What It's All About

Jim came to see me yesterday afternoon.

He has a mixture of Chronic Obstructive Pulmonary Disease (COPD), and Congestive Cardiac Failure (CCF) secondary to his Ischaemic Heart Disease (IHD).

Jim is always short of breath, but has been more so of late. He is seen occasionally at the hospital, but more often by Dr Phibes.

When he goes to the hospital, he is often recommended a change in medication, with a further appointment in 3 to 6 months time. Jim is one of those patients who is intolerant of a large number of medications, and he often comes to see me shortly after a hospital appointment saying that the latest change is causing intolerable side effects. Yesterday was no exception.

As I looked back through his medication history, we discussed possible alternatives.

"Dr Phibes, you're making this up as you're going along aren't you?" said Jim.

"Yes." I said. We both started laughing at this point.

But there are a couple of serious points that arise from this.

There are people who say that GPs are failed consultants, only able to deal with coughs and colds, and needing to refer everything else on. They say we don't need GPs, and that everybody should be able to refer themselves straight to a consultant, or could be seen by a nurse. Jim's case is complicated, but the bulk of his management is done by me. There is no way he could be seen purely by a consultant because of the frequency he needs reviewing. And there is no protocol or algorithm that a nurse could use to manage him adequately, hence the "making it up as you're going" comment.

This type of consultation is, in fact, the real bread and butter of General Practice. In the view of Dr Phibes, General Practice is much more about managing chronic diseases, than acute illnesses.