GP Charging - Is this normal?

cuckoo

Reading this thread i now have a new appreciation for my GP - cheaper follow on visits, and often times freebie on the phone advice, eg "if it doesn't clear up by Wed, ring me between 9 and 9.30am and we'll discuss if you need a new prescription, then you can just pick it up, or if you need to come back in again to see me".

Tbh, i have a lot of sympathy for GPs in terms of what they're expected to do, and the way that a lot of people must be nightmare customers. I used to live opposite a GP, and the same faces would be going in again, and again, and again..... While i understand that some people do have ongoing health problems, there seems to be two extremes in Ireland - there are some medical card holders who treat the GP's surgery as a social club, and then there are those private patients who save up three or four ailments per visit due to the expense.

mad m

I have never paid again if I went back about same complaint. Even the secretary said it to me as well.

Thoie

sam34 wrote: »

as regards referring onto someone else - whats wrong with that? they are still providing a service to you, and as such are entitled to charge for that

What's wrong is the fact that often your GP (certainly in Dublin) won't actually refer you to a specific specialist. The last few times I've needed a specialist the doctor has written me a referral letter, stating what I've just told him, then I have to go ring around various hospitals/clinics asking for a private appointment. So I'm paying him €60 to write what I've said in bad handwriting on a bit of headed paper.

In other countries (Switzerland, for example) if I know I need a specialist (for an ongoing condition, for example) I can just call up, make an appointment and just pay the specialist - saving myself the €60 for the original letter.

I have an ongoing condition that requires a basic test every 2 years. Because this is outside their magic one year rule, every two years I have to go to my GP, get a referral from him (€60), then get an appointment with a specialist x months later (€180), then get a hospital appointment for the test (€80 last time). I'm given the all clear at the hospital at the end of the test. Why can't I just phone the hospital and pay the €80, instead of wasting my time and an extra €240 for two people to write me letters that I've just dictated?

As an idea, why don't doctors charge by the minute? Let's say the average doctor sees 7 people an hour, at €60 a pop. So if they charge €7 a minute, then getting the pill renewed costs €14, but spending 30 minutes telling the GP about your child's school results when you went in with a mild sore throat costs €210. It would help clear out the waiting rooms as well as people wouldn't be so eager to sit down and chat. If people objected to that, they could have a system whereby Mon, Weds and Fri are "per minute" charging, and Tues/Thurs are set fees. If someone's suffering from depression and needs to talk to the doc for 40 minutes, they'll probably be still suffering from it 2 days later. If you want a new prescription, you can organise to go on the "fast" days. It would also spread the stress on doctors over the days as well - they know they can write off Tues and Thurs for paperwork, but will probably get time to do it the other days.

cuckoo

Thoie wrote: »

As an idea, why don't doctors charge by the minute? Let's say the average doctor sees 7 people an hour, at €60 a pop. So if they charge €7 a minute, then getting the pill renewed costs €14, but spending 30 minutes telling the GP about your child's school results when you went in with a mild sore throat costs €210. It would help clear out the waiting rooms as well as people wouldn't be so eager to sit down and chat. If people objected to that, they could have a system whereby Mon, Weds and Fri are "per minute" charging, and Tues/Thurs are set fees. If someone's suffering from depression and needs to talk to the doc for 40 minutes, they'll probably be still suffering from it 2 days later. If you want a new prescription, you can organise to go on the "fast" days. It would also spread the stress on doctors over the days as well - they know they can write off Tues and Thurs for paperwork, but will probably get time to do it the other days.

That's an interesting idea - although, I think that there could be a slight issue in that people would be going in with a specific budget in mind, and would be getting anxious if the doctor wanted to ask lots of questions. It'd be like a taxi metre in the corner of the surgery - if the GP paused to look something up in a reference book would the metre stop?

The faster customer is suffering due to the standard charges, it's like an airline charging the same fare to New York as it would to Shannon. My GP asks on the website to request a longer appt if you think you need it (don't know how much extra it costs), but dosen't mention the option to book a quickie.

My main annoyance about GPs is how few of them are open in the evenings, even one late opening a week would be convenient for everyone who needs to get routine stuff done and dosen't want to take time off work.

Thoie

cuckoo wrote: »

That's an interesting idea - although, I think that there could be a slight issue in that people would be going in with a specific budget in mind, and would be getting anxious if the doctor wanted to ask lots of questions. It'd be like a taxi metre in the corner of the surgery - if the GP paused to look something up in a reference book would the metre stop?

