GP wouldnt do stitches

daheff

So my youngest had a fall yesterday and ended up with a cut head. We bandaged it up and it seemed to stop bleeding. However this morning it still seemed to be bleeding so my OH brought the child to the GP to see if the GP could put in a stitch or two to close up the wound. My OH was shocked that the GP refused on the basis that the GP doesn't do stitches for children (youngest is almost 4). The GP 'specialises' in families & young children


This attitude makes me wonder...what the hell is the gp for then??? And with this kind of attitude to dealing with minor injuries, is it any wonder that our A&Es are overrun with people presenting with these issues!

RobFowl

Some GP's do not stich are they feel they are de-skilled and simply don't do it often enough to keep up their technique to an acceptable level.
Some don't do it (especially on medical card) as the amount you get paid for doing it is actually less that the cost of the equipment needed.
Other simply do not see it a a task GP's should be doing (I personally disagree).

In terms of what does a GP actually do have a look here for the European definition of the role of a GP.
http://www.woncaeurope.org/sites/default/files/documents/Definition%203rd%20ed%202011%20with%20revised%20wonca%20tree.pdf

his_dudeness

Depending on where it is on the head, you could be looking at a nice trip down to your nearest plastic surgeon, as many ED units and even general surgical teams won't stitch heads/faces.

beyondbelief67

When my son cut his leg it was the practice nurse who glued it, instead of stitches, after the Dr had checked to see if it needed that.
I don't think many places do stitches any more.
Apparently they feel glue heals better with less scars.

Oink

My gp did a beautiful job stitching me up 3-4 years ago. It was more than just stitches in fact, as he had to do a small job under the surface as well. I would call it minor surgery. Very impressed.

daheff

youngest ended up getting a couple of paper stitches in A&E - seriously think the GP could have done that...hell if i had some i'd have done it.

I remember when we were kids, the local GP had to give one of my sisters stitches cos she fell and cut her knee...none of this washing hands of it and off to A&E with ya

Me thinks its time to get a new GP

Ryder

daheff wrote: »

youngest ended up getting a couple of paper stitches in A&E - seriously think the GP could have done that...hell if i had some i'd have done it.

I remember when we were kids, the local GP had to give one of my sisters stitches cos she fell and cut her knee...none of this washing hands of it and off to A&E with ya

Me thinks its time to get a new GP

Decision to stitch versus glue versus paper stitch depends on the wound and location. Also depends on the skill level of the GP. Typical ed doctor may have had specific surgical training and see many examples of this per day. The gp may not be trained and may well see very few patients needing stitches. Hard to blame him/ her especially in this litigious society

Icemancometh

Part of the problem is that there is no formal trauma educations as a part of the GP training program. Some trainees rotate through ED, but not all, and it isn't a requirement. I think rural schemes in particular should have some trauma training.

Kristopherus

Icemancometh wrote: »

Part of the problem is that there is no formal trauma educations as a part of the GP training program. Some trainees rotate through ED, but not all, and it isn't a requirement. I think rural schemes in particular should have some trauma training.

Surely they would have had a good grounding when they worked in hospitals during internship, House Offership,etc? Seems to me to be a cop-out.

Vorsprung

Kristopherus wrote: »

Surely they would have had a good grounding when they worked in hospitals during internship, House Offership,etc? Seems to me to be a cop-out.

Many interns will get no practical surgical experience, my only suturing was in a Basic Surgical Skills course I did in my own time.

The only part of the GP training programme in which you would get suturing experience is the ED rotation - requires you to have a registrar/consultant to talk you through it. Many SHOs will leave ED without the experience to allow them to suture confidently in the community.

iwillhtfu

If it's not to bad and in an obscure area get some steri strips for your local pharmacy. They'll hold a small but slosed no problem just be sure to clean the area properly before hand.

daheff

Thanks for all the replies & opinions. To be honest, I'd expect a Dr to have the skills to suture a wound. BUT the Dr didn't even look at it. The receptionist just said point blank go doesn't do stitches on children!!! Didn't even get to look at it. Very disappointed in gp.

If gp had, then probably would have put paper stitches over it in the end (like a&e did).


I'm just shocked that a gp wouldn't/couldn't do something a basic as this. On the back of this, I'm not surprised in the state of the health service

Raminahobbin

It was likely just down to the fact the cut was the face.

