What qualities should a caring doctor possess?

30 October 2020

Antibiotic Prescribing During COVID-19

Do you feel the way I do about your antibiotic prescribing? Like many of you, I really miss seeing my patients face to face, and every day I feel that I haven’t done quite as much as I would like to protect this precious resource. I remember clearly when working as a locum one grandmother’s witty retort, when she brought her four-year-old grandson to me at 4pm on a Friday.

The child was slightly flushed but otherwise well and it was one of those moments during the consultation where I couldn’t quite understand what the patient thought they needed. I put it to her directly “Do you think he needs antibiotics?” Her reply nearly made me fall off my chair: “Doctor, if I wanted the child to have an antibiotic, I would have bought him a chicken from Safeway!”

While I can’t comment about her assertions of the state of Safeway’s chickens, I will continue to ensure that I prescribe as appropriately as possible.

The NICE guidelines on antimicrobial prescribing include a helpful table which is useful to download onto our work desktop computers and although we are all doing a difficult job at the moment, it is important we continue to protect antibiotics as much as possible.

We have discussed Point of Care C-reactive Protein (CRP) testing before and this week RCGP has announced its research paper of the year is on this topic. It has shown that “CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use.”

Importantly, there was no reported evidence of patient harm. It would be hard to replicate this research in our practices at present but not impossible. Please get in touch if you use Point of Care CRP testing in your practice - I would really like to learn more about your experience.

Time to care

Friday afternoons can be a difficult time for all of us, but not for me last week when I attended a fabulous conference discussing the ASME ERC Research Paper Award (2019) which was conducted by our colleague Dr Hannah Gillespie, with Professor Tim Dornan from Queen’s University Belfast. Hannah presented her paper on how to educate doctors to be caring.

If any of us thought about what qualities a caring doctor should possess, we could all give textbook answers of compassion, patient-centred care and so on. What impressed me so much about Hannah’s work was that she turned this question on its head and asked the people this matters most to - our patients.

To me, her findings can be summarised simply. Patients feel that doctors are caring when they are genuine. They do expect us to have advanced and appropriate knowledge, but patients know when a doctor’s caring is truly genuine. You can watch Hannah presenting her paper on YouTube. I thought this a fantastic finding and one we can all benefit from. Hannah has a bright future ahead of her and I look forward to hearing more about her career plans and future research.

Multidisciplinary Teams

We continue to highlight the importance of Multidisciplinary Teams (MDTs) at the highest levels. I have been so impressed with my own practice’s Mental Health Worker, Sam. She has seamlessly blended into our team and has a terrific “can do” attitude. Dr Ursula Mason and I met with colleagues from the Health & Social Care Board and Department of Health last week and we have highlighted that the process and criteria for the next Federation areas to go live with the MDT model is not clear, so we have asked for formal guidance.

Are you part of a Federation which has not yet introduced the MDT model? Are there questions you need answered to help you to prepare for when the time comes to introduce it? Please get in contact and we will see if we can help.

It is important the next Federation of practices is enabled as quickly as possible, so we do not inadvertently create inequities of service for our patients and inequities in practices where MDT areas are deemed as more attractive places to work.

While we are on the topic of MDTs, could I please ask that any practice who has an MDT in place ensure colleagues are recording all consultations, including telephone consultations? All teams should have frequent huddles and catch-ups over coffee time so please raise this important issue.

I will be representing you at the regional MDT Evaluation Board which has another meeting soon, and to ensure the success of this important scheme it is vital we have all activity recorded. 

Quality improvement

Quality Improvement (QI) is one way of helping us to not only provide best practice, but to critically and objectively analyse what we are doing and see how we can do it better. It is not “just another job to do” but a way to make our practices more efficient thus making our working lives easier.

