Going green on natural gas heating. The economics don’t stack up.

Since the start of the pandemic my partner and I have been working from home 4-5 days per week.  We are fortunate enough to have a study that is large enough for two desks and, not being in a city centre, just about adequate broadband for us both to do simultaneous online meetings.

Since it’s started getting colder we’ve had the luxury of putting our imitation-coal gas fire on to warm the room. That saves heating the entire four bed house all day, and boy does it make the study toasty quickly. And so it should, as, according to the manufacturer’s data it’s putting out 3.8kw of heat per hour when on the max setting. Sadly, the manufacturers say it consumes gas that could produce 6.2kw of heat per hour on maximum setting. By their figures that makes it 61% efficient which is pretty poor in my book.

Early in lockdown we had the whole gas system checked as part of a routine service. The engineer reported this fire is only 49% efficient. Thank God the Glow-worm boiler is 98% his printout reads (is that really true?)

As someone who really tries to do my bit for the environment, I was pretty disappointed to hear that. The figures for modern glass fronted fires reach almost 90% so I considered swapping the fire over.

This blog is to try to see whether changing it to a new modern fire is economical or not.

I’ve considered if I’m using the fire in the study on full setting for an hour and then on the lowest setting for 5 hours on five days a week for say 20 weeks a year – November through to April that the costs would be akin to those in the table below. I’m paying 2.56p per kWh including VAT though OutfoxtheMarket.com.

Setting kWh consumptionCost in pence kWh inc VATHours per dayDays per weekWeeks per yearVolumeCost in pence
Total in £41.42

This seems a staggeringly low figure to keep us both comfortable all winter. Especially given the cost of replacing this fire for a new more efficient one would be around a grand.

I looked at the costs of the house’s gas consumption over all the time I’ve lived in it. The data shows we’re using about 2.82m3 per day, on average. To get the kWh rate from that you have to multiply this volume by a fiddle factor, 1.022640, and by the calorific value of the gas, usually around 39 and then divide all that by 3.6 to get a kWh. I calculate that to be 32kWh, at 2.56p for 365 days comes to a total of £300 per year for almost 12000kWh.

My consumption in summer months is negligible. I have solar panels and an iBoost gadget that switches on the immersion heater whenever the panels are producing more electricity than the rest of the house is using. In the summer the iBoost is generally working before I’ve got up and had my morning shower and it carries on all day providing free hot water all summer. The data proves it!

Clearly most of that annual use is heating water in the winter and heating the rest of our house whenever the temperature dips too much and only a small proportion is the study fire. If I changed the current model to a 90% efficient one I’ll be saving less than 50% of its current costs and so if that’s around £20 benefit a year it’s going to take 50 years to get our money back! Given I’m over the half century I think this one area I can’t be green unless anyone tells me my maths or the cost of installing a more efficient model are wrong. I know I haven’t included the potential resale value of the old one, but let’s be realistic, if it goes for £100 that doesn’t make a big enough difference for the economics to stack up of taking it out.

I almost booked a survey for a new one today, and then, I thought, I’ll just check the maths. Please tell me if I’ve got it all wrong.

Stay warm and stay safe.

Emollients in Schools

Lots of us are getting eczema from the incessant application of alcohol gel and soap we now have to endure. Both break down the natural oils in the skin causing it to dry out, get flaky, crack, itch and, if nothing is done, causing fissures and risking nasty infection.

But hey! Whilst life is difficult for us all some are determined to make it a bit worse. As the world is facing meltdown from the economic and mental-ill health effects of COVID-19 some schools are making life worse for themselves and their charges by declaring any child who needs to use an emollient for eczema must have it prescribed! That is, a doctor must sanction it’s use! For God’s sake!

An emollient is just another word for a moisturiser that I think every adult has used at one time or another, even if amongst tough blokes, it was only to sooth sunburn or when pretending to like massaging their partner whilst really hoping it leads to a shag. So let’s be clear: No-one needs their doctor’s permission to use a moisturiser or an emollient. Even young children can be taught to self-apply the stuff quite easily. Are there any women in the country who have not had it as part of their daily routine for much of their lives? The preventative or treatment use of emollients should be encouraged and there should be no hindrance to that, such as requiring a doctor to get involved.