True - maybe cut it down to "timed" visits 1.5 days per week. If I just want to renew a prescription, I'll go on a fast day (and as most long term prescriptions are monthly that gives me ample opportunity to go on a fast day). If I've got, say, "a pain in my tummy" where I know the doc will need to ask a lot of questions, prod me a bit and try determine what kind of pain, and where, I can go on a standard day.

tallaght01

It's a difficult argument. I firmly believe that all healthcare should be free. But I've also lived in the UK where there's free health. I've worked in the NHS.

A) It's a dreadful service

It gets abused to hell

Free healthcare won't solve our woes. You should see the rubbish that people come to the GP with in the UK, because it's free. It's a trade off. You'll wait 3 or 4 days to see a GP in the UK. You'll see one straight away in Ireland if you want to.

A consultation takes 10-15 minutes on average. At 55 euros a visit, that's a GP making maybe 300 euros an hour. That's assuming they're all private patients. Depending on your catchment area, many of these patients will be medical card holders. That has to pay for his/her MASSIVE insurance. It has to pay for their property, their secretary, the couriers for your blood test and the day to day costs of running the practice.

Don't get me wrong, GPs in Ireland can make good money. But they should. They're a private business. The government has elected not to pay for universal healthcare. So you pay a private provider, your GP. You'll pay 180 euro or thereabouts to see a private consultant. You'll pay as much if not more for an accountant, solicitor, plumber, dentist. Why should your doctor be any different?

When you're seeing your GP, you're getting a highly trained professional. They've spent 6 years at med school. They've then done about 5 or 6 more years working up to 120 hours a week in the public hospitals, getting treated like crap, before they start the process of becoming a GP. They have worked in cardiac units, paediatric wards, intensive care units and maternity units, aswell as doing time in psychiatry and surgery and other specialties. After this, they do their GP apprenticeship, and then usually work with an established practise before eventually outlaying huge amounts of their own money to invest in a business that provides a service that the government should be providing to it's citizens.

If you want to get an idea of what those 5 or 6 years are like, then read the entry in our blog (linked in my sig....the blog entry is called "the hours", and it's written by Dr. Jane Doe). It would shock most people. I saw a junior doctor just crying last night. For no reason other than she was physically exhausted, and couldn't cope. She sat at the desk in the middle of the ward. The ward carried on it's business as normal arond her. They're used to this. It doesn't upset their routine anymore.

There's another point I'd like to make, and it won't be popular. Your GP has probably worked what is essentially slave labour in the public sector. Working up to 72 hours on the trot, soetimes without getting any sleep. These are the people who see your sick baby at 4am when you bring him/her to A+E. They were very possibly getting paid less money than anyone in the hospital for doing this job, depending on their age (it's only fair to point out that junior doctors are now paid much better than they were previously).On top of that, you truly honestly would not believe the dog's abuse that you get as a junior doctor seeing sick people.

You can have 5 or 6 people trying to die at the same time, you're on your own, and then when you finally stabilise them you go and see the person with a minor chest infection, and they throw a wobbler because they waited a long time to see you. This happens all the time. I'm a hospital doctor. I recently spent an hour resuscitating a premature newborn who got ill as I was going to see a kid with a skin infection in A+E. It took me and the team an hour to stabilise the baby. I then went and gave the other kid a cream for his skin and solved his problem. I apologised to his parents for the wait, and explained the reasons. They wrote a huge letter of complaint.

How do we expect people whoo've been on the receiving end of this kind of thing for years and years to keep a sense of loyalty towards the public when the public don't care that these youngsters work slave labour so that they can access 24 hour care? Someone above talked about his socilaist credentials. Where are the socialists when these young people are being driven to exhaustion and often mental illness, because we want 24 hour healthcare? It's no accident that doctors have such high suicide and mental illness rates.

Why, now , suddenly, does the guy who's left the hospital system to become a GP because he just can't take it any more, suddenly have to feel a debt of gratitude to the public. I can see why he says "I've given up my 20s, for a tiny wage. Now that I've a bit experience, and am pretty skilled, 55 euro is my fee. I don't care if your sore ear is the same one you came to me with last week. Your lawyer still gets paid if you got to jail. I'm still charging if your illness turns out to be complicated".

I think if a GP earns 150k or more a year, then they deserve it. You might think he's "going through the motions". Doing the routine stuff is not the big deal. The big problems arise when you're blood pressure is a bit off kilter. Or when your blood tests are a bit off.

