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Personal contacts between patients and doctors

Another change that has happened as treatment has become accessible to everyone is that the doctors often have so many patients, or are part of a team of doctors, that they no longer have any close knowledge of their patients. They may not even recognize who they are. For example, in local surgeries, the occasional visitor will rarely see the same doctor, and at most is likely to be in the surgery for less than ten minutes. This is the target number. Diagnosis is inevitably very rapid, and it puts intense pressure on the doctors to perform consistently. This retrograde step is mainly driven by financial constraints and administrative procedures. Additionally, demands on analysis technologies have increased and are made elsewhere. In principle, this is sensible, but one hears many stories where the results are not fed back to the patient. Less often, the central analysis sites are overloaded and records are confused.

A further downside of the multi-doctor practice is that the patient may be seen by those who have a very limited record of the patient’s history or lifestyle, and consequently are unaware of a patient’s responses to different drugs. This may not be serious for routine problems, but it can (and does) lead to errors for more complex conditions, (e.g. where the patient has serious allergic reactions to certain drugs, or even intolerance to the lactose content used in the drug fillings).

The official response to such criticism is that there are computer records and files, so this knowledge should be available. However, from the experience of my own friends, this is certainly not the case. For example, one man with a rather long record of treatments had a hospital file many centimetres thick, but rarely was seen by the same members of staff. There is no way the latest expert would have had time to read all the background history, and only intervention by a determined wife stopped him from being given drugs to which he had already shown major allergies. Unfortunately, this is not an atypical example.

General practitioners need an exceptionally wide perspective and breadth of knowledge, but such breadth is only feasible at a nonspecialist level, so one cannot expect perfect diagnoses for more exotic conditions. In this instance, modern technology offers some advantages, as a cautious Web search of conditions that match one’s symptoms may actually offer more detail and diagnosis than one could reasonably expect from a doctor who is seeing a different patient every ten minutes.

I also have a personal criticism of the apparent attitudes of the medical system in that there is an emphasis on trying to use drugs, surgery, and all the other medical advances to treat patients to prolong life. For me this is often totally wrong, and the priorities should be to maintain the quality of life, not the length. I have had a number of friends and relatives who have said that the treatments of terminal conditions were not worth the extra few months that it might have achieved. In some cases, they consciously stopped treatment because of this. This is not an unusual situation, but it needs determination and family support.

 
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