That schools, in some parts of the country, have been requiring doctors to confirm by prescribing the need for children to use emollients for their sore hands is beggar’s belief.

Why would one (underfunded) public service saddle another (underfunded) public service with more cost is beyond me, though it happens repeatedly. Not only does such an insistence cause great inconvenience to parents and an inevitable delay in the kids getting something on their hands it dumps on the NHS the cost of a consultation with their GP or nurse practitioner, the cost of the emollient itself and the cost of a pharmacist dispensing it. Free all this may be, at the point of delivery i.e. to the child, but free, it is not. Every tax payer has to shell out, not to mention the parents in lost time and hassle. There is a real lost opportunity cost here because every time NHS staff time are used that time can’t be used doing something more helpful to preserve or treat the health of their patients. They could, for example, be phoning patients who have missed their cancer screening and trying to persuade them to have it, or supporting patients with poor control of their diabetes, or their drinking. But opportunities like this are lost when the clock ticks by doing something else. Remember we are at least 5,000 GPs short in England alone. You do know the quality of care in the UK, isn’t what it could be, don’t you?

If the NHS wasn’t spending around £47 million annually[i] on moisturizers prescription perhaps it could have coped better with the COVID-19 pandemic. Perhaps it might be able to recover services faster afterwards. Let’s remember all emollients can be bought without a prescription and I suggest if you can afford a car to take your cherubs to school you should buy your emollients yourself and the school should not need a GP to sanction your duty as a caring parent.

If you’re struggling to make ends meet then I’ll happily ensure your cherubs do get some emollient by putting it on prescription. The last thing I want is a child to suffer because their parents can’t afford to pay, what are sometimes outrageous mark ups on retail prices. If it helps here’s a CCG’s table of most cost-effective products. These are NHS prices so you can work out what the retail mark-up is when you shop. If your local pharmacy can’t be competitive go elsewhere, online if necessary though ensure it’s a reputable site. Just because your child might get free prescriptions don’t abuse the NHS if you don’t need to. You want it to be good when you really need it don’t you? You do? Well be a good citizen and don’t undermine it before that time comes. Ten years of austerity in the NHS have done that for you already, and the debt the country now bears is unlikely to mean the service is going to be ace anytime soon.

Luckily for some, CCG pharmacists have worked with the local authorities who have now advised schools that emollients do not need to be prescribed and should not be regarded as medicines. If you need support with such issues there are links here for parents and schools.

We still have to solve the problem of schools not being able to administer paracetamol to kids. Meanwhile the poor little buggers continue to burn up and feel shit until their parent or carer can get away from work, get to school, get them home and get some paracetamol in them. My God, when did we become such an uncaring society?

[i] https://openprescribing.net/analyse/#org=regional_team&numIds=21.22&denom=nothing&selectedTab=summary

Time to cut the cholesterol testing load

GPs and patients this is for you: Routine annual testing of cholesterol is a waste of public resources

There are hundreds of thousands of cholesterol tests being done in the UK under the guise of monitoring. I contend this is an utter waste of resources.

It costs way over £5 for every cholesterol test by the time the phlebotomist has been paid and the sample has been transported to the lab and analysed. It takes even more cash for your GP to process the result and the practice staff, if not the GP themselves, to discuss the result with you. That is rarely a good use of GP time if they’ve done it once before with a patient. Yeah, I know the GP is paid anyway but there are a lot of better things they could be doing with their time to improve the nation’s health and there are only so many hours in the day. If you’re not prepared to heed the advice the first time you get a cholesterol result why should the NHS use valuable resources checking your cholesterol each year? If you have an obsession with the numbers get it done privately and let the NHS spend money on things that will help the population more.

Why do I say this?

Well first let’s be clear I’m not saying that we shouldn’t have a cholesterol done ever. We probably all should. When that’s done is debatable. If we assume our lifestyles have settled into a consistent pattern by the age of 40, when our age and other risk factors start to have a greater impact getting a cholesterol between 40 and 50 is wise. But, please then act on the result, or decide not to and leave your GP and the NHS alone.

