Sherlock continues to struggle with general practice. Some enlightenment has come from reading Quality outcome framework. This goes some way to explaining General practice as it now exists. Sherlock of course, trained and qualified in general practice when prof was just a twinkle in a bureaucratic eye. Sherlock was working 100 hours on the wards while the trainers in her training practice were still in nappies. They see her as a grandmother returning to suck eggs that have long since hatched. There seems to be some surprise amongst the trainers that the patient seemed to like her style of consultation, it may echo back to a time before computers and before a patient was more than a BP and urine test.
It doesn't look as though Sherlock will survive much longer in the nasty, cutthroat environment of a modern training general practice. It came to a head on Wednesday over a prescription for the pill or rather patches for the pill. The lady requesting patches came fully armed with every bit of information she wanted. Sherlock noticing she was somewhat overweight, rang the trainer or micromanager, to ask whether this was in order. Reassured that this was a safe effective method of contraception, Sherlock duly prescribed the patches. In the regular post-mortem session that follows every surgery, during which Sherlocks every move is poured over and relentlessly criticised, it emerged that this particular prescription went against the guidelines.
The trainer screamed "What on earth have you done? You can't do that." Sherlock explained that she had enquired whether or not this was appropriate. Eventually the situation resolved with the trainer apologising for this outburst. The problem with the prescription that led to this outburst was easily enough resolved, the fallout would harder to clear up. Sherlock had had enough, and by this stage was close to tears. Sherlock is not one to easily show emotion, but three months all relentless criticism and constant disrespect had taken their toll. This had been preceded by six months of bureaucratic enquiry interviews, expensive courses, expensive exams and expensive delays. Enough is enough, the minuscule bursary intended to cover costs of returning to general practice, means that Sherlock is going into debt at the rate of £1000 a month. With her rapidly dwindling savings, the situation looked like good money after bad. Insid her head a switch flipped. Sherlock replied "I am within the hairsbreadth of walking out".
This response produced consternation in the trainer, who assumed Sherlock was a sitting target within the practice to kick and beat as anyone felt, and be put down at the end of 12 months, unregistered. The idea that Sherlock might be a sensate body was startling. In her mind, the old dog was a scapegoat. Sherlock is an old dog, whom it may well be hard to teach new tricks, and consequently had a bad name in the practice. Having a problem doctor was good for practice' dynamics, she was the proverbial donkey on to which to pin the Tail of Blame.
Nonetheless Sherlock had survived so long only by recognising danger early. It was now obvious that there was no future for Sherlock in this practice. The game had changed too far, these doctors had been raised on QOF and knew no other life. They did not need care about the patient welfare, or even know what it was. Patient centred consultations were ancient platitudes, the biomedical model of measurement, monitoring, interventions, guidelines and drugs is the modern coinage. They loved their computers, their QOF points and the antiquated computer system that delivered the golden eggs of their newfound wealth.
Sherlock must either change practice or hand in the towel.
It doesn't look as though Sherlock will survive much longer in the nasty, cutthroat environment of a modern training general practice. It came to a head on Wednesday over a prescription for the pill or rather patches for the pill. The lady requesting patches came fully armed with every bit of information she wanted. Sherlock noticing she was somewhat overweight, rang the trainer or micromanager, to ask whether this was in order. Reassured that this was a safe effective method of contraception, Sherlock duly prescribed the patches. In the regular post-mortem session that follows every surgery, during which Sherlocks every move is poured over and relentlessly criticised, it emerged that this particular prescription went against the guidelines.
The trainer screamed "What on earth have you done? You can't do that." Sherlock explained that she had enquired whether or not this was appropriate. Eventually the situation resolved with the trainer apologising for this outburst. The problem with the prescription that led to this outburst was easily enough resolved, the fallout would harder to clear up. Sherlock had had enough, and by this stage was close to tears. Sherlock is not one to easily show emotion, but three months all relentless criticism and constant disrespect had taken their toll. This had been preceded by six months of bureaucratic enquiry interviews, expensive courses, expensive exams and expensive delays. Enough is enough, the minuscule bursary intended to cover costs of returning to general practice, means that Sherlock is going into debt at the rate of £1000 a month. With her rapidly dwindling savings, the situation looked like good money after bad. Insid her head a switch flipped. Sherlock replied "I am within the hairsbreadth of walking out".
This response produced consternation in the trainer, who assumed Sherlock was a sitting target within the practice to kick and beat as anyone felt, and be put down at the end of 12 months, unregistered. The idea that Sherlock might be a sensate body was startling. In her mind, the old dog was a scapegoat. Sherlock is an old dog, whom it may well be hard to teach new tricks, and consequently had a bad name in the practice. Having a problem doctor was good for practice' dynamics, she was the proverbial donkey on to which to pin the Tail of Blame.
Nonetheless Sherlock had survived so long only by recognising danger early. It was now obvious that there was no future for Sherlock in this practice. The game had changed too far, these doctors had been raised on QOF and knew no other life. They did not need care about the patient welfare, or even know what it was. Patient centred consultations were ancient platitudes, the biomedical model of measurement, monitoring, interventions, guidelines and drugs is the modern coinage. They loved their computers, their QOF points and the antiquated computer system that delivered the golden eggs of their newfound wealth.
Sherlock must either change practice or hand in the towel.