We are very lucky in RCPGNI to have two amazing QI advocates Dr Philip Lusty and Dr Caren Walsh. I look forward to linking up with Philp, Caren and Dr Louise Sands to develop our College vision for QI in Northern Ireland and see how we can help you introduce QI in a simple way which will hopefully help to develop some measures to make our lives easier. Philip recently brought a great paper from Scotland to my attention, which is the best guide to all the various QI tools I have ever seen - it is definitely worth checking out.

Have you performed a piece of QI work that you are particularly proud of? If so, we need to hear from you

The annual Health & Social Care (HSC) QI Awards have been launched and have a separate award for general practice. It is important that we show off what we can do and hold our place in the wider HSC, so please speak to your team and get involved. It would be great if any of our MDT practices had a project in mind to highlight the services these teams can offer. To find out more please visit the HSCQI website.

Post-COVID-19 syndrome

We are encountering more and more patients who have made a safe recovery from COVID-19 but are still experiencing long term effects, long after the acute illness has abated. Post viral fatigue is a well-documented potential complication of all flu-like illnesses but we know very little about the diagnosis, cause or treatment of a post-COVID-19 syndrome.

We also still do not fully understand the full implications of the virus and must be mindful of the impact it could have on our patients’ lives where it could affect employment and so on. The most commonly cited symptoms of this condition are “brain fog” where patients complain of an impaired thought process.

NICE are due to publish guidance on this soon and we have been invited to feed in to it, so please feed back to me if you have any thoughts on this subject. The most helpful website I have seen is this NHS resource on COVID recovery and if you have any other information sources on this important topic, please feedback so we can share with each other. 

Cancer diagnoses and services

I have just completed my own findings for the National Cancer Diagnosis Audit (NCDA). The hardest part of my data collection was sitting down and getting on with it, but the whole process was relatively straightforward. I look forward to finding out more about how my results tie in with the NCDA findings more generally. My initial observations were that my practice was good at referring quickly to a service, but some of my own records could have included more codable data, including patient symptoms in the history function. There was a glaring need for improved efficiency in respiratory medicine, with several patients referred via Red Flag with clear lung cancer findings on CT who were appointed to a clinic rather than fast tracked to bronchoscopy.

I hope the findings of this audit can help improve services. RCGPNI Executive Member Dr Gerry Millar has led on a fantastic new development in the Southern Trust to establish a new scheme to allow GPs direct access to request CT chest scans. If you are a GP in the area and use this service, please feedback to me and we will see if this welcome new scheme can be rolled out across the region and help to improve survival in this deadly disease.

Engaging with medical students

Last week, Ursula presented at the Queen’s University Belfast GP Society meeting on GPs with Special Interests, sharing information about the role of the College and how we provide support for members throughout their careers. The society has a great series of podcasts with interesting and helpful topics for students with Castbox and Apple formats available.

They are a useful source for undergraduate medical students and I was also glad to hear the Jolly GP podcasts have restarted after a break. They are a great resource for our speciality trainees and First5s particularly, and I really enjoyed listening to them this week while doing a gym session. You can access via Podtail if you are interested. 

Click and Connect

On Friday 6 November we are hosting our ‘Click and Connect’ meeting. I will be available on Zoom from 13:00-13:30 and as with previous meetings the format is very informal. Please drop in for three minutes or 30 minutes - I would love to catch up and hear how you are getting on in your practice and see if there are issues we can help with

Post written by

Dr Laurence Dorman, Chair of RCGP Northern Ireland

Dr Laurence Dorman took office in November 2019 after three years as Deputy Chair of Policy for RCGPNI. A GP principal in Mourne Family Surgery, Kilkeel, Co Down, since 2007, he is the fourth generation of GPs in his family. He was also, until recently, the Chair of Newry and District GP Federation. 

Laurence has particular interests in new ways of working in primary care, cancer care, and inspiring the next generation of GPs. He set up the successful Dear Colleague initiative to improve the interface between primary and secondary care and has been a strategic advocate for interface and communication since September 2017.

During his time as Chair, he wants to support College members to ensure that the future of GP services is protected, supported and sustainable.

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