Seemingly daily we read of GP misdiagnosis costing lives.
From long experience I would say this. First; understand that GP’s are, general practitioners with the emphasis on “general”. That is they can only really deal effectively with relatively minor obvious issues.
If a GP ventures into more specific conclusions but the problem persists, seek a specialist’s view. Over my life GPs have caused me a great deal of damage, mostly permanent and I bear the scars to prove it.
A few years ago, after pressing my eldest daughter to have a routine colonoscopy she raised it with her female GP and was told women can’t get bowel cancer.
We have the highest incident of female bowel cancer in the world, why being a mystery.
Not only that but women in their 20s are now being hit, including vegans. I mention that as for a time our high incident of bowel cancer was attributed to meat consumption.
My daughter had a colonoscopy and just in time, it revealing a host of polyps, some at a menacing stage.
Our universities continue to pump out law graduates, only a minority of whom will find employment in law. What a terrible waste of young people’s time this is.
To encourage more students towards medicine, why not pay their fees and hostel accommodation. Currently we rely on filching doctors from 3rd world countries with a need even greater than ours. But most of all we need specialists for in some fields such as dermatology there is a desperate shortage.
As a result the patient is obliged to rely on GP’s advice on something he or she is not equipped to give, often with disastrous consequences.
Any wonder why medical practices are called practices. Overall, totally agree with your assessment.
Otago University is turning away very bright A+ students every year from Medical School. For the past 2 years they have admitted about 80% Maori and Pacifica students, so no room for non-Maori and Pacifica. My mate who is 3rd generation Chinese-Kiwi had his daughter turned away after getting A+ passes. Reason given was no room – you’re the wrong colour!
While a degree if intelligence is needed to understand the biology and chemistry associated with medicine, it does not necessarily follow that the brightest will make good doctors. Inter-personal are very important. In my experience, the brightest, of which I am one, are often lacking in this regard.
Problem is Max there are double standards at work here. Preferential entries make up approx 150 of the 200 pre-med course entries, There is no equity in the system. Kids with negligible Maori or Polynesian make-up and who may have enjoyed a super privileged life and education get an armchair ride whilst another kid who may have worked an awful lot harder and comes from a very low socio-economic background has no chance. There is no account given to these considerations in the selection process. Med schools are only interested in ticking boxes. Pref entries need achieve only approx 75% to get accepted. Yet the balance are selected almost solely on grades and needing to average well into the 90s. If it follows that 75% exam results are suitable to make a good doctor then why not evaluate the few remaining on a wider selection criteria? But yes NZ needs hundreds more medical graduates – seems brain dead we cant ramp up the numbers.
We have a large number of people wanting to train to be doctors, but simply not enough capacity in medical school. I hear stories of very bright people missing out because scores in the mid-90s on the first-year examinations are not enough to secure a place in the actual medical schools, such is the demand.
The other reason for the ongoing shortage is that the medical profession is largely a closed shop and protecting the incomes and status of its members by insisting on a high bar for entry is the main way they achieve this.
If red meat was the issue the Argys would be worse than NZ. They are thinking nitrates may be causing it, which makes sense in NZ with amount of nitrogen we put on farms and those nitrates finding it into our drinking water waterways. They probably should study if the incidence of bowel cancers in rural areas is higher?
In respect of GP’s from my current experience of a child looking at a medical career, there is little to enthuse them with 5 years of study , large debt , slave labour with long hours and finally age 30 before becoming a GP with a lifetime of unhappy ,sick clients. Our situation was not helped when a trainee doctor applied and was our childs math tutor. She was trying to earn some extra funds as the 12 hour a day, 7 days for two weeks in a row was not earning her enough. Needless to say any child with enough clues to be a doctor, wonders WTF. Luckily for NZ the children of Indian and Chinese immigrants are choosing prestige over reality and will apply for the medical places at Uni. Otherwise we would be stuffed.
Its hard to blame GP’s as an aging and overweight population means all sorts of unusual medical ailments are now commonplace. GP’s are also having to fight against Dr Google and the decline in antibiotic potency.