If we want to attract the brightest and the best to medical school, simply allowing them the privelege of spending the best part of their adult years working slave hours simply won't be enough of an incentive.

I'd better stop or this will never end :P

tallaght01

Thoie wrote: »

In other countries (Switzerland, for example) if I know I need a specialist (for an ongoing condition, for example) I can just call up, make an appointment and just pay the specialist - saving myself the €60 for the original letter.

That would be the worst thing int he world. I can tell you as a hospital doc working in a specialist service, I would do everything in my power to avoid a system like that. I do paediatrics, and I constantly get calls from people at work who want me to see their kids with all kinds of minor ailments. It just attracts the worried well, who would get as good a servive from their GP.

Plus the public are in no way equipped to know what type of specialist they need in most cases. For your chest pain, do you need to see a cardiology doc? or an orthopaedic doc? Or a respiratory doc? Or even a psychiatrist?

cuckoo wrote: »

My main annoyance about GPs is how few of them are open in the evenings, even one late opening a week would be convenient for everyone who needs to get routine stuff done and dosen't want to take time off work.

Why should the GP stay open every week, because you don't want to take time off work, say, once or twice a year? Most of these GPs have well and truly served their time in out of hours work for the public. I see a lot of the stuff in A+E that people just can't be bothered taking time off to see their GP for. And even then, I'd be against it, depsite the fact that it would make my life a lot easier.

parsi

tallaght01 wrote: »

T


Why should the GP stay open every week, because you don't want to take time off work, say, once or twice a year? Most of these GPs have well and truly served their time in out of hours work for the public. I see a lot of the stuff in A+E that people just can't be bothered taking time off to see their GP for. And even then, I'd be against it, depsite the fact that it would make my life alot easier.

That's just plain wrong. The hard training many years shouldn't be used as the reason for everything else. It's not as if they are being asked to do it for nothing.

A lot of folk cannot get off work for doctors visits without being docked pay. An appointement may be for 3.10 but you may be waiting for 40 - 50 minutes. It is a good suggestion that a practice changes the hours so that on a certain day it accepts evenening appointments. This would seem to be good customer service and also an ideal way of drumming up business.

A GP that started an innovative practice with innovative hours and a reliable appointments system would surely make a bomb.

(btw: Not all use couriers for Blood Tests - twice my doc has asked me to drop them in on my way home after my appointment....)

tallaght01

parsi wrote: »

That's just plain wrong. The hard training many years shouldn't be used as the reason for everything else. It's not as if they are being asked to do it for nothing.

A lot of folk cannot get off work for doctors visits without being docked pay. An appointement may be for 3.10 but you may be waiting for 40 - 50 minutes. It is a good suggestion that a practice changes the hours so that on a certain day it accepts evenening appointments. This would seem to be good customer service and also an ideal way of drumming up business.

A GP that started an innovative practice with innovative hours and a reliable appointments system would surely make a bomb.

(btw: Not all use couriers for Blood Tests - twice my doc has asked me to drop them in on my way home after my appointment....)

It's not neccesarily only about their training. It's also about the fcat that they've worked many many years of almost continuous out of hours work. Most would be happy to see out of hours emergencies. But that's not what they end up seeing.

The question always asked by GPs is why is your right to work 9-5 5 days a week more important than his or hers. You're only likely to need a GP for routine stuff once or twice a week, but you're aksing them to give up 52 evenings a year.

They also ask will people be happy with them closing for a few hours during the day to make up for it.

They also want to know if people will be willing to pay the increasd costs (say the GP and his secretary get time and half).

Having said that, my local GP in Dublin opens until 6 most nights, and til 7 one night a week.


People now complain about all of the above.

parsi

tallaght01 wrote: »

The question always asked by GPs is why is your right to work 9-5 5 days a week more important than his or hers. You're only likely to need a GP for routine stuff once or twice a week, but you're aksing them to give up 52 evenings a year.

What ?

The public are suggesting that GPs hours should be more flexible. They are not being asked to "give-up" anything. They'll still get paid. They don't necessarily need an after hours secretary.

What about my right to be seen at the appointed time and not a hour later ?

tallaght01

parsi wrote: »

What ?

The public are suggesting that GPs hours should be more flexible. They are not being asked to "give-up" anything. They'll still get paid. They don't necessarily need an after hours secretary.

