Liam Farrell: GPs are the great constipators of healthcare

The BBC headline was stark and as usual, without context: 'Early warning signs may have been missed in up to one in six people who died of a heart attack in English hospitals.' This report was based on a study from Imperial College London (so it must be true).

A spokesman for the Royal College of Physicians (so it must be true) said, ‘Education of GPs is essential if we are to improve even further the care we offer to patients having a heart attack.’ You can’t beat Ivory Towers when it comes to handing out advice to those of us at the coalface.

Apparently we are missing out warning signs such as anxiety, coughing and wheezing, dizziness. and back pain. This list, of course, would just about cover every patient we see during a morning surgery.

I can’t recall any obvious missed diagnoses, but I’m sure I’ve missed a few in my time because, you know, I’m human.

Conversely any doctor who has never missed a diagnosis is probably referring too many and squandering the already stretched resources of the NHS. The obvious solution is just to send everyone in for investigation.

But the truth is that the buck stops with us GPs, we have to have the courage to manage our uncertainty; ‘Our doubts are traitors/And make us lose the good we oft might win/By fearing to attempt.’

We are the Thin Red Line, a pudgy, middle class Horatius at the bridge. If healthcare were a bowel movement, we would be the constipation.

Because freedom isn’t free; the price is eternal vigilance. I may be only a small soldier, but I am still a soldier; the war against unreason and wasted resources is unending.

Our’s is a thankless duty, yet no less noble for that. If a deed is valiant and brave, does it matter that the minstrels do not make a song of it? We stand between the candle and the darkness and if we slumber, the soft underbelly of hospital medicine and drug budgets would be swiftly disembowelled.

Yet we family doctors do not begrudge them their innocence and ignorance. We don’t brag, we don’t wear robes or hoods, we don’t need the validation of academic processions or gaudy pageantry.

We don’t need these superficial things because our cause is just and our bonds run deep, deeper than mere sex; we are the few, the happy few, we band of brothers.

For us, every day is St Crispin’s Day.

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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