc herniation etc, but that's not to say you dont have to exclude other causes before deciding on a diagnosis.
I guess we will have to agree to disagree on this one John. I am sure you are a fabulous GP that offers and provides his patients with a good service. It just comes across that because someone else isn't a doctor that their opinion, training, expertise, is thought to be less valid.
4 minutes on a subjective Ax, 3 minutes on a objective Ax, 3 minutes prescribing meds.
I'm sorry but there is no way you can conduct an accurate assessment of a new acute episode of back pain in 7 minutes. No way at all. As I said, I work with two spinal specialists, two, that deal with nothing but backs day in day out. One is a physiotherapist extended scope practitioner, the other is a DOCTOR who was a rheumatologist that got frustrated at the level of care being given and went back to uni and studied osteopathy. With all their years of experience and expertise, and believe my they are good, not once have I sat in shadowing them and seen them Ax a new patient in less than 30 minutes. In 7 minutes you CANNOT take a accurate Hx and objectively Ax a back. Do you even know how to test for and decipher whether the pain is being cause by a herniated disc, a facet joint, at which level, on which side, by muscle imbalance, which muscle, where it originates or inserts, it's actions, whether they are in pelvic tilt, posterior or anterior, whether its due to SIJ dusfunction etc etc etc etc. Absolutely not a chance in hell you can do just the above in 7 minutes let alone the rest.
Perhaps this is why many GP's miss something as simple as a leg length discrepancy. You said earlier you measured from ASIS to the floor. How is something this simple going to be accurate measuring like this? What if the person has a pelvic imbalance? Have SIJ dysfunction, are e-verting or inverting on one side? How can that be accurate? Seriously. Yet you can accurately and correctly Ax a new back in 7 minutes.
"The vast majority will not get a strong opiate on the first visit"
Exactamuno. This person was fine the previous day, went to bed fine, woke up with back pain. No mechanism of injury etc.
Have you never gone to bed one night and woke up in the morning with a stiff and painful neck you are unable to rotate? Do you go in and give yourself the same cocktail of meds? I'd hazzard a guess at not. Personally, and that is all it is, I would have thought a anti-inflamatory and softer analgesia would be have been appropriate as a first line Tx rather than jumping straight in with Oramorph. You may disagree.
"It is all automatic now and very efficient indeed"
Maybe that's the problem. No two patients are alike or present in the same way. Yes certain things have common presentations/symptoms but no one cap fits all. Spinal stenosis has a common presetation/pattern, as does a disc herniation etc, but that's not to say you dont have to exclude other causes before deciding on a diagnosis.
I guess we will have to agree to disagree on this one John. I am sure you are a fabulous GP that offers and provides his patients with a good service. It just comes across that because someone else isn't a doctor that their opinion, training, expertise, is thought to be less valid.
Last edited by need4speeduk; 11 November 2012 at 02:38 AM.
11 November 2012, 08:33 AM
#55
This thread is 
I prescribe an injection of humour.
And to get the ball rolling, an oldie but goodie.
Q : What is the difference between a Doctor and God?
A : God doesn't think he is a Doctor.
I prescribe an injection of humour.
And to get the ball rolling, an oldie but goodie.
Q : What is the difference between a Doctor and God?
A : God doesn't think he is a Doctor.
Last edited by cster; 11 November 2012 at 08:34 AM.
11 November 2012, 10:08 AM
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10 mins is what I have for an acute episode so I prioritise. The patients I am seeing are very different from the ones you are seeing and the majority settle. The plan I mentioned above along with a patient not settling merits further exam, investigation and/or referral. Everything is either about relieving symptoms, avoiding danger or deciding the where the 10% that don't settle go next. I think you place much emphasis on the subset of back pain presentations that come your way which gives you what appears to me an unrealistic perspective when applied to the emergency and time constraints in primary care which was the setting of the original poster. Why do you confuse that with your domain? By doing so it is you that waded in and commented on a scenario which you do not experience or have the credentials to deal with and then get defensive about your status compared with doctors which is not necessary. It was interesting to hear about the rheumatologist who retrained as an osteopath, I wondered if you were thinking of retraining to be a doctor as you wanted to prescribe. A severe acute back pain may merit morphine, it is in the NICE guidelines.
In terms of diagnosis, a whole group have mechanical back pain which then go to physios, biomechanics etc. the neurosurgeons have no treatment for them and apart from analgesia and helping avoid yellow flag behaviour along with lifestyle and work advice they are not our domain. I am keen to sort the acute ones that settle with analgesia and find the spinal stenoses and prolapsed discs, as well as malignancies, infections, inflammatory causes - ie things with medical or surgical treatments. The rest is probably your domain?