What about my right to be seen at the appointed time and not a hour later ?

LOL at "hours should be more flexible" not being the same as giving up your evenings :P

Who cares about getting paid, when you're paying a cost in terms of your family. I'm sick of seeing my colleagues going through relationship breakup after relationship breakup, and never seeing their kids. When they leave that crap to become GPs, they're sacrificing bigger money to have a life.

On top of my normal working week, I work a 15 hour shift every thursday and a 15 hour shift every 2nd sunday. I'm lucky to be of a seniority where I get well paid for it. But next january, I'll be dropping those shifts like a hot snot when I get my promotion. We have lives too.

What about your right to see your solicitor or bank manager or accountant out of hours?

Most GPs don't run an appointment system. Those that do should stick to it. If they don't then go elsewhere, just like you would with any other business.

parsi

tallaght01 wrote: »

What about your right to see your solicitor or bank manager or accountant out of hours?

One professional group at a time...

pickarooney

Lollipops23 wrote: »

i have actually "saved up" minor complaints for my next visits!!i know the french health system is one of the best in the world,but apparently it is crippling their economy as they are the worst hypocondriacs around!

Annoyingly true. The oul wans with their phantom tummy-bugs and insistence on branded drugs added to the lightweights who run to the doc for a stubbed toe will end up destroying the system for everyone.

While I really appreciate not having to pay for a visit or for most prescription medicine, it's horrifying to see the wastage that goes on with brain scans almost de rigueur for headache complaints and weekends in spas funded by the government for the most spurious complaints.

They've made small steps like refusing to pay for non-generic drugs and requiring everyone to have a named doctor who is the only one allowed to refer to a specialist, but there needs to be some system which forces people to pay for essentially wasting doctors' time and the people's taxes.

sam34

i second all of what tallaght has said.
nobody wants to work evening shifts... doctors have families and social lives too, but the general public dont seem to appreciate that.
when i was a student i was doing an attachment with a gp for 2 weeks, and staying in their house. their practice was part of a gp co-op, so the area had an on-call out of hours system. yet, without fail, every single evening, and many of the nights, people would still call up to the gp's house (which was not where he had his practice) asking for "a quick word" or a prescription because theyre running out or.... it was nightmareish for him and his family. i later heard that they had moved to a different town because of it.

Thoie

tallaght01 wrote: »

That would be the worst thing int he world. I can tell you as a hospital doc working in a specialist service, I would do everything in my power to avoid a system like that. I do paediatrics, and I constantly get calls from people at work who want me to see their kids with all kinds of minor ailments. It just attracts the worried well, who would get as good a servive from their GP.

First off, I appreciate everything you've said about the life of a GP. I'm not a doctor myself, but went through college with a number of close friends doing med, and saw first hand the effects of the junior system, and the GP training etc.

Going back to the idea of being able to make an appointment with a specialist without a doctor's letter. I still don't see what's so bad about it. If someone wants to spend €180 on a paediatrician to look at their child's tummy ache cos he ate too many sweeties, what of it?

There are certain things wrong with people (me, for example) and they know what the problem is, their doctor knows what the problem is, and they both know that they need to see a particular kind of specialist for it. Taking two half days to first see a GP and then see the specialist seems a bit crazy when most of the time I could write the letter myself (Dear Blah, Thoie is presenting with blah blah which has been blah blahed on that date and that other date. I'd appreciate if you could investigate the current occurrence of blah).

If I wake up with a vaguely sore arm I'm still going to go to my GP to get his opinion on whether it's a heartattack or a pulled muscle from the heavy thing I lifted yesterday, or maybe a break from where I fell out of bed this morning. If I fall over and hear a loud crack and half my arm is hanging sideways, I'm going to go to A&E or Swiftcare, or somewhere they can x-ray it because I know my GP will take one look and say "you'll need to get that x-rayed". If I have a nasty cough with green phlegm, I'm going to go to my GP, not to a pulmonologist.

I suppose this is all a very roundabout way of saying "let the layman see a specialist if they want to". After a few €180 visits to a specialist to be sent home and told to wrap up because you've got a cold, I reckon most normal people will start appreciating that €60 to see a GP isn't so bad. People will start making damn sure they're not needlessly wandering off to a gastroenterologist just because they feel a bit queasy.

killbillvol2

The bottom line here is that you're paying for a service which involves a great deal of expertise. You'd pay more for a plumber to look under your sink.

