The image of general practice is in the hands of GPs

People are dependent on the service given by GPs but there exists the perception that they are overpaid, says Dick Vinegar. Photograph: Alamy

My last two blogs have been advice for Dr Chaand Nagpaul, the new chair of the GPC. I am afraid I must importune him again, this time about improving the marketing of general practice. I find that GPs have an image problem. On one side, people are clearly dependent on the service given by their GPs, and surveys regularly show that 70% are happy with the service they get.

On the other hand, there is a strong contrary perception that GPs are greedy and overpaid in these hard times. And they have a very secure job, unlike the rest of us. Stories float around that two GPs earn more than £450,000, the highest earners in the public sector, and more than 1,000 of them take home £250,000 and above.

And doctors' pensions seem to be over £50,000, which is a high number when most pensions are being cut. Dr Sarah Wollaston, MP for Totnes, let the cat out of the bag on a recent Question Time, when she admitted that she had taken a £40,000 pay cut to become an MP. That means that she was earning £100,000 as a quite young GP.

I hear GPs complaining that these figures are gross, and their take-home pay is much lower, after paying for their receptionists, their surgeries, their insurance, their computers and their pension contributions. Some claim to earn no more than £80,000, and not to have met any other GPs earning more. I am confused, and I feel that Dr Nagpaul should tell us what the take-home pay really is across the profession. If the numbers are relatively low, it could help the image problem.

One result of the general feeling that GPs are overpaid is that the public does not take kindly to their complaints that they are overworked, at the end of their tether, and are so fed up that they intend to move to Australia. What's with all this whingeing, if they are paid so well? And if the government is grinding them down, then it is up to GP leaders to negotiate a better contract.

The image of general practice is in the GPs' own hands. And let us have no more talk of strikes - they are death to the image of GPs.

Doctors like to blame the press, particularly the "Daily Wail" for their bad image. I find this a bit unfair. Even in the "Wail", I find the short articles to be based on uncomfortable facts or surveys. They are usually negative, but nothing like as negative as the torrent of denunciatory patients' comments which accompany them. I get a sneaking feeling that it is these patients' complaints which get under the doctors' skins, not the articles themselves. But the doctors prefer to blame the media, not their own shortcomings, because the articles give a platform, which did not exist before, for unhappy patients to complain.

Perhaps, a General Practitioners Committee/Royal College of General Practitioners marketing exercise should investigate how to handle this new phenomenon; like making formal complaints procedures more user-friendly and responsive, or setting up a rebuttal service. These measures won't stop the trolls, but they might deter some of the habitual complainers. Every organisation has to learn how to handle the press. Recently, the medical profession has been spectacularly bad at it.

There is another way that GPs shoot their image in the foot. In their house magazines they make comments which make the hair stand on end. Here is an example from Pulse earlier this month: "I have no interest in knowing what my patients think of me. I try my best and be polite and nice to them but ultimately I'm here to manage their health, not enter in a popularity contest." Malicious hacks browse these publications for unprofessional comments like this.

Dr Nagpaul and Dr Clare Gerada have a lot of thinking to do about improving the image of general practice. It will be tough for them, as they probably consider marketing to be rather demeaning for "professionals" like them. But they must do it, if general practice is to realise its potential.

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here

Ethical issues are often not addressed in national clinical practice guidelines for dementia

Main Category: Alzheimer's / Dementia
Article Date: 13 Aug 2013 - 14:00 PDT Current ratings for:
Ethical issues are often not addressed in national clinical practice guidelines for dementia

Twelve national dementia clinical practice guidelines included only half of 31 ethical issues the authors had identified as important in patient care, finds a study by Daniel Strech, of Hannover Medical School, Hannover, Germany, and colleagues, published in this week's issue of PLOS Medicine.

The authors identified current national clinical practice guidelines for dementia care published in English or German. They had previously systematically reviewed ethical issues in dementia care and they used thematic text analysis to assess whether and how the ethical issues were addressed in the guidelines. In the 12 national practice guidelines identified, an average of 49.5% of the 31 ethical issues were addressed (range, 22% to 77%). National guidelines differed substantially with respect to which ethical issues were represented, whether ethical recommendations were included, whether justifications or citations were provided to support recommendations, and to what extent the ethical issues were explained.

The clinical practice guidelines were published by a central governmental institution in 6 countries (Australia, France, Malaysia, New Zealand, Singapore, United Kingdom), by a medical association in 4 countries (Canada, Germany, Scotland, United States of America), one by a statutory health insurance body (Austria), and by an expert panel in one country (Switzerland). The authors state, "All guidelines explicitly acknowledged the involvement of experts from different specialties (most often from psychiatry, neurology, gerontology, and family medicine)."

Four (13%) ethical issues were not addressed in at least 11 out of 12 CPGs: "Adequate consideration of existing advance directives in medical decision making.", "Usage of GPS and other monitoring techniques ", "Covert medication" and "Dealing with suicidality."

The authors conclude, "Ethical issues and how to deal with them are important for guidelines to address, for the medical profession to understand how to approach care of patients with dementia, and for patients, their relatives, and the general public, all of whom might seek information and advice in national guidelines."

Furthermore, although clinical practice guidelines are "meant to improve standards of clinical competence and professionalism by referring explicitly to evidence-based information on benefits and harms", the authors state that clinical practice guideline development manuals worldwide fail to address how to include disease-specific ethical issues.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our alzheimer's / dementia section for the latest news on this subject.

This work has been funded by the German Research Foundation (DFG) through the research project Ethics Guide (STR 1070/2-1). The article processing charge was funded by means of the DFG-Project ‘‘Open Access Publishing’’ by the German Research Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Inclusion of Ethical Issues in Dementia Guidelines: A Thematic Text Analysis

PLoS Med 10(8): e1001498. doi:10.1371/journal.pmed.1001498

Knüppel H, Mertz M, Schmidhuber M, Neitzke G, Strech D (2013)

PLOS Medicine

Please use one of the following formats to cite this article in your essay, paper or report:

MLA

Medicine, PLOS. "Ethical issues are often not addressed in national clinical practice guidelines for dementia." Medical News Today. MediLexicon, Intl., 13 Aug. 2013. Web.
14 Aug. 2013. APA

Please note: If no author information is provided, the source is cited instead.

'Ethical issues are often not addressed in national clinical practice guidelines for dementia'

Please note that we publish your name, but we do not publish your email address. It is only used to let you know when your message is published. We do not use it for any other purpose. Please see our privacy policy for more information.

If you write about specific medications or operations, please do not name health care professionals by name.

All opinions are moderated before being included (to stop spam). We reserve the right to amend opinions where we deem necessary.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

Please send any medical news or health news press releases to:

Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

View the original article here