An unproductive doctor

Three of my patients came to see me because they were worried they might have cancer. There may have been more than three, because often patients are afraid or embarrassed to admit the real reason for coming to see their GP.

There was one lady with a headache who was worried about a brain tumour, a lady with breast pain worried about breast cancer and a man with a testicular lump worried that it might be cancerous.

By taking time to listen to their concerns, to take down a careful clinical history and perform an examination I was able to satisfy myself that the symptoms they were describing did not indicate cancer. With some more time and the aid of a basic anatomy atlas I keep on my desk, I was able to explain their symptoms and reassure them that they did not have cancer. I arranged for follow up in case of any change and explained what to look out for. I checked that they understood and answered their questions. I took a little longer than my alloted 12 minutes for each of them, but they left reassured, and I enjoyed my work as I very frequently do.

I’m tired of hearing politicians going on about NHS productivity without bothering to explain what they mean, which is almost certainly because they don’t know what they’re talking about. I suspect that most privilaged politicians, if they were worried about cancer would call up their private specialist. When I spoke at Civitas (the think tank dedicated to scraping the barrel of evidence to justify the introduction of markets into the NHS) the pin-striped audience could barely hide their contempt for GPs, and even went so far as to suggest that Google was going to replace GPs.

If I had been less competent or more rushed or less caring … I could have taken a cursory history and referred them to a specialist, or sent them for scans or other investigations, setting in motion a whole train of clinical events. This would have created a whole lot of ‘productivity’ leading perhaps, given the problems of defensive medicine, diagnostic uncertainty, false positive test results and eager surgeons to unnecessary surgery.

Next time a politician starts talking about NHS productivity, do ask them what they mean.