My friend fainted in my house on a Friday night a while back and banged her head, resulting in a small enough wound on her forehead that required stitches- she went to a GP on Saturday morning who refused to do anything and sent her to A&E in James's Hospital, where she sat for 6 or 7 hours only to be patched up temporarily and told to come back on Monday when she could see a plastic surgeon.

The plastic surgeon was livid, because the wound had started healing and she had to cut it open again to restitch it- she told my friend that doctors had refused to touch it because of where it is. If it caused a scar, they were afraid of being sued. She gets referrals all the time for tiny little cuts that only need a couple of stitches as a result of this, apparently.

daheff

Raminahobbin wrote: »

It was likely just down to the fact the cut was the face.

Possibly, but seeing as the doctor didnt even see it i'm skeptical on this. The OH went over to the GP & the receptionist says the gp doesnt do stitches for kids....




** I appreciate my original post implied the GP had seen & refused

AmcD

Any GP will do steri-strips, but doing stitches is completely different
1. Depending on the wound and where it is, many children have to be put under a GA to be stitched.
2. It is better to be stitched by somebody who does the procedure regularly, to get a good result. I have probably only seen one wound in the past year, that needed stitching. On the other hand I do smear tests and blood tests daily.
3. Patients still sue pretty regularly, even if you prevented the inconvenience of an A+E visit. If the wound is on the face, parents are particularly sensitive about the subsequent appearance of the scar.

Extrasupervery

I once had a doc in a VHI swift clinic do an absolute botch job on facial stitches...the wound re-opened and the advanced nurse practitioner in James's Emergency Department stitched me back up. She advised me to always go to a specialist (which she was) for facial stitching. If I had gone to her in the first place I'd have a much neater scar. I'd have preferred if the first doc turned me away in the first place as your GP had, than **** it up.

Traumadoc

I think that the cost of suturing - sterile equipment, sutures, time - it would take at least 40 minutes, would make it unprofitable for most GPs - far easier to send them into A&E

Graces7

Traumadoc wrote: »

I think that the cost of suturing - sterile equipment, sutures, time - it would take at least 40 minutes, would make it unprofitable for most GPs - far easier to send them into A&E

Says it all..

L1011

Graces7 wrote: »

[/B]
Says it all..

That General Practice is woefully underfunded and is causing problems elsewhere as a result? Yes, it does...

RobFowl

Graces7 wrote: »

[/B]
Says it all..

It does, if your gp stitches you on the medical card they lose about 25 euro and if they charge you 50 lose a far bit too. People don't realise (or don't care) about that.

Mrs OBumble

RobFowl wrote: »

It does, if your gp stitches you on the medical card they lose about 25 euro and if they charge you 50 lose a far bit too. People don't realise (or don't care) about that.

In fairness, I've never met a GP who only charges the usual consultation fee for a visit that involves materials.

Sure the GP may be thinking "I could do it for you for E80, or A&E will do it for free" - but I'd rather they gave me the option of avoiding the hours in the A&E waiting room if possible.

sleepyheadh

The GP most likely didn't want you to turn around and sue them if the scar wasn't perfect. Thats why he sent you the the A&E, thats why when your getting facial stitchs they often take a photo..so you don't go home, take out the stitches, re-stitch it poorly and then haul the Doc though the courts.

This is also, why plastics are called to do a simple stitch job.

sleepyheadh

RobFowl wrote: »

It does, if your gp stitches you on the medical card they lose about 25 euro and if they charge you 50 lose a far bit too. People don't realise (or don't care) about that.

RobFowl, are you serious..I really find it hard to believe that you are a Doc?

locum-motion

sleepyheadh wrote: »

RobFowl, are you serious..I really find it hard to believe that you are a Doc?

I know his real world i.d., and he is a Doc.

sleepyheadh

locum-motion wrote:

I know his real world i.d., and he is a Doc.

I know he is. .i just find it hard to believe!

RobFowl

sleepyheadh wrote: »

I know he is. .i just find it hard to believe!

Yawns and gets popcorn ...

El_Duderino 09

daheff wrote: »

I'm just shocked that a gp wouldn't/couldn't do something a basic as this. On the back of this, I'm not surprised in the state of the health service

What do you think a GP is exactly? Would you be surprised to hear that GPs don't generally engage in manual labour?

They study for long enough and know what they are expert in and what they aren't. I'd be happy to take the GP at their word when they don't do stitches in children.