By the way, there's no such thing as "free" healthcare. It's paid for from taxation. How much would you be willing to pay on top of the current rate of income tax?

My GP charges €50, has never charged me for a repeat visit and has a surgery 3 evenings a week as well as every morning. His communication skills need some work and the receptionist is a weapon but I'm happy enough with him. If I wasn't I'd change. This country is not short of doctors.

tallaght01

Thoie wrote: »

.

Going back to the idea of being able to make an appointment with a specialist without a doctor's letter. I still don't see what's so bad about it. If someone wants to spend €180 on a paediatrician to look at their child's tummy ache cos he ate too many sweeties, what of it?

There are certain things wrong with people (me, for example) and they know what the problem is, their doctor knows what the problem is, and they both know that they need to see a particular kind of specialist for it. Taking two half days to first see a GP and then see the specialist seems a bit crazy when most of the time I could write the letter myself (Dear Blah, Thoie is presenting with blah blah which has been blah blahed on that date and that other date. I'd appreciate if you could investigate the current occurrence of blah).

If I wake up with a vaguely sore arm I'm still going to go to my GP to get his opinion on whether it's a heartattack or a pulled muscle from the heavy thing I lifted yesterday, or maybe a break from where I fell out of bed this morning. If I fall over and hear a loud crack and half my arm is hanging sideways, I'm going to go to A&E or Swiftcare, or somewhere they can x-ray it because I know my GP will take one look and say "you'll need to get that x-rayed". If I have a nasty cough with green phlegm, I'm going to go to my GP, not to a pulmonologist.

I suppose this is all a very roundabout way of saying "let the layman see a specialist if they want to". After a few €180 visits to a specialist to be sent home and told to wrap up because you've got a cold, I reckon most normal people will start appreciating that €60 to see a GP isn't so bad. People will start making damn sure they're not needlessly wandering off to a gastroenterologist just because they feel a bit queasy.

It's not as simple as that.

Going to see the paediatrician because your kid ate too many sweets stops me seeing a properly sick kid. Well, when I say "me", I don't literally mean me, as I don't do private work. But you get the point.

Secondly, there can be big, but subtle, differences in the letter your GP sends for, say, your tummy pain to the gastroenterologist.

You might go to your GP with abdominal pain, and think you could write the referral letter yourself.

However, your "tummy upset" might read in the referral letter as...

Thoie is a 55 year old smoker who presents with recurrent worsening GORD symptoms for the past 3 months. They seem resistant to PPI treatment. He reports occasional dysphagia on questioning, but is not particularly troubled by this. On examination today, he has moderate hepatosplenomegaly, some subtle musle wasting and stigmata of anaemia".

Immediately your gastro doc is taking the message that you have cancer of your oesophagus, and you get an appointment in 2 days time for a scope.

Similarly your letter might read

"Thoie is a 55 year old overweight male who presents with his third episode of prolonged diarrhoea in 2 months. He reports less energey than before, and some weight loss, which he attributes to recurring stomach bugs. He has had a few episodes of breathlessness recently. There is no melaena.No other family members have been unwell with gastroenteritis. There is no significant family history. On examination of his abdomen there is no organomegaly, but PR examination reveals a craggy 4X4cm mass, that is non tender. He has conjunctival pallor."

You may have wrote a letter to a gastroenterologist, regarding your recurring tummy bugs. Your GP has written that letter to a surgeon,though, as he knows you have colon cancer. You will be seen on wednesday.

If he writes

"Thoie is a 30 year old healthy male with recurring GORD symptoms and occasional recurrent diarrhoea. He feels well, and leads and active life. He has put on some weight recently, and has a good appetite. There is no blood in his stool. He has no dysphagia. Thoie has been under a lot of stress recently, with the breakup of a long term relationship. On examonation today, there are no abnomal findings. His abdomen is normal, with no tenderness, masses or organomegaly. PR examination is unremarkable. PLease arrange to see him in your clinic at your earliest convenience"

..then the specialist knows there's not alot wrong with you,a nd you'll be given the next available routine appointment.

It might just seem a like a letter to you, and you may think the above examples are silly. But what I have written will fill the inbox of doctors all over the country every day. Many lives have been saved, by the subtle messages sent in those letters between colleagues.

You can tell the difference between an obvious emergency and a non emergency (although most A+E docs will refute that), but sometimes it takes a trained eye to spot the more subtle signs of a problem. For that reason, it's important that we keep appointments free for people who are actually sick, so they can be seen quickly.

