GPs are used to dodging media bullets but the latest round of fire came from an unlikely source in the form of The London Review of Books.
Why The London Review of Books? Were there no more books left to review? Did an editorial meeting took place where some bright spark who wants to get ahead in publishing said, ‘I know a brilliant way to get more readers – we’ll have a pop at GPs.’
What actually happened was this: GP Gavin Francis wrote an essay on the harms of cash-for-diagnosis in dementia – a thoughtful piece on why doctors need to make diagnoses based on an individual's interests and not because the GP gets £50. Fair enough. We've already been round and round that one and this isn't what this article is about.
But Francis was fired on by Professor June Andrews, nurse, academic and dementia expert from the University of Stirling. Responding to Dr Francis’s essay, Andrews wrote, “The sooner someone sues a GP for failure to diagnose (dementia) as early as possible, the better.” (Scroll down to the bottom of the essay in the link where you can read the letter in full).
Unlike the days of print journalism, once a story starts on the internet, it's the beginning, not the end. There was the inevitable Twitter storm from GPs. Andrews decided to erect a virtual barricade against them by blocking them, including BMJ columnist and GP Margaret McCartney.
Then it was Pulse's turn, who ran an article on Andrew's statement last week. This ignited a bushfire in the comments section which is proving difficult to put out in the face of GPs who have already been globally warmed up enough by other things, thank you very much.
Any practising GP who sees patients will tell you that not every person wants a diagnosis of dementia. Those patients in a muddle but still just-about coping; that person whom the receptionist phones in the morning to remind them of their appointment – well, they don’t all want it socked to them.
We've all seen patients curling up like a leaf at the suggestion of going to the memory clinic. Give them a 2 week cancer referral, a stroke or failure of another major organ and they’ll usually take that on. But dementia? Well, not everyone is all that keen on being diagnosed asap.
Few people are 100% bad and that includes Andrews, who did take up Gavin Francis’ subsequent offer to spend a half day with him as a GP. Courageously she also stepped into the croc-pool of commenters on Pulse. (Someone should have told her – there ain’t no waders high or thick enough to save anyone's skin in there.)
Andrews, in her responses in Pulse, does make a few valid points. Making a diagnosis will make a difference to some people – if it means they can be signposted to services (presuming they exist). Or the patient might still be driving and be unsafe. GPs are also a large and diverse group, half of whom will be below average and some will get inevitably it wrong.
But what she failed to accept is the problem of the actions she proposes in stating that GPs should be sued. Sued? Litigation is already costing the NHS £1.3 billion per year. Medical defence premiums are one of the factors driving GPs away from the NHS.
Litigation is shown to increase GP stress and anxiety and make them practice defensive medicine. Is this really what we want to promote in an already beleaguered profession?
Some patients who have experienced harm do need financial compensation, for example to cover care costs. That will apply to some dementia patients too. But too often litigation is driven by vexatious individuals who simply think that this is the best way to teach someone a lesson rather than help them learn.
Andrews seems passionate about helping people with dementia and most GPs care too. Wouldn’t it be better to find ways of doctors and nurses working together for a common purpose instead of promoting new ways to punish each other?
If suing GPs is what Andrews wants, maybe she would be happier promoting the dementia cause by moving to the litigious land across the pond. Might as well – because by saying that patients should sue their GPs, then there might not be any of them left on this island if we promote bitterness between clinicians as a value we want to uphold.