Maybe you should write a letter to the minister and suggest that GPs should have a go at procedures they aren't trained in. I mean what's the worst thing that could happen? If he leaft a dirty scar on your child's head, I'm sure you wouldn't have complained or sued.

dr.fuzzenstein

Is it any wonder I haven't been to the GP in 10 years and not planning on going any time soon. By the time I need medical attention it would have to be a major catastrophe.
GP's are pill dispensers sponsors by the pharmaceutical industry and the aim is to maximize profit. You will walk out the door with a prescription for antibiotics, steroids, cortisone cream or if nothing in particular is wrong with you, antidepressants. Part of the reason for that is people expect to be given something and big pharma only too happy to oblige. We are a nation of pill poppers. As for people suing: that is the number one excuse trotted out when someone doesn't want to do something. We are quite happy to ignore the rules in Ireland when it suits us. But more than willing to suddenly strictly obey them if we want to avoid something.

El_Duderino 09

Graces7 wrote: »

[/B]
Says it all..

Like the fact that some people think GPs work in the voluntary sector?

Or that some people are surprised that GPs wan to avoid being sued?

Some posters seem to be suggesting it would be a better system if GPs applied the old 'Tis grand' attitude to medicine.

dr.fuzzenstein

El_Duderino 09 wrote: »

Like the fact that some people think GPs work in the voluntary sector?

Or that some people are surprised that GPs wan to avoid being sued?

Some posters seem to be suggesting it would be a better system if GPs applied the old 'Tis grand' attitude to medicine.

The best way to avoid that is not to practice medicine at all, or maybe have a solicitor present in the treatment room.
Also, the constant whine of "we're on the breadline here!" with at least fiddy bucks a pop and full waiting rooms I'd say doctors are doing OK.
I know doctors like to complain that medical card holders cost them money, as the government only pays about €70/year irregardless of how often they come to visit, but one has to take into account that older patients get paid at a higher rate and that not every single medical card holder comes to visit. Since your average GP would have a few hundred of them on his books, there's money in it at the end of the day.
And yes, it would be nice if a doc said "Sure I can fix that" instead of "I'm sorry, but that's more than my job's worth and you might sue me, so no, I won't help". Nobody asked for major facial reconstruction or bone fragments sticking out of open wounds that needed to be set. Maybe in the city, if the hospital is round the corner and they have a specialist, but a small 2-4 stitches wound shouldn't be beyond the ability of a GP. And in rural practices it should be possible anyway.

edit:
As much as I think the suing culture is exaggerated by people who may not feel like doing something and always like to trot it out as a justification, seeing how much people are awarded for superficial little blemishes (still no excuse, that's what insurance is for), there should be new legislation covering minor cuts and bruises on Mammy and Daddies little precious. The jist of it should be unless someone lost a body part, kids will get scrapes and bumps, go away and put some ice on it. Here's an invoice of a hundred Euro for wasting the court's time.

El_Duderino 09

dr.fuzzenstein wrote: »

The best way to avoid that is not to practice medicine at all, or maybe have a solicitor present in the treatment room.
Also, the constant whine of "we're on the breadline here!" with at least fiddy bucks a pop and full waiting rooms I'd say doctors are doing OK.
I know doctors like to complain that medical card holders cost them money, as the government only pays about €70/year irregardless of how often they come to visit, but one has to take into account that older patients get paid at a higher rate and that not every single medical card holder comes to visit. Since your average GP would have a few hundred of them on his books, there's money in it at the end of the day.
And yes, it would be nice if a doc said "Sure I can fix that" instead of "I'm sorry, but that's more than my job's worth and you might sue me, so no, I won't help". Nobody asked for major facial reconstruction or bone fragments sticking out of open wounds that needed to be set. Maybe in the city, if the hospital is round the corner and they have a specialist, but a small 2-4 stitches wound shouldn't be beyond the ability of a GP. And in rural practices it should be possible anyway.

edit:
As much as I think the suing culture is exaggerated by people who may not feel like doing something and always like to trot it out as a justification, seeing how much people are awarded for superficial little blemishes (still no excuse, that's what insurance is for), there should be new legislation covering minor cuts and bruises on Mammy and Daddies little precious. The jist of it should be unless someone lost a body part, kids will get scrapes and bumps, go away and put some ice on it. Here's an invoice of a hundred Euro for wasting the court's time.

Or they can limit their exposure by only practicing the parts of medicine they are competent in.

