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The Dorsal View

The right tools for the right job in primary care

With the introduction of the under-sixes scheme and ever-increasing pressure on GPs, it is truly baffling that primary care physicians achieve so much in the face of limited funding. It’s also amazing that what they do manage to achieve, they do without the necessary tools to do their jobs. 

In recent months, I have had need of the services of an electrician, a motor mechanic and a mobile phone repair shop. While these services are diverse, each of the people I dealt with had one thing in common — they all had the right diagnostic tools.

Many GPs are thankfully now aware of the dangers of over-prescribing antibiotics but convincing patients (and sometimes their parents) that an antibiotic is not necessary is another extra drain on precious clinic time.

A conference in the RCPI earlier this month heard how Ireland is the ninth-highest prescriber of antibiotics out of 20 European states and Irish nursing home residents are more than twice as likely to be on antibiotics than anywhere else in Europe. Overall, 80 per cent of antibiotics in Ireland are prescribed at community level.

International data shows that 90 per cent of doctors feel under pressure to prescribe antibiotics, while in hospitals, 50 per cent are prescribed for no documented reason.

If this trend continues, on a worldwide scale we are likely to see many of the hard-earned advances in medicine simply cancelled out by rampant antimicrobial resistance.

At the conference, it was pointed out that GPs — and pharmacies — should be resourced with tools that allow them to instantly identify bacterial infection. 

Just as a super-tanker can take 30 minutes to change direction once the captain gives the order, the HSE and Department of Health need to act now to give us a chance to ‘catch-up’ with antimicrobial resistance. If GPs are not routinely provided with the tools to do this, we are all facing into some seriously choppy waters.

Just as it is amazing what the average Irish GP quietly achieves every day with limited resources and ever-increasing pressure and disillusionment, it is equally remarkable that they make these achievements without access to the necessary diagnostic tools. But that doesn’t mean this state of affairs should be allowed to continue.  

Government has committed to publishing a National Action Plan on antimicrobial resistance next month. Its contents should be of great interest.

Ask a silly question… 

On the topic of making the optimum use of your time in the clinic, a reader kindly sent me a list of the most inappropriate and/or ridiculous questions asked of GPs in the UK. The list, which was published in a supplement of The Independent, contains a few beauties.

How would you deal with these enquiries? Would you be more Gandhi or Doc Martin?

Of course, I would be delighted to hear any similar earth-shattering questions that have been put to you in your surgery or clinic, which of course will be anonymised.

“Is my nipple too hairy?”

“Is there a pill I can take so I can have a baby boy?”

“I have ugly feet.”

“Do you have something to make my nails stronger and hair shinier before my holiday tomorrow?”

“Doctor, please tell my son to study harder so he can get into Eton.” (The child was six years old.)

“My skin is too soft.”

“I get sore feet when I dance in high heels.”

“I’m addicted to crisps.”

“I have blisters on my hands since I started in the rowing club.”

“My lodger is annoying me… he’s spending too much time in his room.”

“Can I have a sick note for six months because I am nearly at retirement age?”

“Please can you fill out my driving licence application? I’m not sure how to.”

“Doctor, please can you write to my daughter’s school to say I’m finding the school run tiring and can they arrange transport to and from my house?”

“I’ve just been on holiday with my mistress… work want to know where I’ve been. I’d like a sick note to cover me.”

“I burnt the top of my mouth on pizza five days ago… ”

“I am allergic to cats. I am getting a cat. Can I get a vaccination?”

“I’m allergic to avocados; if I eat eight, I’m sick.”

“I’m really worried my daughter has a splinter… can you get it out? We haven’t tried by the way, because we were so worried.”

“I don’t know why I’m here doctor, my wife made the appointment.” “Well, shall we bring your wife in or telephone her, perhaps?” “We can’t. She’s in Portugal.”

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