Live with your decision. Lowering cholesterol levels and reducing the impact on your cardiovascular risks is a long process so start early or decide to live life the way you want to and accept the consequences (premature heart and stroke disease, earlier cognitive decline, high blood pressure, kidney disease, peripheral vascular disease and impotence).

If you do act on your GP’s advice you should change your diet to reduce your carbohydrate and fat intake, increase activity levels if you can, lower your weight, temper alcohol intake and stop smoking. If you have high blood pressure take whatever your doc prescribes for that. It’s more important than a statin for cholesterol. If you’re not prepared to do these things forget worrying about cholesterol. It’s a low risk factor. It doesn’t have as much impact on your likelihood of developing cardiovascular disease as smoking, obesity, high blood pressure or a sedentary lifestyle, unless it’s very high. If you’re diabetic take that seriously. Diabetes is terrible for your heart and arteries but in Type 2 weight loss can reverse the diagnosis and the impact.

Your GP will use your result to calculate your risk of developing cardiovascular disease over the next ten years, the so-called Q risk. NICE advise offering patients a statin if their risk is greater than 10%. That means out of 100 people with the same risk ten people will develop cardiovascular disease over the next ten years. Taking a statin will reduce that risk by a third – so seven or so will still develop the disease and three will be ‘saved’. Unfortunately 100 people have to take the statin for ten years to achieve this incredibly small impact. But in health economics terms NICE reckon it’s worth it. Having a heart attack or stroke is very debilitating for individuals and can be very expensive for the NHS and society as a whole. A statin for 100 people for ten years costs in the region of £20,000 (the drug costs alone – not the costs in issuing the prescriptions or pointlessly monitoring cholesterols). The costs of treating three heart attacks or strokes will easily exceed £20,000 so you can see why NICE encourage it. Three hospital stays will probably cost this much and then there’s the additional drug costs for ever, time out of work and so on.

I’m not going to get into a debate about the pros and cons of taking a statin. In my book, as a GP, we all have the option of believing what others say about how good or bad statins are, what side effects they cause, allegedly, or just trying them out and seeing for ourselves. The vast majority of patients are able to take statins without any great side effects harm. That’s why you can even buy them over the counter now. In Yorkshire they say ‘You never get owt for nowt’. You decide if any symptoms you develop are due to the statin or not. Stop them. Your doctor doesn’t need to know if they’re minor. Do those symptoms go away? If they do, start them again. Do the symptoms come back? If they do, decide if you can live with them recognising there is a benefit from statins too. If you have bad symptoms, particularly muscle aches talk to your doc. It’s rare but statins can cause muscle breakdown that can be serious. I’ve seen one case in my 25 years as a GP.

There’s some evidence that the long-term anti-inflammatory properties they have might help more than we have recognised to date. I’m really not interested in what the media say about statins or your nextdoor neighbour. Try them for yourself and see, or don’t. NICE say they’re worth trying. That’s good enough for me.

NICE say we should aim to lower cholesterol by 40% from the original measured figure. That requires lifestyle changes too, not just swallowing the pill and carrying on hedonistically, though arguably you might be reducing what must be an even greater risk. But hey! Decide do you want a long healthy life or not? If not stop bothering us please.

Even with the drugs and lifestyle change the 40% is a tough target. After three months you should have had a check blood test. This is important to see both if your cholesterol has come down and whether your liver is coping with the pills. The liver does react to statins and we can detect this, if, the blood test is done. For the vast majority of patients, the liver reaction is not clinically relevant, i.e. it doesn’t matter. Keep swallowing the pills. If your cholesterol hasn’t dropped by 40% you have the option of taking a higher dose. It’s up to you. If you haven’t addressed, as Blur put it, your “pork life mate” then reconsider your priorities.

Once you have achieved a 40% reduction or, if you decide not to up the pills to get there, then just keep swallowing them for the next ten years, or don’t. It’s your choice. You should have a single further check of your liver at 12 months in and if that’s ok we refer to the treatment as ‘fire and forget’ or as some more frustrated doctors put it ‘fire and fuck off’ – we have better things to do than keep measuring your cholesterol level for your personal interest.