Thoie

tallaght01 wrote: »

It's not as simple as that.

Going to see the paediatrician because your kid ate too many sweets stops me seeing a properly sick kid. Well, when I say "me", I don't literally mean me, as I don't do private work. But you get the point.

True. I suppose I was looking at things from a purely capitalist viewpoint and thinking "If this was the way of things, then more people would train to specialise". There'd be an obvious ramping up period, but it would require a complete overhaul of the way the medical system works in Ireland. Nonetheless, it does work in Switzerland, and I've never seen Swiss headlines of "Critically ill kid waits 6 months for appointments while others get seen for tummy aches".

tallaght01 wrote: »

It might just seem a like a letter to you, and you may think the above examples are silly. But what I have written will fill the inbox of doctors all over the country every day. Many lives have been saved, by the subtle messages sent in those letters between colleagues.

I've got a letter from my GP in front of me that I'm to give to a consultant next week. Other than "Thank you for seeing the above pleasant lady" (which may be code for "she didn't kick me when I hurt her" - I can't really see a reason for it), the rest of the letter is pretty much what I've have said myself, except I'd have spelled the word "history" out fully

the_syco

Thoie wrote: »

Going back to the idea of being able to make an appointment with a specialist without a doctor's letter. I still don't see what's so bad about it. If someone wants to spend €180 on a paediatrician to look at their child's tummy ache cos he ate too many sweeties, what of it?

I'm waiting for about 4 months to see a certain specialist, referred to by a doc. The doc doesn't have a private practise, and is the only one of his type in Ireland. So yeah, I'd have a large problem with someone going to him rather than their local doc for something that they don't know the cause of, only the symptoms of.

Thoie

the_syco wrote: »

I'm waiting for about 4 months to see a certain specialist, referred to by a doc. The doc doesn't have a private practise, and is the only one of his type in Ireland. So yeah, I'd have a large problem with someone going to him rather than their local doc for something that they don't know the cause of, only the symptoms of.

Yes, but see my post above - if there was a free market, maybe 10 other, or 100 other doctors might go on to specialise in that area?

As I said, things couldn't change overnight - it would take years for there to be an adequate supply of specialists in whatever because the training takes time. It takes 11+ years "just" to become a GP (from scratch).

tallaght01

Thoie wrote: »

Yes, but see my post above - if there was a free market, maybe 10 other, or 100 other doctors might go on to specialise in that area?

As I said, things couldn't change overnight - it would take years for there to be an adequate supply of specialists in whatever because the training takes time. It takes 11+ years "just" to become a GP (from scratch).

There is a free market, essentially, in Ireland. No specialist can't get work in a private clinic.

I know that, far from encouraging any docs I know from going into a specialty, giving the public free access to specialists would deter people from going into a specialty.

Switzerland has more than twice the number of doctors per head of population than Ireland, too.

sam34

i worked in a service which had free access. it was a psychiatric unit, and people could just walk in off the street with no referral, and theyd be seen on the spot.
it didnt work well.
it was abused to high heaven and back.
people would walk in looking for repeat prescriptions... now, they couldnt figure out that you couldnt rely on what list of meds they told you, so you'd have to dig out the chart from records and go through it. imagine this happening 20 times a da, while you are on call and dealing with the 50 patients on the ward, plus the calls from a&e, plus teh calls from the general hospital about their patients with psych problems, plus the gardai phoning to say theyre on their way in with someone...) this "just a prescription" takes up precious time that you dont have.
the best thing to do to discourage this, would be to refuse, each and every time. but if you refuse, youll get the sob story. or youll get the "but i'm suicidal" threat. (which had never been mentioned prior to your refusal, in fact they'd been saying "im fine doc, im just out of the tablets")

thats just one example of how that practice was wrong.
you would also get the crowd who thought it was the latest thing to have a "shrink", and expected a spot of on-the-couch analysis.
and you got people who would have been managed perfectly well in the gp setting, and did not need psychiatric care.

