Posted by Jonathan on March 17, 2003, at 23:00:00
In reply to Re: Why don't pdocs call to remind of appointment? » jane d, posted by Dinah on March 17, 2003, at 17:22:29
Last April the AD which had got me through my Dad's illness and death a couple of months earlier (thanks to an unauthorized dose increase - my mother's GP prescribed two months' extra supply of moclobemide for me on the pretext that I had left the original supply at home at the other end of the country) pooped out. For the first time ever I missed an appointment with my pdoc because I just couldn't bear to get out of bed and take a bus to the hospital. I couldn't bear to phone and apologize either, but my wife did this for me and got me a new appointment a couple of weeks later, and she made sure I kept it :)
The doc put me on a new AD (lofepramine, a tricyclic NRI) and told me to come back in the usual three months, in early August. Unfortunately, lofepramine never really worked for me; it was better than nothing at all, but only just. The August appt would have been the time to change or augment it, but we both forgot about it until the day had passed. I phoned a couple of days later and was told that I'd receive a letter informing me of the date and time of my new appt.
Another three months passed, but still no letter, and I was feeling very much worse so I went to see my GP. She wouldn't change my medication unless the pdoc wrote to her with new instructions: the system here is that GPs prescribe and specialists tell them what to prescribe. She did, however, promise to try and get me an urgent appt with the pdoc.
This was arranged for mid-January, eight months after my previous appt. It turned out that my pdoc had taken me off his list of patients because I had missed two appts. His letter informing my GP of this had arrived while she was away and a locum had put it unread into my file. Informing the patient directly of this is, apparently, considered unnecessary.
The same story from the viewpoint of an NHS manager:
Treatment of Patient J1 was terminated in August 2002 and his GP was informed; ten brownie points to Dr X for his successful treatment of this patient. In November 2002 the same GP referred a new patient, J2, to Dr X; five brownie points to Dr X for taking on a new patient, and five more for seeing him just inside the recommended maximum waiting time of three months. Why don't pdocs call to remind of an appointment? It would reduce successful terminations of treatment and new referrals, and there's also the cost of the call to consider.
In the old Soviet Union, the steel production figures improved every year, yet the system inexplicably collapsed.
I'm still taking lofepramine, but now with lithium augmentation. Miraculously, the AD has started to work! I don't feel well, but I'm better than I've felt for more than a year. When I read Ace's posts on the joys of Nardil I feel like saying "I'll have what he's having" (almost like the woman at the restaurant in "When Harry Met Sally"); but I know there's little hope of getting an irreversible MAO inhibitor in the UK.
poster:Jonathan
thread:209545
URL: http://www.dr-bob.org/babble/20030314/msgs/210214.html