That firm attitude is because there is no benefit from measuring your cholesterol every five minutes or even every year. This applies whether you have a strong family history, have had a heart attack in the past or are diabetic. Your statin, will, if you are swallowing the pills, lower your cholesterol by the same amount all the time. What you consume will affect your cholesterol levels so don’t eat tonnes of fat or carbohydrate ever again. If you do want to do this think about why you’re bothering with the statin and what your priorities are.

GPs…ask the question ‘Are you taking your statin?’ When patients say yes – congratulate them – they’re good citizens given they’ve potentially less than a 1 in 30 chance of it helping them personally. When they say no, calmly take it off the repeat prescription list, exception code them in QOF and see if you can understand what they do want from the NHS. If we keep wasting resources it may not be there to look after them at all in the future. These are testing times, er but not of cholesterol! Stop testing!

The GP Appraisal System is Pants. Part 1.

“Pants” is the polite version. “Utterly pointless, demeaning, futile, bullshit” is a bit stronger. “One of the biggest piles of wank there has ever been in the history of the NHS” is more accurate. “One of the greatest causes of stress that GPs face and one of the largest losses to GP productivity that idiotic medical leaders have yet dreamed up” (and there are many) is a tragically true description.

It takes most GPs at least a week of normal working hours to fill the sodding forms in for themselves and their colleagues. That’s a week out of seeing patients, seeing their family or sleeping (as it’s often done late at night and early in the morning) just to get the crap done.

Let’s start with the section that covers feedback from colleagues.

Every five years we have to submit a (Warning NHS Jargon shite:) ‘360 degree survey’ by asking enough colleagues to rate us. I am in a small practice, thank God, but I still have to do several a year. This is also partly because I am such a old fart others who I vaguely know ask me to do one for them too. Usually I haven’t a fucking clue what they get up to in their consulting rooms but I have sympathy with them because if they don’t have sufficient colleagues they trust then they have to go wider just to jump this particularly futile hoop.

It’s futile because we are now into round two of (Warning NHS Jargon shite:) “Revalidation” from which I, like most of my colleagues, are burnt out. Well, to be honest we’re burnt out with the NHS full stop. Revalidation and 360 surveys are just two of the many straws that have broken us.

I have done tens of bloody 360s in the last 8 years or so. In the beginning I relished the idea of being able to anonymously tell certain colleagues I thought they were shit but the novelty soon wore off as it was hardly rocket science for them to guess who was being more honest than others. These relationships will almost certainly never recover and what bloody good for patients has that been?

Nowadays I am competing for the world record for the fastest time it takes to complete one. It does depend on whether I already have an account with one of the multitude of fee earning sharks that are capitalising on this bullshit at my and every taxpayer expense (- of course it’s a tax deductible). If I do have an account, the sequence is

  • get heart sink email from equally broken colleague,
  • click on link, hope the computer has remembered my password because I really cannot be arsed to reset it and…
  • Hey Presto! I’m in and ticking “fucking marvellous” for everything.

The speed of completion also depends on the speed of my internet connection and location when I complete it.

I managed one at home, where my internet connection is moderately good, in under a minute. The record at the practice is more like 4.5 minutes because NHS internet speeds are shite. It’s quicker doing them on my mobile driving home or cycling to the pub. Of course I would never ever do either. I have much greater respect for breaking the record and sometimes I have to watch the road.

All those who ask me get a 6, top marks, for everything. I am beyond quibbling on 4-6. Everyone I know works bloody hard and they would have to have seriously pissed me off to score less. I give no-one free-text comments in the hope they will give me none back. Otherwise the knobhead appraiser will want me to reflect until the end of time on the banality of “Dr R is a great colleague and clinician”. God forbid anyone leaves a more negative or cryptic comment such as “Dr R is much loved by his patients”. Shit! I am? Is that sarcastic or true? Is it a snide comment, a view that I am dishing out too many antibiotics or painkillers? How the fuck do I reflect on that? Being loved by them is entirely inappropriate! The only person I love is the wife, and the dog. How can I stop such inappropriate attention? I can barely be ruder.

