Wednesday, March 27, 2019

What your GP receptionist REALLY thinks about you: Think they're all nosy, brusque and impossible to reach on the phone? This diary of a doctor's assistant on the timewasters, no-shows and vile abuse she puts up with might change your mind

The average adult patient has to wait a month for a GP appointment, new research reveals. And this week one woman in Wales revealed she rang her surgery 250 times before getting through. No wonder many patients are furious and GPs’ receptionists often feel their wrath. But what is it like for them? Here, in an eye-opening weekly diary, one receptionist, Nicola Thomas*, 35, reveals the real reasons you are being kept on hold . . . 
Monday, February 25, 2019
Mr S would like an urgent appointment with his GP. He has phoned the surgery right on cue as the lines opened at 8am and he’s lucky to be the first person I pick up.
Seconds in and he’s exasperated. He says he’s been ‘in pain’ all weekend.
He ‘can’t wait another day’ and informs me it’s ‘none of your business’ when I ask for medical details.
‘I’m sorry,’ I begin. ‘But if you can give me even an idea of what the problem is, I can see who is the best person available to see you.’ There’s a pause as he weighs his options. ‘It’s my foot,’ he snaps. ‘My verruca is killing me. I need something from the doctor.’

A verruca. A common wart that can be treated with over-the-counter medicine from any pharmacy. But Mr S is adamant he has to see the GP. I’m going to have to let him down gently.
I explain we only have two emergency appointments this morning and they can’t be given to someone with a verruca. I suggest he visits the chemist. There’s another silence before he barks: ‘******* hell’ and slams the phone down.
It’s a lovely start to my working week but not uncommon. Over the next 15 minutes, my colleague Ann and I will answer around a dozen calls each until the eight routine appointments are given out to patients with earache, stomach ache, coughs and colds.
The two emergency appointments are given to children under five, pensioners or anyone experiencing chest pain or similar conditions which warrant a GP immediately. We have only two doctors on duty today covering an area which has around 7,000 patients so it can be crazily busy.
I’ve definitely noticed it get busier over the eight years I’ve been working on reception and that’s hardly surprising. More than a thousand GPs have quit since 2015 and although I’ve been at this practice for only two years, my colleagues tell me they used to have four full-time GPs before they retired.
This morning is no different — I field calls about splinters, nits and even cracked lips. I may not be medically qualified — something I’m often reminded about by patients — but I am trained in triage and know nits should not be taking up seven minutes of precious time with an overworked GP.
I am very aware of how most people view GP receptionists. We have a reputation for being dismissive, abrupt and on occasions downright rude, but from this side of the desk, I’m amazed more of us don’t blow our tops.
When the phone lines open, around 40 per cent of the calls I’ll take will involve some kind of insult in my direction — maybe a slammed down phone or an actual threat of violence.
When I first started out, I’d take those calls very personally and would often be reduced to tears. Nowadays, I stand up for myself. I get paid £8 an hour — I’d get more if I worked in Primark — so I’m not going to stand for any nonsense. Does that make me a battleaxe? I’m not sure.
By 8.30am, when the doors to the surgery open, all the appointments have gone for the day. That doesn’t stop the queue outside filing in, hoping to see a GP. I’m going to disappoint them too, unfortunately.
Some might be genuinely worried and feel rotten but with no appointments left, what can I do? I don’t feel ashamed of our surgery because I know that the doctors, nurses and receptionists work so hard to see as many patients as possible. But it’s a numbers game — we can’t possibly see everyone.
TUESDAY, February 26
Today is slightly quieter, but we have a lot of people insisting on seeing their doctors with coughs and colds. Nearly everyone in the waiting room today is there for a cough or a cold.
Many have come in because they think it’s a chest infection and want antibiotics. But chest infections are rare and GPs are now — rightly — very wary of prescribing antibiotics to patients, because their overuse is making many resistant to dangerous bugs.
As receptionists, we’re exposed to more germs than most and I’ve had at least four colds in the past year. The difference is with us, we take a couple of paracetamol and work through it.
Even if the doctor tells them to take paracetamol, I’m astonished by the number of people who still demand a prescription for it. They could walk into the chemist and buy a packet for 25p, but they insist on a prescription which costs the NHS around £6.
It’s such a drain on the service but GPs give them because it’s less hassle than arguing with a patient over cost.
WEDNESDAY, February 27
My first caller today tells me this is his 91st attempt to get through to the doctors this week. I’m sympathetic and not entirely surprised. He says he has blood in his urine which could be something serious and needs to see a GP quickly. I book him in for 10.15am . . . and he doesn’t show up.
Ten per cent of patients never attend appointments, which is incredibly frustrating for others who genuinely need them. While these non-attendees will get a text message and a letter of warning, they’re rarely struck off.
It’s got to the point where often I can recognise a voice of one our regular hypochondriacs wanting to be referred for a blood test or a scan because they feel something ‘isn’t right’.
I have patients telling me they’re coughing up blood — it may just be blood vessels in their throat which have burst after a nasty cough, or something more sinister — so naturally I have to book them in. Or people will say they’re suicidal and you can’t turn them away. But they come in and it turns out they’ve simply forgotten to fill in their repeat prescription form, and need some more tablets quickly.

