We should adopt "American attitudes" with our GPs

*How does socioeconomic status affect access to a medical career?
People from lower socioeconomic backgrounds are underrepresented in medicine, according to our survey of the UK’s doctors in training*

These are the results of a survey undertaken by the general Medical Council and published in November 2013

''This year, for the first time, we asked the 39,000 doctors in training who completed both their secondary education and medical degree in the UK five questions about their socioeconomic status.

Our key findings from the report on socioeconomic status show:

65.0% of doctors in training have a parent or guardian who completed a university degree or equivalent
a third (33.7%) went to private school and nearly a quarter (23.7%) went to selective state schools
11.5% grew up in households that received income support
8.3% received free school meals
6.3% grew up in the most deprived areas of the UK.
The results give an indication of the socioeconomic profile of doctors in training in the UK and suggest that people from lower socioeconomic backgrounds are underrepresented in medicine.''

Be more like the Americans, hhmmmn......... I have often thought I would like to go in with all guns blazing when I see my GP, trouble is I would shoot first and ask questions afterwards.

I remember seeing a documentary about a HUGE free clinic in the USA being run by a British doctor. The queues to be seen there ran round the building. It was all people with no health insurance as a result of poverty and included people with advanced cancer who had had a diagnosis but couldn't afford treatment. It included a young mother with a simple cancer that could have been successfully treated but was now terminal because she had been unable to afford the treatment.

We should always work for the improvement of the NHS - and some terrible examples of poor treatment within it have been revealed in the last few years but we should be on our knees thanking, whoever we thank, that we have a free health system in this country that treats all regardless of economic status and in most cases gives them the best possible treatment available.

Watch Michael Moore's documentary "Sicko" to see how ghastly the American healthcare system is.

How about people who are no longer employed, DeeS, and have reached an age where they need more, not less healthcare? Without their previous income, they are less able to pay the premiums, but more likely to have to make use of the resources they can no longer access?

Hi DEE < are you a Newbie ? Not seen you post before ?

Here in the US, we have a wide range of what health care looks like primarily based on what payment system is used for the meds or treatment. In California one of the highest rated systems is an HMO, Kaiser Permanente. It's expensive and many people have this coverage through their employers. Alot of preventative services are offered. You do have to go through a primary care phsycian to get referral to specialist but they are generally pretty accommodating. I've always been satisfied with my care with Kaiser and when I wasnt pleased with a doc it was very easy to get that changed. On the other hand, its alot about meds and there is an increasing share of cost for eveything.
Every year, the cost of Kaiser insurance has gone up at least 10% a year and some years as much as 39%. Affordable Care Act and Covered Caliornia is mostly going to help people with pre-existing conditions and limited income.

Well, I read that on average every patient sees the doctor 11 times a year and someone must be making up for the roughly 10 I miss each year. Even DH, who has high blood pressure and mild diabetes only sees the doctor 4 or 5 times a year.

I wonder if this figures included visits to the nurse?

We all get older from the day we are born, Eloethan?

My grandma is very lucky to have had the same GP for almost 30 years. He was a newly trained doctor when he first met her ( and my late grandad) and has looked after her ever since. I know she is very fortunate and that he is probably a rarety these days but he always has plenty of time for her and often makes himself a cup of tea during his visit.

I, on the other hand cannot even name "my" GP whoever he or she is!

In the "I" today there is a headline "Young patients without a GP add to growing pressure on casualty units", going on to say that the bulk of attendances were by people under 29 who made up 43 per cent of all visits to casualty.

But then it goes on to say that a report by the NHS Health and Social Care Information Centre says that "The increase was driven by improvements in data quality, but also by rising demand from the ageing populations." I'm confused - if it's largely younger people attending A&E what has this got to do with the ageing population?

Ooops Anno- I hate the way one can't edit on this site. Sorry. BMJ Jan 2014 of course.

The article talks about 'normal' General Practice- and no mention of drug addiction or real mental health problems- although of course it must play a part. Ask any GP and they will tel you about those patients who come again and again, for no particular reason- and same for emergency dept.

granjura it is apparently a reflection of the relatively poor services for people with mental health problems and drug addiction.

So that's a prediction, then?

Source Jan 2024 BMJ.