I only ask people to do my 360 that I think I get on with. Trust me, in most partnerships there will be at least one pair who feel each other are slime filled toads who can never compromise let alone agree. No-one is going to ask their toad to do a 360 on them as we all know they’ll bring the average score down a lot and our knob head appraisers will expect us to reflect on how this can be improved. Often little more than a rampage through the surgery with an AK47 will improve the 360 scores and that, I think, is what the process is designed to prevent.

If I’m stuck for colleagues I will ask the wife to do one, (as she practices under her maiden name so no-one will ever know). She knows what I’m like with her and the kids when they’re ill so she has seen my doctoring skills at their best and she doesn’t do bloody free-text comments, I think….!

Of course I do have to lie a lot whilst filling in the health bit. All of us, by definition, are mentally ill. No-one would do this impossible job for the decreasing professional satisfaction or the money. We are trapped by our social and economic realities. Even those of us whose kids go to state schools are trapped but we can explain that more another time. Many of my colleagues have had time off with stress. It may have been as little as one day, it may have been months. One or two I know have jacked it in at 40, and 50. At least they don’t have to lie that they know of no health reason why Dr A, B or C should be working! Of course I do, they’re all on the edge. WE ALL ARE! But if I state that and their knob head appraiser gets them to start reflecting on it, they’ll be off to occupational health and starting counselling before I can say “Fucking appraisals”.

Then we have to check our locum insurance and scour the earth for a locum, A locum, that is who, just because they are wise enough not to buy into the idiocy of permanent GP roles, is regrettably treated with skepticism, if not contempt, by the patients. For me though they’re fucking angels. I really should start a charity “Help for GP Locum Angels” with two GP partners carrying a locum on a stretcher. Without them, the service would be even more shit, though perhaps that would help persuade the leading medical dickheads that GP appraisal should be scrapped. Our mental health and productivity would then soar.

And I could delay the purchase of that AK47.

Brexit anxiety

The nightmare goes on. I thought today it would be over, that parliament would accept Mrs May’s deal for the third time of asking. But it wasn’t to be, hence the nightmare has yet to cease.

A therapist colleague said she has seen a marked up turn in her patients symptoms being influenced by the Brexit chaos, and on the radio today I heard many stories of families and friends suffering deep and possibly irreparable rifts over the outcome.

Is it any surprise the numbered prescriptions of antidepressant and anti-anxiety drugs has doubled in the last ten years? What has it done in the last two years alone?

In truth few of my patients are asking for medication primarily because of Brexit but without doubt it is impacting on people’s lives, not just those having political debate but those whose jobs depend on their companies continuing. Do the workers of Honda or Nissan think their future has been put in peril by the Brexit shenanigans? If so how do the hundreds of thousands of Brits feel who are married to Europeans living and working in the UK, who have children learning English at school and their parent’s mother tongue at home? Do those European want to stay in such a divided country? Will the country even let them? What bureaucratic hoops are needed to do so?

It might sound trivial but i’ve been surprised by the vehemence of the young, particularly those too young to vote in the referendum. Many seem furious with the Brexit decision let alone the farcical nature of the actual exit. They lament at the doublespeak of the political classes on both sides, the divisions within the opposition and they struggle with the value of leaving compared to the vagaries of leaving. This could readily be put down to youthful naivety if wasn’t for the joining of forces of the CBI and TUC calling for an urgent change of direction.

The many years of austerity have hit many patients very hard. Few in work have had a pay rise for years. The stresses on family relationships have been huge. Universal Credit has been a nail in the coffin for many. The NHS hasn’t met it performance targets for years. It takes at least two weeks to see a GP and longer if you have a life you can’t just drop everything for that sole available appointment. Local authorities are in crisis over social care and public health. Hospitals are clogged with so called Delayed Transfers of Care, known to the rest of us as ‘bedblockers’. In some parts of the country there is little in the way of locally funded prevention services other than the national screening programmes. The wave of knife crime seems to be getting worse and police numbers are thousands down.

Yet for the last two years the country’s political representatives have been obsessed with leaving a union that almost half of the electorate wanted to stay in at the referendum and which, if you believe the opinion polls, more than half now want to stay in.