This band of ‘worried well’ patients are nearly all under 65. The older people — particularly those who went through the war — are made of sterner stuff. They never want to bother us and apologise for being ‘a nuisance’.
A lady in her 70s rang and said sorry as she asked if she could possibly speak to her doctor. She was struggling to breathe and had pains in her chest. I urged her to call an ambulance as I was concerned she might be having a heart attack. But clearly nervous about ‘bothering’ the ambulance service, she asked to speak to the doctor.
In these situations I have to trust my instinct. I knocked on the door of the GP who was between appointments and he immediately spoke to her, reassured her help was on its way and called the ambulance himself. On the opposite end of the spectrum, we get a lot of people in their mid-20s who are a bunch of total hypochondriacs. If they have a cough, it’s cancer. Today a 19-year-old man wanted an appointment that day because he’d run out of sleeping pills. When I tell him there are no appointments today he threatens to come to the surgery and ‘kick my head in’. Charming.
I no longer get rattled by threats. The worst incident I’ve ever had was six years ago when a drug addict came into the surgery because she’d lost her prescription. When I asked her to call back tomorrow, she started hurling obscenities at me.
We call the police several times a year, particularly in the summer months when the heat is getting to people. Drugs and alcohol problems are rife in this area.
I read recently that 3,000 people were barred from their GP last year for being violent. Sadly, as mental health services decline, I’ve also noted an increase in recent years of the seriously disturbed people who end up at the GPs.
We want to help them, but if they don’t need medical assistance and are simply creating a nuisance, we often call the police.
THURSDAY, February 28
The usual round of morning calls with another verruca, a urine infection, a pulled muscle and conjunctivitis — all of which can be treated at the pharmacist. So many patients don’t want to tell the receptionist the problem, thinking we’ll gossip about them but we’re not even allowed to talk to our partners about patients.
We also have Mr W on the phone just before lunchtime. He’s one of our patients who regularly rings us just to find out how we are. He’s 81 and was widowed last year and he’s simply lonely.

We’re more than happy to have a quick chat if we’re not too busy but other times I have to cut him off abruptly as I may have up to 50 people trying to get through. Yet I’m acutely aware I might be the only human voice he hears all day.
One of the best parts of my job is getting to know patients, many of whom are lovely. When you have worked in the same surgery for years you get to see people at key moments in their lives — the births of their babies, the deaths of their loved ones. It’s touching when people bring in cards, flowers or chocolates to say thank you.
FRIDAY, March 1
Two of the local care homes ring today wanting home visits. They phone all the time and even admit that nothing is wrong with any of the residents. But if someone dies in a care home and they haven’t been seen by a doctor in the preceding two weeks, the death will have to be looked at by a coroner. So they play it safe.
We get a woman ringing in because her ten-year-old child has diarrhoea. She’d been to her pharmacist and dialled 111, the NHS helpline, but 111 are a nightmare for us because they say to patients that they need to see their doctor within two hours.
That’s not helpful when it comes to diarrhoea which can be easily passed on if the patient comes into the surgery.
We are given a lot of training about who to give appointments to and who to direct elsewhere.
Many of the courses are online and we are encouraged — although not obliged — to do as many courses as possible.
For instance, I hope I could recognise symptoms of sepsis. In the early days, I’d worry about making a mistake. I once had a woman ring in to say her four-year-old son had a twisted testicle.
That didn’t sound urgent to me but I double-checked with the GP who said he needed to come in straight away as it’s a medical emergency and if untreated could result in infertility.
But you learn quickly and I’m constantly updating my training.
While we may have a reputation as being brusque, our aim is to be approachable.
We’re not all saints, though. I’ve worked with some people who could be offhand with patients. I remember a young man coming in saying he had a cold, who was given short shrift by a colleague.
When she’d gone into the office, he turned to me and said: ‘I’m sorry, I don’t have a cold, I feel suicidal and I need help — but I didn’t want to tell her that.’
You can’t be so unfriendly that people can’t open up.
The surgery closes at 5pm but if we have emergency appointments they can go up to 5.30pm.
At 5.25pm we get another flurry of calls from people asking if we can fit them in for a last-minute appointment. We can’t and suggest they come back in the week or visit their pharmacist for advice. I’m always reluctant to advise patients to go to A&E, which is already overrun, unless it sounds like an actual emergency. As I prepare to leave to spend my weekend with my husband and boys, it’s been a fairly typical week.
If I was in charge of the health service, what would I change?
We need more doctors for a start but I can’t see anything to change that. Two regular GPs for a town serving 7,000 people is not nearly enough. People need to use their pharmacists more.
These are highly trained people who can often help and if they can’t, they will advise you to see your doctor. And more education about your health in general.
Oh, and don’t phone your GP if you have a verruca.

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