When you appreciate how different our case mix is you will perhaps reluctantly agree that I can treat the self limiting majority, spot the immediate serious causes that are medical emergencies and review the remainder? Should I spend three appointments on an acute back and then not bother seeing the chest pain and pneumonia? Is there actually any evidence to show that a 30 min primary care assessment gives better outcomes and is value for money? I am not a physio, I don't want to be one, I want to send people that don't settle to one. Should it surprise you that they then have something a physio can do something about?
I am not sure about humour, correct management of back pain doesn't need it.
In terms of diagnosis, a whole group have mechanical back pain which then go to physios, biomechanics etc. the neurosurgeons have no treatment for them and apart from analgesia and helping avoid yellow flag behaviour along with lifestyle and work advice they are not our domain. I am keen to sort the acute ones that settle with analgesia and find the spinal stenoses and prolapsed discs, as well as malignancies, infections, inflammatory causes - ie things with medical or surgical treatments. The rest is probably your domain?
When you appreciate how different our case mix is you will perhaps reluctantly agree that I can treat the self limiting majority, spot the immediate serious causes that are medical emergencies and review the remainder? Should I spend three appointments on an acute back and then not bother seeing the chest pain and pneumonia? Is there actually any evidence to show that a 30 min primary care assessment gives better outcomes and is value for money? I am not a physio, I don't want to be one, I want to send people that don't settle to one. Should it surprise you that they then have something a physio can do something about?
I am not sure about humour, correct management of back pain doesn't need it.
Last edited by john banks; 11 November 2012 at 10:32 AM. Reason: Typed on phone, forgive typos and no link to NICE
11 November 2012, 10:48 AM
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As I said John, I have no axe to grind with you and I am sure you are a very good GP. I am also not trying to score points. You are, I am sure, good at what you do. I am good at what I do. Two differing methods/specialities with the same goal = Patient well being. If it has come across as defensive I apologise but, just because someone isn't a doctor/GP it doesn't mean they do not have a reasonable indepth understanding of acute medicine.
My simple point was/is, with an acute episode of back pain, you, or anyone else (including myself), CANNOT accurately assess the cause in 10 minutes.
Therefore treatment is aimed at symptom relief, not causative or preventivie treatment and relief.
As I get 90% of my referrals in my out patient setting from GP's I am well aware and honestly do appreciate the ridiculous times contraints you guys are under.
As for retraining, no. I did consider doing MBBS but in all honesty, while I have completel respect what you do, personally I have no desire to become a doctor. As for prescribing that would simply be a matter of taking a couple of post grad courses, but again, at this point in time I have no real disire to go in that direction.
Many a nurse practitioner, MS nurse, PD nurse, physio etc are now able to prescribe or alter medications. As far as that goes for me clinically, I simple write to GP's suggesting it might be an option to trail a patient on XYZ. The decision to then do so or not then lies with professionals such as yourself.
Cheers
My simple point was/is, with an acute episode of back pain, you, or anyone else (including myself), CANNOT accurately assess the cause in 10 minutes.
Therefore treatment is aimed at symptom relief, not causative or preventivie treatment and relief.
As I get 90% of my referrals in my out patient setting from GP's I am well aware and honestly do appreciate the ridiculous times contraints you guys are under.
As for retraining, no. I did consider doing MBBS but in all honesty, while I have completel respect what you do, personally I have no desire to become a doctor. As for prescribing that would simply be a matter of taking a couple of post grad courses, but again, at this point in time I have no real disire to go in that direction.
Many a nurse practitioner, MS nurse, PD nurse, physio etc are now able to prescribe or alter medications. As far as that goes for me clinically, I simple write to GP's suggesting it might be an option to trail a patient on XYZ. The decision to then do so or not then lies with professionals such as yourself.
Cheers
11 November 2012, 12:34 PM
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Do you accept though that in an acute situation following what I described in 10 mins you can do a good job of sorting out whether you have a spinal emergency (rare) and then get on with sorting out the majority who are self limiting, offering appropriate follow up? If not, why not? Primary care has a repeated follow up ethos that through a series of brief encounters is effective and efficient. The people coming to you need longer because they are a very select group of the initial presenters. If you could get funding for a 24/7 acute access physio assessment with 30 mins available and also covering all the medical presentations (are you happy to diagnose pneumonia, PE or aortic aneurysm? If not they still need med assessment).
11 November 2012, 01:11 PM
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Wow ... this turned into something that I didn't expect.
I wasn't complaining .... the Doctor did what he could to make my wife comfortable and even followed up a few days later. Valium made her completely loopy even at this small (5mg) dose and she can't remember any of last weekend!
It was just a general comment that drugs are easily administered, which is good but easy to abuse I imagine. The follow up appointment got even more.
I wasn't complaining .... the Doctor did what he could to make my wife comfortable and even followed up a few days later. Valium made her completely loopy even at this small (5mg) dose and she can't remember any of last weekend!
It was just a general comment that drugs are easily administered, which is good but easy to abuse I imagine. The follow up appointment got even more.