The Witch Doctor is having a little rest just now.
So am I. The two of us have temporarily faded away.
But, unlike The Jobbing Doctor, we will be back!
However, as an obedient witch’s cat, in view of the fact that NHS 111 is hitting the headlines once more, I have been asked by The Witching Community to un-vaporize for a moment or two and re-spew a post that featured here at the end of March about that afore-mentioned outfit and other related phenomenon.
Here it is :
WAITING FOR APRIL FOOL’S DAY:
My Black Cat is reminding me that they brought in people like window-cleaners to man the ‘flu helpline a few years ago.
The Witch Doctor thought this was ridiculous at the time but supposed there was a bit of a panic and they had either run out of qualified people to do the job or they were not prepared to pay a professional wage.
The new NHS111 service is due to be rolled out on April Fool’s Day. Who on Earth would be witless enough to roll out a new service like this over the Easter Holiday weekend? That speaks volumes.
According to Jobbing Doctor, those triaging patients are likely to be “trained” teenagers employed on low wages.
“Lets have a single number that can be used and services can be channelled through this. We don’t need expensive nurses to run it any more, we can now have barely trained teenagers to do it on the minimum wage. National standards, uniform quality, cost effective: what’s not to like?
The answer is just about everything. At least the nurses had a modicum of training in medicine to fall back on: the teenagers won’t. There will be a culture of covering your a*** in this system where any departure from the easiest algorithm will be met by “Call an Ambulance” or “Visit your doctor within 6 hours”
The Witch Doctor totally and utterly disapproves of doctors participating in telephone consultations apart from in circumstances that are well-defined and exceptional. It should never be considered best practice. In the past she herself has initiated a telephone consultation service in such well-defined and exceptional circumstances and so she knows a little about the advantages and limitations of such a venture. She can, however, think of no circumstances when it would be safe to use a routine telephone consultation in an emergency or out of hours setting. That means she does not approve of NHS Direct, NHS 24 nor any similar service manned by medical staff, nurses, or lay persons. These services up till now have been telephone consultations that generally do not in the first instance involve a doctor although the conversation with a nurse may well direct the patient towards seeing a doctor in a face-to-face consultation.
But doctors creep.
The General Medical Council creeps.
The government creeps.
It has gradually become OK with doctors, the GMC and government to employ “others,” untrained in medicine, to follow algorithms in order to make a diagnosis without seeing the patient. However, algorithms, although useful in certain circumstances as a type of personal “Aide Memoire” are really only a way of propelling a patient down a “pathway” which takes them on a “journey” which may or may not lead them to a proper face to face consultation with a medical practitioner. It may or may not lead them to an accurate diagnosis. In this witch’s view, an “Aide Memoire” whether it be a reminder such as putting your shoes on the wrong feet, tying a knot of string around your finger, or peering at an algorithm on a computer screen should always, in the case of making a medical diagnosis, be used in conjunction with full medical training and experience. The medical training The Witch Doctor received involved spending time with the whole patient, not just a distant voice. It involved taking a full medical history followed by examination.
This too has crept. It is a rare thing for a doctor nowadays to have enough available time to take a full medical history and do a proper examination.
This is Bad Medicine.
It is very easy, especially when time is limited, to put the tick in the wrong box that leads to a patient embarking on a journey along a path whose destination is disaster. Sure, the qualified medical practitioner may get it badly wrong during a time limited face-to-face consultation but at least, in these circumstances, there is somebody in charge who has professional responsibility for the error or malpractice.
Who exactly would be responsible if a wrong turning is taken by a teenager / student / window-cleaner / nurse employed from April Fool’s day by NHS111?
Nobody of course…….
Just as nobody was responsible for Mid-Staffordshire……….
So, it seems things are now going from bad to worse in England.
However, The Witch Doctor thinks that the easily remembered single number 111 could be developed in such a way that it has an important function – an information resource only – a function that would not involve triaging patients in an out of hours / emergency situation utilising teenagers and others “trained” to play at being doctors and nurses.
My Black Cat has an idea to enhance such a “111 information only” service. She believes that many patients who own a computer would themselves be able to follow algorithms much more safely than “trained” teenagers or others who are not medically qualified. They would be able to take their time to do so. They would have more of a chance of answering the questions accurately. They would be able to have ongoing observations of their condition that may lead them down a different pathway. Many patients will be far more knowledgeable about many things including their own health issues than those “trained teenagers” and others supposed to be triaging them.
Is it madness having patients triaging themselves or ill relatives by using an algorithm to decide whether it is necessary to see a doctor?
But not nearly as mad as the Creep that is already happening as a result of the demise of medical professionalism carefully orchestrated by Alan Milburn – a previous, and very clever, Secretary of State for Health responsible for offering a huge financial carrot to GPs and consultants leading to a change in contracts. A change that opened the door to healthcare becoming a commodity.