Wednesday, 8 August 2007

Why are you stroppy Irene?

I had a stroppy day, first is my colleague , more like the problem is me,rather than her because i am affected by her because she has always been like that.She is just so nosy. She wants to know every single thing that goes on at work, my conversations etc... since she sits next to me. She knows everything with everyone in the organisation. I don't deny her person skills is good. She is good at what she does, she is good in her job too. I don't deny her capability. But sometimes it just irritates me. I was conversing with my manager when he comes round to my desk, discussing about some medicine prescribed by a GP when he shouldn't, should be a specialist medication for multiple sclerosis. So i said the GP prescribed because the patient ran out of medication, so he prescribed some while referring the patient to neurologist at Queen Square.

Then my neighbour, Ms. A, joined in the conversation, with her normal agitated tone saying the GP shouldn't prescribe etc.. so i was irritated, i said : Let me finish my sentence.. then after i finsihed she continued.. then i said : i am just a messenger for the GP , this is what he said bla bla..

As a matter of fact, the GP prescribed 2 months, which he shouldn't. There is too long to "tie him over". It is a specialist drug, and it's beyond the scope of GP'S expertise. The conclusion of all this: GP should contact me whenever such specialist, expensive drug is required.

Guess what? This is what i told the GP.. what's the fuss about?

Just drives me up the wall.. my neighbour, it's love and hate relationship.. grrr... she annoys me ... which i think i do as well.. as i am the only person in the team, who disagree with her sometimes when we have different perspective. Just can't stand her big mouth, it's her strength and her weakness. Her tone, her speed, the way she say things ARGGH...

sometimes i see myself in her... a taste of my own medicine huh...

Second, is my job, my meeting with GP.

I don't know why i am so easily persuaded. I am not very firm when it comes to my job. Mainly because i don't agree to the philosophy of the health care system in NHS and hence, i am the vicitm of this imperfect system. That's not new, considering we are living in a imperfect world. There will be no problem-free world.

Maybe because i had 3 meetings with 3 different GPS in two days, within 24 hours.

The bread and butter of my job is to ask the GP to save money, do not squander tax payer's money on expensive medication, when there is a cost-effective one that does the job. Unfortunately, it is not as straight forward.

Today, i tried my best to persuade the GP to prescribe individual fluticasone and salmeterol inhaler instead of the more expensive combination inhalers called SERETIDE. Well, he said patients are more likely to inhale the combination inhalers, compared to individual inhalers. If they are non-compliant, their asthma will deteriorate and end up in the hospital.

I argued that there is evidence that combination inhalers do not increase compliance in patients. The have done trials on two separate groups of patients: one with combination inhalers, and the other on separate component inhalers. The outcome showed that there is no difference to disease control.

I was a bit agitated when i argued my case, because to a certain extent, we can say if we do this, patients are more likely to take the medication. Studies shown only 50% of patients take their regular medication anyway, regardless of what you do. There is this sphere of patient psychology that there is untouched.

After all that, the GP asked me : Irene, why are you stroppy ?

I kept quiet. The discussion continued for the rest one hour.

In light of the evidence, the GP dispute that it's reality that counts. His experience and his patients that he sees.

Too many issues thrown in my face today. He said i just sit in the office, looking at data and statistics. On their back, saying they should prescribe this and that, do this audit and that audit, making their life difficult etc..

What are they moaning about? 100 K per year minimum for what they are doing, they are telling me it's stressful? Telling me patient demand this and that so they have to prescribe, they find it difficult to say no. So who is the patient now? Who is listening to whose demand?

That's not it, everyone is helping the GP , because their "burden" is too much, so i identify areas of savings, and guess what? We pay them for good quality,cost-effective prescribing, It goes into their bank account. Sometimes i ask myself, how can i work with an organisation when i don't agree to their philosophy ? We also have long term condition nurses who help GPs to take care of their patients, because they do not have the skills to take care of them. Classic examples: diabetic patients.

Historically, GPs who think they are not expert enough to control the patients' blood glucose, they refer the patient to hospital. Now, because the government want to save money, as a consultant definitely cost more, so they are asking the GPs to reduce their inappropriate referral. So we employed nurses to go around taking care of this patients whom their GP are not capable to do so.

I told the GP my job is not easy either. It's the system. If we are in America, i will not be in the job at all. In america, everything is paid by insurance, so doctors prescribe whatever choice of drugs. But because we are in a free for all health care system, only one limited pot of budget , to treat heart transplant to hip replacement to blood pressure tablets, we need to prescribe cost-effective drugs.

I don't like my job either, going around asking GP to save money, and having to tell myself everyday that i am saving lives, because the money saved from the tablets can be used to fund a chemotherapy somewhere, to someone.

Today, i am stroppy. Blame the hormones.

Today i feel like changing my job. (not only today you may have noticed by now)

Today, i question the meaning of my job.

Today i question myself : why am i stroppy.


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