Furthermore they are constrained by becoming quasi-government employees with all the paperwork and financial constraints this brings.
Perhaps worst of all-GP’s are relying on patients to accurately describe their symptoms-something that must be infuriatingly vague at worst and only modestly helpful at best.
No surprises then that many GP’s privately think Harold Shipman wasn’t such a bad guy.
The best thing a person can do-eat well, excercise regularly and take advantage of regular checks for the types of disease mentioned above.
Wholly agree about funding med students-so long as their is a quid pro qo on working in NZ.
Argh-should say “There is a quid pro quo” … I hate making basic stuff ups.
Maybe GP’s find it hard to say..”I’m really not sure. I don’t know”…and instead guess? My sister and brother-and-law are pharmacists, and they tell me doctors make f* up’s all the time. I’m under the impression that ego really is a part of it.
My solution? Give everyone a master health file, online, that any professional can access with the patients authority. Include pictures and even videos when appropriate. Then, with humility, our GP’s can give access to the master file to the best specialists, who can then review the patients condition in maybe less than five (cheap) minutes from their homes – checking the diagnosis. Easy. Cheap.
If I’m allowed to include this, I will link more of my right-wing thoughts on vastly improving the health system here:
This would take a long essay so I will be brief.
All Doctors make erroneous diagnoses. regardless of GP or specialist status.
It is purely the nature of the Beast. The problem is not being open and honest about it.
The worst thing that has happened to the health profession in general is the Health and Disability Commission.
It has more in common with witch-hunting cadres of the same ilk as China in the Sixties. Struggle sessions and as much humiliation as possible for the nasty arrogant Doc.
That said, General Practice as it is, is a total fucking nonsense and soon will be gone. The first step will be nurse practitioners, or some version of the “Barefoot doctors” as happened in China from the 30’s onward. Leading up to the Long March.
GPs try and train themselves as some sort of specialty currently. Good luck with that.
The HDC and other pressures have meant that the GP has become some sort of risk-averse castrati manque.
The art of medicine is well and truly going under, and being given a good stomping.
Best advice. Stay away from the medical profession as much as possible. Especially as you get older.
( from a former GP)
While your panacea is one solution, Sir Bob, it does not address the significant loss of talent overseas after graduation.
As they say, only doctors and drainlayers bury their mistakes.
Yes, lost my daughter at 22 due to the medical profession being unable to diagnose her rare but treatable disease despite both her mother and later her over a period of seven years or so doggedly trying to get to the bottom of things before the catastrophic event which resulted in her death.
Moral of the story for me- if symptoms persist insist on tests. If the physician won’t take things seriously, go somewhere else, and keep going until an explanation is gained. Too often it seems, particularly with women, symptoms are dismissed too lightly.
There’s a few big problems with medical school intake: It is insanely competitive to get in – many candidates and only a couple of hundred places. So to get in, an applicant has to be a flat-out A+ out of school, or qualify in one of the special admission categories such as Maori/Pacifika or rural.
Then, many of them decide on graduation that either they don’t want to be a doctor, or they prefer to take their valuable taxpayer subsidised degree abroad and make more money for less work.
The rural admission preference was there to encourage more doctors to go work in rural areas. However getting in on the category doesn’t mean the graduate has to go back to pokesville. They can head off to Sydney like the others!
It is such a small sized intake, they should be putting a lot more effort into the selection process.
Since GPs were corporatised and forced to join one of the supervising HPO (?) organisations, they have to conform to the ‘guidelines’ and get the consultation done in the 10 minutes or so allotted.
When GPs ran individual practices, answerable only to the Medical Assn, their patients and themselves, they could get to know the patients and their history/family etc and so be aware when something changed. Not perfect but generally worked well as the human touch was there.
Once corporatised, the patients became just products in the production line, and all else flows from that.
I’ve done best by staying away from the medical system as much as possible. Yes, an early diagnosis might save me in some situations, but the risk be being killed by the system is lower. However many years I might or might not have, I don;t want to spend them reading 10 year old magazines in waiting rooms and the old body being prodded and modified to meet the current short term theory
Great post. What an inspiration.