Cost of visiting a GP

171170 wrote: »

Hence my observation that they might be able to interpret SIMPLE x-rays! (I assume that you were so eager to pontificate that you overlooked that word in my post!)

Only an idiot would expect a GP to have the same level of competence and expertise as a consultant radiologist - and I am not an idiot!

Take my example of going to VHI Swiftcare after an accident after I fell over sideways, injuring my foot in a very painful way. I had zen examination and X-ray, after which the doctor there said he couldn’t himself see a break, but that the image would later be reviewed by an Orthopaedic consultant, and that he would phone me if said consultant found anything. I had huge difficult weight-bearing, but was just stepping into a taxi outside to go home and rest it, when the doctor came rushing out the door, calling me back. The Orthopaedic consultant had identified two broken bones in the foot, and I was given boot and crutches and I was nearly back to normal after 4 weeks.

Now, it wasn’t at all critical that the less trained doctor hadn’t spotted the break, and the outcome would have been the same even if the Orthopaedic consultant had only seen the X-ray next day. It would only have been a matter of inconvenience going back in another taxi to get the requisite boot and crutches. A GP led X-ray service could be in this league, with follow-up consultant review of image. Most cases are people with a condition that doesn’t require instant fully accurate diagnosis. In the case of a chest X-ray the GP will be able to assess whether there is a pneumonia that requires an immediate antibiotic to get the situation under control, but that the X-ray be reviewed over next days by a consultant radiologist to rule out, as much as the image can do, what might be a likely malignant process underlying it.

I think there is a need for many more small Imaging, Phlebotomy & Specimen Collection Clinics serving GPs. A hypothetical example, I develop a painful cough with a bit of fever and some darkish sputum and go to my GP in, say Ranelagh, then he would listen to chest and might still be in a bit of doubt as to whether it’s a self-limiting virus or could there be a bacterial pneumonia in a portion or two of my lungs. He wants to spare an unnecessary and useless antibiotic if chest is clear of potentially serious infection and then sends me to the Community Imaging & Laboratory Service (or whatever it might be called) that he and other GPs in the wider area are subscribed to. M

It’s 4pm, but I don’t seem to be that terribly ill, so can wait until 9am next morning when the CILS in Rathmines opens. They will have the electronic referral sent by my GP, I show up and the radiographer takes the X-ray and asks me to wait in the lounge (where there’s a coffee machine) until my GP (or one of a pool of on duty GPs assigned to check images if one’s own GP is not available at that time) has looked at the image. It turns out I have a bit of pneumonia, so GP then produces an electronic prescription for pharmacist to process. An attached pharmacy would be an advantage. As it is not one for opiates etc, it doesn’t have to be written by hand.

Within a couple of days the image will have been seen by a consultant radiologist, who is trained to spot things accurately without having to spend much time looking at it. Hypothetically she sees perhaps something that warrants further imaging or a fast-track referral to a specialist clinic in St James Hospital, so she produces that referral electronically with a notification to my GP. All the while complying with GDPR etc.

Ideally this is the way primary care should work with good back-up services without everybody necessarily always having to turn up at A&E.