i realise that psychiatric services are different to general medical/surgical services, but still i would oppose a system whereby the patient dictates who they see

sondal

There is some excellent insightful posts already said about GP's and fees. I fear that while 90% of young Doctors are caring professionals, a good few I met are only interested in the financial gain and status attached. It is very annoying going to see you GP, pay out €50. Then there is over a 50 50 chance that you will only be seen by his or her substitute Locum on a follow up appointment. The Harney think tank Primary Care Roll out was supposed to bring hundreds of Doctors together in out dated Surgeries into new state of the art Medical Centres. These would open at 7.30am and close at 8pm. The staffing was never thought out, so it is more likely you will see a Locum when your own GP is away. In regional towns this is a major problem, and if you see your own GP its a bonus to get 15 minutes for the €55 fee.
The previous posted comments on all the 7 years training plus are fine. However if one looks at any GP over 45 years of age, I bet a huge majority need retraining on how to prescribe new medication. Lots of GP's have no emotional side, are too inflexible and reluctant to ask the difficult question to the patient. A good majority have been enticed by vested interest and the extra sum for practicing beside Pharmacies. Too many Doctors have got involved in developments during the celtic tiger years and have left their Surgeries to be staffed by various foreign Locums who will work in Ireland for €70.000 a year. How many Doctors still have their GMS lists but who no longer practice? How many Doctors spend all their time in academia instead of seeing patients. How many have become unskilled, that when they are prescribing an impotence pill, they have to go through their big blue book for the various drug company suppliers.

Thoie

I still want to know what "the above pleasant lady" is code for

Is the consultant going to ask me out on a date? Ask me to babysit his children? Tell me jokes? Cos that'd be kinda cool. Sadly I think he's going to prod me and tell me something I already know. *sigh*

sam34

Thoie wrote: »

I still want to know what "the above pleasant lady" is code for

Is the consultant going to ask me out on a date? Ask me to babysit his children? Tell me jokes? Cos that'd be kinda cool. Sadly I think he's going to prod me and tell me something I already know. *sigh*

it means just that- that you are pleasant! if anything, it probably means that you are exceptionally pleasant . when i get a letter with that written, i get some (small) relief knowing that the patient is going to be pleasant and not antagonistic, in-my-face, obnoxious, ranting about the health service (like i can influence that :rolleyes:) etc etc.

its when the letter says "thank you for seeing this lady" without the "pleasant" that you need to worry (nah, not really, some people just put the minimum in a letter)

sam34

sondal wrote: »

How many have become unskilled, that when they are prescribing an impotence pill, they have to go through their big blue book for the various drug company suppliers.

gp's dont know everything, they cant know everything. whats important however, is firstly, being aware of what it is you dony know and knowing your limits, and secondly, knowing where to find the information you need.

theres nothing wrong with looking up the MIMS or BNF (which is what i presume you mean by "big blue book") to clarify a dose or side effects.

sondal

sam34 wrote: »

gp's dont know everything, they cant know everything. whats important however, is firstly, being aware of what it is you dony know and knowing your limits, and secondly, knowing where to find the information you need.

theres nothing wrong with looking up the MIMS or BNF (which is what i presume you mean by "big blue book") to clarify a dose or side effects.

I agree Sam34. Nobody says GPs know everything. In my experience too many male GP's over 50 seem a bit out of date, and dont seem to realise. Say a gp takes a career break then arrives back at their surgery a few years, are they exepected to just start where they left off in 2005, or do they do a masterclass course on prescribing, read all the medical journals and intrinsic periodicals. I dont think so. Some GPs seem to take the opposite view (again in my opinion) having been away from day to day patient matters. It seems lots of GPs take breaks to join other organisations to futher their career financially, learn all the buzzwords and jargon which slowly creeps into the newfounded conversation. All you have to do is see all those GPs that have jumped on the HSE gravy train, and issue us mere mortals with their plagiarstic know it all vision and half baked truths, then at the same time refer to themselves as ordinary GPs. I would rather see a young Irish graduate from UCD or Trinity anyday

sam34

sondal, i really have no idea what youre talking about. what is this hse gravy train? why do gps tell "half baked truths"?

im not being smart with you, i genuinely dont know what youre on about

Lynott

After reading the posts above it seems to me that those who take issue with GP's are people who have reason to visit their GP's more often then they would wish and those who are supporting GP's above do not have the same frequent bad luck with their or their families health. Also I would suggest that they are in a better financial situation and giving 60euro 'once in a blue moon' does not hurt their wallet. GP's high fees are never going to be a problem for high incomers.

deisemum

From personal experience I think GPs over here are far better than any of the GPs I had when I lived in London. Over there GPs along with NHS dentists really ripped off the NHS.

I do think GP visits are expensive but I think the care is generally much better.

If I have to go back to my GP if I'm not better after the 1st appointment I just don't pay and it hasn't been a problem.