GPs need to get their house in order

Private, FAMILY doctors, or at least their association, feel that their work is not "entirely understood in its complexity and not fully appreciated by both patients and the public". Ah, shame, my heart bleeds.

I hope that at least their wives/husbands understand them.

Don't get me wrong, I think that on the whole doctors are good people and perform an onerous task. But when they start whingeing about their work complexity and not being appreciated, I start to wonder.

First of all, the public knows them through the patient/doctor relationship. The majority of the public fall ill at some time in their lives.

And as Dr Martin Borg, the spokesman for the association, told The Times, "the private family doctor is very frequently the first point of contact when a patient falls ill".

Therefore, the service delivered and attitude of the doctor are what the patients' (public's) impressions are based on. If a doctor is brusque and patronising and does not give the patient information, s/he is not likely to be appreciated, or seen as a "friend". Dr Borg specified the latter as important in the doctor's role.

On the other hand, a doctor who respects his patients' intelligence is appreciated and respected.

When people are ill enough to call a doctor, or need attention at a clinic, they are so grateful for the service that I find it hard to believe that they do not appreciate the doctor's work. It is only when a doctor, maybe because of too heavy a workload, behaves as mentioned above that patients lose respect.

Dr Borg says "very frequently" and "private, family doctor", because some people do make use of the public General Practitioner (GP) service. Long queues and waiting time are the main reasons why some people give up on the polyclinic service.

But it is not the only reason. A family doctor, as the name implies, infers intimacy. S/he is someone who, sometimes, knows more about you than your own family, and who is expected to be available when you really need him or her. (I am not talking about people who expect doctors to be on call for every little ailment.)

Another implication of a "private" doctor is that you pay to get a better service. Therefore, patients are entitled to expect more from the private, family doctor.

And here lies the rub. As Dr Borg pointed out, "the phenomenon of solo practices, where doctors practise on their own, is instilled in our culture. This means that if a doctor is ill or needs time off, the clinic is closed."

But although the association "is aware of this problem, it does not see a solution in the near future," Dr Borg said.

Now how can a doctor consider him/herself a family doctor, when s/he does not arrange an alternative service when they are not available, for whatever reason?

That is the kind of thing that concerns the general public.

Doctors are not supermen or superwomen. They get ill, have their own family needs, go on holiday and have time off for seminars, etc. No one expects them to be individually on call 24/7.

But what the patient/public expects from a private, family doctor is that there is someone at the end of the line in an emergency, which does not require an ambulance and hospital attention.

You do not have to be dying, or seriously injured, to be very ill and require medical attention.

People who have lived in countries where a "family practice" is the norm, or who watch the soap Doctors, on BBC Prime, know what a good family practice entails.

The chances of getting hold of a family doctor to call, if someone falls ill enough to be unable to move, either late in the evening or at weekends, are minimal if not impossible, at the moment here.

The aims of the association to "establish minimum requirements for a private family doctor's clinic" and set up an after-hours service, which Dr Borg said were on the association's agenda, are admirable.

However, this will not be a philanthropic venture. "The ultimate aim is to quantify the real value of what a consultation costs, whether in a clinic or a home visit," Dr Borg said.

He quotes the practice, in Holland, whereby a family doctor giving a "consultation" over the phone charges half the fee of a "face to face" visit.

Dr Borg complains of time taken up by phone calls during surgery hours, i.e. the time they are seeing patients. This frequently disrupts an ongoing consultation with a patient, "robs the doctor's time" and could also be detrimental to other patients, he said.

So what does that tell us? The most important factor is that the doctor is "robbed", and a secondary negative outcome is that it "could also" be detrimental to other patients.

First of all, taking calls during a consultation is downright bad manners, which shows disrespect to the patient in front of the doctor. Secondly, it shows bad management.

Calls to doctors during surgery hours should be filtered, and only the urgent should be put through. Besides, as a matter of courtesy, the patient present should be asked whether they mind the doctor taking the call. After all, the patient is paying for the time, so if anyone is being "robbed" it is s/he.

Good management suggests that a time either before or after the doctor is seeing patients is allocated to returning other patient calls. Which means that doctors have to have a responsible person to take the calls. Someone who can evaluate how urgently the patient needs to talk to a doctor, and then allocate a time when the doctor can talk to him or her.

Many people already have to pay for the chair they sit on while waiting to see a private, family doctor. Okay, so it is the pharmacy that charges for the chair. Those who charge are obviously not content with the profits they make on medicines bought on their premises.

But the doctor chooses to have his clinic in a pharmacy that charges his patients for the privilege of waiting to see him or her, so they do have a responsibility towards this practice.

What I would suggest, to people who are charged for waiting in a pharmacy (clinic), is that you buy your medicines elsewhere, preferably somewhere where patients are not charged for waiting to see a doctor.

Pharmacists who charge for waiting time need to know that they cannot have their cake and eat it.

Dr Borg mentioned other points which should concern the public. He implied that when doctors refer patients to hospital, they do not get any feedback on the patient from the hospital.

I found that incredible. Just like I find it incredible that some doctors do not even keep notes on their patients. That is something which the Health Ministry should correct a.s.a.p.

"Family doctors are never consulted in any discussion regarding future health care reforms," Dr Borg said.

Of course Government should consult GPs on health reforms; it is astonishing that they do not. But, it would also help if doctors, not just the ones with political ambitions, got involved in politics in the wider sense. Lobbying, for example.

How many doctors lobby for change on government policy when it comes to affecting the nation's health?

Had the medical profession as a whole been more vocal on the damage caused by smoking, it would have been banned in the workplace, restaurants and other public places a long time ago.

And are doctors lobbying about air and noise pollution? I know some do, but very few.

Alarming levels of dust have been reported, which are bound to affect public health. What is the private, family doctors association doing about that?

The summer season will soon be with us and so will the festas and their nerve-racking petards. Will the PFDA be lobbying for their control?

The health care system in this country is not a bad one, but there surely is room for improvement, and it is essential that private, family doctors get their house in order.

phansen@timesofmalta.com