It feels there are more good reasons to forget Brexit and start concentrating on rebuilding our society. To not do so feels a monumental mistake that will cause us more economic and mental health problems than it is worth. It’s now clear the NHS will never benefit from a weekly Brexit dividend of £350 million, and…shock horror we will have to get visas to go to Europe and we might not be able to use our free calls and data in Europe! No wonder the young are up in arms. They know the value of the good communication.

The internal squabbles of the Tory party are not a justification for wrecking our society, physically, mentally or economically. That’s for the Tories to resolve themselves and not to damage everyone else with.

Time for another referendum with the benefit of all we now know.

No more posters or leaflets

Christmas is over but we still keep being given stuff!

My CCG has just asked if I could put up a poster about something and has sent the practice about a hundred leaflets on something too. It’s not just the CCG though, the hospital and charities, and drug companies all send us posters and leaflets to put up in our waiting room.

Has anyone ever researched whether posters or leaflets in GP waiting rooms reach many patients? I have antibodies to aging posters in GP waiting rooms. I like the walls to be plain, calming and minimal. There are enough signs and notices that we can’t avoid without adding more. My own GP’s surgery has a medicines waste poster that has been there for nearly ten years. I know that because I can recall the Primary Care Trust (remember them?) producing it!

I appreciate that the modern NHS is still using fax machines but posters..and leaflets…in 2019??? We do have a website and some practices have social media feeds. We can even text patients links when we remember how. Some colleagues do this quite a bit during consultations though the removal of free texting from our computers has hindered this ability, and patient education in the process.

Even my elderly (and slightly dementing) father has his second iPad and an iPhone. He spends his life on social media and whilst I know not everyone is ‘online’ nowadays the vast majority are. And they spend heck of a lot more time not in the GP surgery, so why the demand to put up posters in our waiting rooms?

In surgeries that are run well patients don’t wait long to see their clinician. If I’m running early, usually because someone hasn’t turned up, and the patient who is also early, exclaims on being called in before their appointment time, I joke I don’t want them wearing out the chairs. Perhaps I should leave them to gaze round the room for a bit longer, but I’d have to take their phone off them for them to do that.

Even when they are stuck in the waiting room for half an hour I’m not convinced they take in the detail of the overly colourful shouty messages on many posters. Sometimes the colour contrast and font sizes are totally inadequate for anyone with sub-optimal vision or anyone who isn’t within a metre of so of it, which, will be most people.

If you’re actually feeling ill, you don’t want to look at posters. You just want to get in and out as fast as you can. If you’re there for a check up, you might have more inclination to gaze around, though this can be a bit intimidating and not very British. Even before we had smart phones to gaze non-stop at, us Brits aren’t the sort of people who crane their necks trying to take in every last poster in a GP waiting room. We’ve always preferred to look down – so perhaps that’s where the information should be, within the flooring!

We do have a practice information screen in the waiting room. It’s a 40″ LCD! It scrolls through several pages of information we want to impart, including how many bastards booked appointments but didn’t turn up last month, the fact that the chemist can help with hell of a lot more than you think and a reminder to chase your test results yourself (see here). Patients do gaze at that, much like they’re zombies. We could put the posters on there, but again, not everyone waits that long, not everyone looks at it when they do have the time, and certainly they might not see every other message that’s deemed important enough to put up there. We could readily have a feature film of rotating images if we bothered but we don’t have the seating the cinema does.

The same ‘philosophy’ applies to leaflets. In the past we’ve had cupboards of leaflets on every topic under the sun and we still get sent tonnes. My CCG loves getting them printed and sent out to us but I doubt they measure the benefit of such a cost to the public purse, or the environment.

Its 2019. If anyone wants to look something up or remember something, they do it online. There is not the demand for a leaflet on the latest campaign to raise awareness about something else. That’s what the news media is about and we don’t have enough surface or cupboard space to display or store all the leaflets everyone wants us to share and besides we have computers and printers now so I can access any information the patient in front of me might need. If I’m feeling generous I’ll print it out for them. If I’m feeling green, or they’re young I’ll just tell them where to look themselves. If they’re interested they’ll do it. If they’re not I’d be wasting paper and toner printing it for them.