Now a slight diversion, but sobering figures:

It is estimated that 'frequent' attenders cost the NHS a staggering 15 billion a year- enough to fund NHS London and bigger than the divisive proposed cuts to welfare. Some people attend emergency department (for non emergencies...) 50 times a year, and many patients (usually with no specific or serious ailments, but fatigue, sleep disorders, etc) once a week on average at their GPs too. In Ye Olde days when those patients saw the same doctor every time- this could be kept in check to some extent- but now patients often see another doctor- each will request tests, prescribe, etc- which is a/ bad medicine and not good for the patient at all and b/ hugely expensive.

3% of patients in general practice generate a conservative estimate of 15% of the workload, and recieve 5X more drugs and tests than other patients.

Incredible.

Apparently it does take a lot longer, honest.

Really good to hear your daughter has her head firmly screwed on, hope she gets better soon.

It takes no longer to say 'no' than to say what is being prescribed, why and how to take it and what to avoid. Most patients are usually quite content to accept a doctor's decision if they decide not to prescribe. Of course some patients will disagree, and some will be right, but the opposite also occurs; doctors prescribe and patients do not want the medication.

DD is still receiving treatment for an accident 2 years ago, during that time she has three times been told that she needs further major surgery, only to be told later that a more minor operation may suffice or in one case that the operation will not be necessary. She has never felt any desire to push for a major operation if the surgeon thinks a minor one may suffice.

Thank you Margaret- same here in Switzerland. Operating pays- waiting and seeing if it gets better by itself, without the invasion and dangers of surgery- does NOT. Another reason why the good old NHS as was was so much better. But to explain why it is better to wait, why it is better not to have antbiotics, why vaccination for Measles makes sense, etc, etc- takes a lot more time and dedication- and brings no money in. If your GP or Consultant advises waiting and not over medicating, or over-treating- it mya well be, in most cases- because they know from study and experience that it IS THE BEST solution- and nothing to save money for NHS or threshholds, or whatever.

A lot more operations and investigations done in private systems- and not always for the best, that is for sure. One of the best (or worst) examples of this is prostate cancer in the elderly- where aggressive treatment and operation often make things much worse rather than better.

Germany leads Europe in Operations for knees and backs. Most slipped discs get better by themselves but it takes many weeks. They would rather you had a MRI or CT scan than take the time to ask a few questions.
if you are a private patient here, you get far more treatments, most of which are unnecessary. DH was offered magnetic treatment for his shoulder - to pay for himself of course. He asked our GP for his opinion. He said 'you can either have the treatent or throw 300 Euros in the bin. its your choice' and then both laughed.

It takes a lot lot longer to explain to a patient why it is NOT a good idea to prescribe antibiotics (or other medication, tranquilisers, etc), or why it is best to wait and see and NOT to jump in and operate- and some patients will always take NO as BAD- rather than see that NOT doing something is often the very best treatment, and NOT just to save money.

When the DSs were little, we had an Egyptian GP, trained in the US, who liked to prescribe antibiotics for every sniffle. I eventually decided to ask for another of the GPs in the practice who were less cavalier in their approach to prescribing.

Eloethan, an excellent post. Over testing, over prescribing- is very lucrative in private system. And so is over operating! If your GP or specialist tells you it is best to wait and see- rather than go in with invasive surgery- it is usually because it makes total medical sense. But there is no money in it, is there? All the GPs I know agree totally that mixing payments for certain treatments, etc, has totally destroyed faith and trust in the NHS- and that it is totally tragic. My OH grieves for the NHS he left behind- and although totally and absolutely dedicated to it for all his life- is really, really glad he has now retired and left this total mess behind. It is so sad, and much worse.

I do not understand all this fuss about doctors refusing drugs where they are not necessary. The first time a doctor saw me and said he would not prescribe drugs because my recovery was well underway was 40 years ago and a variety of doctors since at three different surgeries have decided not to prescribe drugs for me on various occasions. I can only think of one occasion when I queried this and after further discussion I was given a further five days prescription for antibiotics. Other friends and relatives tell me their GPs are equally slow to prescribe so I assume most doctors must do it.

My DD2 is a micro biologist and I am always surprised how open her GP and other consultants are with her. They open up and discuss the pros and cons of treatment etc. In her preganancies she got up to date information, and was even asked what she thought.

I decided if I ever move house and need another GP I shall register myself as Dr XX and perhaps get some relevant information instead of being pushed into the little old lady corner.

When I told my GP my medication didn't last 24 hours he said it did, it was stated in his files. So I told him that DD2 had told me that to get that 24 hours lasting period in the trials 15 % were less than 24 hours and 15% were over that.
After that he accepted it but I wish he had just believed me.
Still we don't really want the American system. I prefer the German one anyday but can't speak for the NHS.