Back as GP after 15 years

This time last year my wife and I were here. It's Milford Sound in the South Island of New Zealand. Click on it and get a fuller sized picture.

May the 8th, 2006, I started back as a general medical practitioner. I hadn't seen a patient for a year and a half and I hadn't been in a GP surgery for 15 years. It's now August. I am no longer drowning but I am concerned. I have spent a zillion hours catching up and I have a zillion more hours to go. The steepness of the learning curve has been steep and is now a wee bit less so.

Guidelines have been my saviour. They are everywhere and on every subject. Most of them bang up to date - well compared to textbooks. And they are free. Anyone can get their hands on these if you know where to go. Have a poke around this site. It's the New Zealand guideline website.

Now that the curve isn't so steep I can take my time. Look here. And then take a look in here and before you go to far take a look at the members of this organisation. There are a lot of MDs and PHds with major concerns about where we are going with cholesterol. Maybe the whole theory is suspect. Is this going to turn out to be a major embarrassment?

There are similar issues around diabetes and hypertension - truths being stretched and stretched so more people are included in various treatment guidelines. So much work and skill required to sniff out the BS.

I still have a lot to learn. My diagnostic skills are reasonable and getting better. I enjoy this bit - interacting, taking a history, examining and finding out what is going on.

But treating people in a paint by picture manner, this I find distasteful. We will, in time, regret this top down, treat all to benefit a few approach. When the benefit is perceived to be huge - immunisation - about 80% cooperate. But when a relative risk benefit of 40% is found to be an absolute benefit of 1% - hmmm - I somewhat doubt anywhere near 80% will be coming to the party.

Take a peep at the table below - click on it to enlarge it. How convinced are you now? Yup the author may well have an agenda - check him out. He is in one of the sites I gave you above.



Take a few moments to read this table. I am not a stats man. Read it and you'll get it. There's a lot of effort going on for little gain.

What about the 50 year old man, I saw today, visibly deteriorating as he waits and waits in pain for an operation to replace his hips. We can fix him but by the time we do, he may only be half the man he used to be. He tells me he reckons his wait will total a year or more. His surgeon tells him he could have it done in two weeks if he paid for it. Pain has a soul destroying impact on folk and so does an ever decreasing mobility and a system that tells this man he has little value - suck it in and wait Buster.

Treat 100 of these folk and benefit 90% - now that's a worthwhile treatment. Why deny it to those who need it? Why pump and pomote hugely expensive treatments that will only benefit a few - maybe!