So please, all do gooders out there. No more posters and no more leaflets, please. I wouldn’t say no to some more toner though!

Test Results…if only.

“Whilst she was there” the patient asked if I had her test results. She had some blood tests done about six weeks ago that a colleague had ordered and had been meaning to check them but she hadn’t heard so she assumed everything was ok. I winced at the word ‘assumed’. It’s a nasty dangerous word with a vicious bite.

She’d also had a scan a month ago that a specialist had organised and hadn’t heard the result. Frustratingly, for me, the patient hadn’t phoned the hospital to see what the scan result was or asked my colleague who she’s previously seen and who had arranged the blood tests. No. Now she was asking me, ‘just whilst she was here’.

The consultation had already dealt with some benign looking skin lesions that she was anxious about and I had taken photos, including super-duper close up dermoscopy. I said I would send the snaps to the local dermatologist for their view. All that had taken the entire ten minutes allocated to her.

I bashed the keyboard for a few moments and found the results. I told her that the blood test results showed she had severe anaemia, renal failure, liver failure, diabetes and an underactive thyroid. She looked shocked. She asked why we hadn’t told her. I assured her the records showed we’d tried to phone her three times and we had sent her a letter to ask her to get in touch. She said she hadn’t received any missed calls from us (though our calls are anonymised, for confidentiality, so she couldn’t be sure. She doesn’t tend to answer unidentifiable calls she told me, and we don’t leave messages in case someone else hears them). The letter must have got lost in the post. Is her address up to date? For that matter is her phone number up to date? I said, as if were a contract, that it also states in our practice leaflet that we encourage all patients to make sure they find out their test results a week or so after the test. Some practices do have ‘contracts’ with their patients. I can see the benefit here.

The reason we ask people to check their results is, believe it or not, we’re human and sometimes an abnormal result gets mis-filed as normal, or an instruction to phone a patient gets accidentally, deleted, or a well-intention-ed attempt to call a patient gets interrupted by a developing emergency and forgotten. We are human. These things sometimes, rarely, do happen. Every practice in the land will know of a time when it has happened. Really.

Most GP practices will regard that advising patients to chase their test results is a safety net. They know they have professional obligations to tell patients when their test results are abnormal and have systems in place to make this as safe and reliable as possible. In all though, there a lot of possible reasons why those systems might fail and why a patient might not be informed of a result. The sample might get dropped and break – that should usually lead to an ‘unable to process’ report. The sample might get dropped and lost. (That shouldn’t happen very often. We have quite secure blue bags for transporting samples, but it’s not impossible). The electronic systems for sending a result to the surgery might have a badly timed glitch just as your result is being transmitted and never get recorded in the GP system. That too is rare but our electronic systems are not infallible. Are yours? Phone numbers and addresses may not be up to date. Electronic and snail mail does not always reach its destination.

The hospital doctor had written to the patient with the result of her scan and asked her to contact his secretary urgently to make an appointment to discuss the scan. I had a copy of the letter on my system. Such a letter would normally put the fear of God in most patients. Not this one, because she didn’t receive it, but I could see she was sweating now. I hadn’t done anything about it because I’m not her nanny. I’ve got quite a lot to do as it is, and as the scan was of her and ordered by someone else, I also kinda thought she might have been more interested in the result, than I. It’s not that I don’t care. I just can’t care enough for every patient. It would literally kill me.

Because she hadn’t cared enough about those results either she was risking her life too. But luckily for her I was joshing.

They were all completely normal. She didn’t have liver failure, diabetes renal failure an underactive thyroid, anaemia or anything wrong with her scan…. but she needed to learn the lesson. Some would call me a cold hearted bastard for playing such a trick, and if this were true I would be, but it isn’t. It’s just a story to help you remember:

Always check your test results, with the clinician who ordered them and assume NOTHING!

None of us want ASS-es made of U or ME. That’s what happens when you ASSUME something you shouldn’t. Always check your test results, with the clinician who ordered them. Hospitals, GPs and almost all patients have had phones for a long time. Yours goes with you everywhere. Next time you have a test, use it, not for social media but to actually telephone the NHS to check out those results. We will try to tell you, but we’re human. Be a good safety net – for your sake please!