Would you ask an electrical engineer to do a structural survey on your house? Sure t'is grand and if the house is unsafe you can sue. Or would you prefer to get the structural survey carried out by a structural engineer? If the doctor says they can't do stitches, why not just do it yourself?

Can't a business person refuse work that will cost them money? How would that attitude work in any other profession?

Your point about waiting rooms full of people paying fiddy a head is kinda undermined by the very next sentence about public patients who could turn up 10 times a year at a total of 7 euro per visit.

Do you have any idea what happens when a GP is sued?

You have a very strange understanding of the business world. People should take on tasks they are not competent at and sure 'it'll be grand, whats insurance for'? Maybe the PG also didn't want to scar the child's face.

dr.fuzzenstein

OP never said the injury was to the child's face. Also, most of GP's seem happy enough doing them, the issue in this specific case was the doctor not doing them on young kids. I think it was more this GP didn't want to get bitten.
In my personal opinion, it would be a poor doctor who couldn't put 2-3 stitches somewhere not too noticeable. We're not talking about major surgery here. I could learn how to do that on YouTube in 5 minutes:
https://www.youtube.com/watch?v=6P0rYS6LeZw
Actually, in America people do, because of the insane and outrageous medical fees over there, but that's another story.

Your point about waiting rooms full of people paying fiddy a head is kinda undermined by the very next sentence about public patients who could turn up 10 times a year at a total of 7 euro per visit.

That one is a point always made by GP's. The argument is "This guy comes 10 times a year and I get a total of €70, this makes €7 a visit". Oh. My God! How do GP's make ANY money! We have to do something QUICK!
But that is not the whole story. A GP is paid per medical card holder on his/her books, regardless if they come 10 times a year or not at all.
Also, not every medical card holder is paid at that rate, older patients earn a higher fee for the GP. So the sums do not look quite a dismal as made out to be.
All laid out here:
http://www.hse.ie/eng/Staff/PCRS/Contractor_Handbooks/Doctor_Schedule_of_Fees1.pdf

Some seem to do quite OK out of this:
http://www.independent.ie/irish-news/gps-earning-up-to-650000-under-medical-card-scheme-29104217.html

GP's like to remind us of the overheads and staff costs, but such is the way when you're running a business, be it a medical practice or a tire place.
Of course you are free to say to people "Nah, I'm not making enough money out of you, you can hop off" or "I don't know, you look like you may sue me", but you yourself reminded me that this is a business.
That kind of attitude is noted by customers. Maybe GP's should start charging for sweets for kids? Wouldn't that make business sense? Instead if giving a kid a lollipop, just refer them to the dispensing machine on the way out...

El_Duderino 09

dr.fuzzenstein wrote: »

I think it was more this GP didn't want to get bitten.

So what if he decided not to risk being bitten. Isn't that the GP's decision to make? You seem to think GPs should provide a uniform service across the board. In fact medical practitioners are trained to a differing degrees in a whole range of areas. So what if the GP decides it's not worth the risk/time to stitch the child's head.

You think the GP should provide the service even if it is below cost, and relatively high risk of being sued. How many other businesses would you make the same argument towards?

dr.fuzzenstein

El_Duderino 09 wrote: »

So what if he decided not to risk being bitten. Isn't that the GP's decision to make? You seem to think GPs should provide a uniform service across the board. In fact medical practitioners are trained to a differing degrees in a whole range of areas. So what if the GP decides it's not worth the risk/time to stitch the child's head.

You think the GP should provide the service even if it is below cost, and relatively high risk of being sued. How many other businesses would you make the same argument towards?

Yep, the doc can decide not to stitch or maybe not to see people with bad breath, anyone he doesn't like the look of or anyone whatsoever. He can have sh*tty attitude, tell people to fcuk off and charge what he wants. Its a free world after all. If anyone other than a clamper manages to run a wildly successful business with that attitude I would love to hear about it.

Nonoperational

dr.fuzzenstein wrote: »

Is it any wonder I haven't been to the GP in 10 years and not planning on going any time soon. By the time I need medical attention it would have to be a major catastrophe.
GP's are pill dispensers sponsors by the pharmaceutical industry and the aim is to maximize profit. You will walk out the door with a prescription for antibiotics, steroids, cortisone cream or if nothing in particular is wrong with you, antidepressants. Part of the reason for that is people expect to be given something and big pharma only too happy to oblige. We are a nation of pill poppers. As for people suing: that is the number one excuse trotted out when someone doesn't want to do something. We are quite happy to ignore the rules in Ireland when it suits us. But more than willing to suddenly strictly obey them if we want to avoid something.

