Liam Farrell - The odds are stacked against GPs in this race

When I was at medical school in Dublin, myself and a few buddies used to skip lectures, bundle into Mickleen Og's little Datsun and go racing.

Fairyhouse, Kilbeggan, Ballinrobe, those names still bring it all back to me; carefree youth, the smell of cigars and cheap whiskey, the rustle of beaten bookie's dockets, the schadenfreude when Patsy's winning jackpot ticket fell at the final fence. As La Rochefoucauld observed: 'There is, in the misfortune of one's friends, something not entirely unpleasant.'

To those of us who share a passion for the turf, the great racehorse trainer Vincent O'Brien was the nonpareil, a man with an unrivalled gift for choosing and nurturing champions. Gold Cups, Grand Nationals, Derbys - all were won by his unique skills. Legend has it that the great Nijinsky was picked out of a field of larger and more imposing animals; only a genius could see past the veneer of size and beauty and perceive the eye of the eagle and the heart of the lion.

We GPs need to possess the same skills as the great man. Every day we see hundreds and hundreds of symptoms begging for our attention, and identifying those which are going to develop into significant pathology becomes an ever more difficult task. Our hospital colleagues can have no concept of the huge morass of symptoms - all of them yelping 'Wolf!' - through which we have to wade. But, despite advances in medical knowledge and diagnostic technology, the situation is getting worse; significant illness is becoming harder and harder to diagnose, because the threshold at which patients come to see us gets lower and lower.

This has two consequences: the sheer numbers of patients and symptoms we see become overwhelming, and diseases present at an earlier and earlier stage, before the recognised clinical features have developed, and are therefore almost impossible to anticipate.

The more URTIs and headaches we see, the harder it becomes to pick out the real case of meningitis or subarachnoid haemorrhage. And no matter how diligently we apply diagnostic criteria, there is always the chance that one will slip through the net.

It's a gamble we take every day and the odds are stacked against us.


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