The standard rabbles of the ignorant.

dr.fuzzenstein

Nonoperational wrote: »

The standard rabbles of the ignorant.

Said some random stranger on the internet.

clogher77

my daughter 18 months bust her head open over Christmas . nasty wound on forehead. deep and i couldn't stop it bleeding. I took her to gp . she closed wound with steristrips. no problems. no a&e. she has a small scar. I think most gp s are great.

Victor

Oink wrote: »

My gp did a beautiful job stitching me up 3-4 years ago. It was more than just stitches in fact, as he had to do a small job under the surface as well. I would call it minor surgery. Very impressed.

Some GPs do minor surgery.

dr.fuzzenstein

clogher77 wrote: »

my daughter 18 months bust her head open over Christmas . nasty wound on forehead. deep and i couldn't stop it bleeding. I took her to gp . she closed wound with steristrips. no problems. no a&e. she has a small scar. I think most gp s are great.

I'm sure a lot of them are still about patient care and being a part of their community.

Pugzilla

Dr. Fuzzestein, you should study medicine and become a real doctor.

Then you won't have an inferiority complex anymore.

RobFowl

Pugzilla wrote: »

Dr. Fuzzestein, you should study medicine and become a real doctor.

Then you won't have an inferiority complex anymore.

Mod note
Attack the post not the poster
Rob

Traumadoc

many Gps have no experience suturing anymore, partially this is because many do not rotate through a&e, also those that do are mostly triaging elderly medical , while the Nurse practioners do the suturing.

plus to suture a face probably takes at least 1/2 an hour to an hour , with setup , anaesthetic , dressing etc. , many GpS cannot afford to spend that much time with one patient.

dr.fuzzenstein

Nobody said face, that was an assumption (ass out of you and me) that someone made early on and somehow stuck.
So the argument has been:
On the pro side: surely a doctor can put in 3 stitches somewhere inconspicuous like the back of the head.
On the con side: a GP should not be expected to do major facial reconstruction which will cost him thousands and the patient will ALWAYS sue for millions.

El_Duderino 09

dr.fuzzenstein wrote: »

Nobody said face, that was an assumption (ass out of you and me) that someone made early on and somehow stuck.
So the argument has been:
On the pro side: surely a doctor can put in 3 stitches somewhere inconspicuous like the back of the head.
On the con side: a GP should not be expected to do major facial reconstruction which will cost him thousands and the patient will ALWAYS sue for millions.

Yeah you're right. The OP is about a cut to the head. Post #13 was about a separate incident of a cut to the face where the A&E doctor referred them to a surgeon.

MrCreosote

Can't believe this argument is still going. Anyone who thinks suturing up a 3 year old girl's face is simple and not a litigious disaster waiting to happen is dreaming.

Most will get a better result (permanent don't forget) with some sort of sedation, which no GP is going to offer.

dr.fuzzenstein

MrCreosote wrote: »

Can't believe this argument is still going. Anyone who thinks suturing up a 3 year old girl's face is simple and not a litigious disaster waiting to happen is dreaming.

Most will get a better result (permanent don't forget) with some sort of sedation, which no GP is going to offer.

Well depends which post were talking about. There is no mention of face in the OP just cut head.
Nothing that would require several skilled plastic surgeons, sedation, a staff of nurses and a 3 week hospital stay.

Nonoperational

dr.fuzzenstein wrote: »

Well depends which post were talking about. There is no mention of face in the OP just cut head.
Nothing that would require several skilled plastic surgeons, sedation, a staff of nurses and a 3 week hospital stay.

No, but perhaps one skilled plastic surgeon and a day case admission may be reasonable to afford the child.

dr.fuzzenstein

Nonoperational wrote: »

No, but perhaps one skilled plastic surgeon and a day case admission may be reasonable to afford the child.

Oh yes, don't forget having the child airlifted by chopper, an emergency team standing by, there should be, of course, at LEAST two eminent and internationally renowned plastic surgeons, an ER staff of at least 25 of the finest experts in their field, aftercare and rehab and physio in a swiss sanatorium and it goes without saying find someone to sue who may be responsible for the child's accident. Then sue the plastic surgeons for millions of there is a scar. What a world some people live in. Meanwhile back on earth...