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Thread: Financial rewards for Doctors who don't do their job properly

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    Financial rewards for Doctors who don't do their job properly

    http://www.dailymail.co.uk/news/arti...-hospital.html

    Usually, when I have a medical problem, I don't seek advice from my Doctor...I simply go to him for a referal to a specialist. GP's do what they say on the tin - They are "general" and therefore, generally don't have a clue about any specific complaint.

    Anyway, after months of problems with my eye's and 4 courses of antibiotics that haven't worked, I asked him for a referal to an eye specialist. It took me a good ten minutes to persuade him to refer me. Usually he just does it straight away.

    Then I read in the paper today that GP's are being given bonus' for NOT referring people.

    I will now be public ememy number one for my GP, because I have no faith in him or any other GP to actually know anything of any use. I will, in future bully my GP to refer me and take pleasure in knowing it's costing him to do so.

    On a serious note though. I wonder how many people will simple accept the Doctors advice about their medical condition, only to find out later that the GP's advice was wrong. Could be a fatal error, just so "Dr £110,000 annual salary per year" can get a bigger bonus.
    Last edited by Double Trouble; 19th-October-2008 at 01:55 PM. Reason: forgot to add link

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    Re: Financial rewards for Doctors who don't do their job properly

    I spent about 10 years, working for GPs before working in mental health (so much more fun) the GPs that I worked for also had specialities and had sessions at the local hospital in areas such as neurology and gynaecology . However, a good GP knows where their expertise ends and when they need to refer to a specialist.

    GPs pay is also structured by reaching targets for things such as immunisations, smears and health checks and you can find yourself removed from a GPs list if you don’t comply

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    Re: Financial rewards for Doctors who don't do their job properly

    Quote Originally Posted by Maxine View Post
    a good GP knows where their expertise ends and when they need to refer to a specialist
    Exactly...! GP's are human, like the rest of us, which means they aren't all "good".

    Quote Originally Posted by Maxine View Post
    GPs pay is also structured by reaching targets for things such as immunisations, smears and health checks
    Yeah, I know, but thats different.

    Surely you can't structure or second guess how many referals any one GP should be making? The town I live in, for example, is like Gods waiting room. I imagine a higher level of referals would be required than the average. Is anyone monitoring this bonus scheme?

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    Re: Financial rewards for Doctors who don't do their job properly

    Yes - I have had some experiences with doctors which were way short of the professionalism I expect. For example, during the summer I had a growth on my head which looked like a strawberry. When I went to doctors, he said "don't worry, just put some cream on it....".

    And last year, when I had a few problems, I went to the doctors and explained that I felt like it was curtains - and he just told me to pull myself together.

    I'm sure other people have heard of not dis-similar experiences.

    When a friend of mine was having some delusional problems, he told the doctor that he kept thinking he was Tom Jones. Apparently the doctor said: "It's not unusual".

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    Re: Financial rewards for Doctors who don't do their job properly

    Quote Originally Posted by JiveLad View Post
    Yes - I have had some experiences with doctors which were way short of the professionalism I expect. For example, during the summer I had a growth on my head which looked like a strawberry. When I went to doctors, he said "don't worry, just put some cream on it....".

    And last year, when I had a few problems, I went to the doctors and explained that I felt like it was curtains - and he just told me to pull myself together.

    I'm sure other people have heard of not dis-similar experiences.

    When a friend of mine was having some delusional problems, he told the doctor that he kept thinking he was Tom Jones. Apparently the doctor said: "It's not unusual".
    You know what might work well? Some of those funny stories about what doctors say to people when they go with a strange complaint.

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    Re: Financial rewards for Doctors who don't do their job properly

    Quote Originally Posted by Barry Shnikov View Post
    You know what might work well? Some of those funny stories about what doctors say to people when they go with a strange complaint.
    U mean these weren't, erm... "mildly amusing"??

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    Re: Financial rewards for Doctors who don't do their job properly

    I know you must be seriously disappointed that I've started a thread about something serious/boring and feel the need to make a joke of it and bring you back down to your comfortable dumbing down level.

    I thought it was interesting and might have been helpful for anyone visiting a Dr who needed a referral.

    I'll put serious/boring DT back in the cupboard shall I?

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    Re: Financial rewards for Doctors who don't do their job properly

    Quote Originally Posted by Double Trouble View Post
    I thought it was interesting and might have been helpful for anyone visiting a Dr who needed a referral.

    I'll put serious/boring DT back in the cupboard shall I?
    Well, I thought it was an interesting subject, and a very useful thing to know. So thanks for starting the thread.

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    Re: Financial rewards for Doctors who don't do their job properly

    Quote Originally Posted by Double Trouble View Post
    I know you must be seriously disappointed that I've started a thread about something serious/boring and feel the need to make a joke of it and bring you back down to your comfortable dumbing down level.

    I thought it was interesting and might have been helpful for anyone visiting a Dr who needed a referral.

    I'll put serious/boring DT back in the cupboard shall I?
    Oh bloody hell dont you start on the woe is me and feel sorry for me bollox as well,, we got enough pats on the back, ego tastic threads going as it is.

    Great thread, dont worry about the jokers..

    here is my view on it...

    Doctors (gp;s) are ****. They are only good for one thing.. referal. Once you have it you then have to decide of the person they have referred you too is good enough. If not.. make waves and get referred to another. I hate the NHS.. im dealing with them at the moment with some problems im having and i have ended up dealing with it myself privately. They were going to put me into hospital to have a procedure done that i have just had done without any anaestetic or overnight stay. Wankers the lot of em IMHO of course
    Last edited by Trouble; 20th-October-2008 at 11:52 AM.

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    Re: Financial rewards for Doctors who don't do their job properly

    Quote Originally Posted by Trouble View Post
    Oh bloody hell dont you start on the woe is me and feel sorry for me bollox as well,, we got enough pats on the back, ego tastic threads going as it is.
    Oh. Ok then.

    Quote Originally Posted by Trouble View Post
    Doctors (gp;s) are ****. They are only good for one thing.. referal.
    That's right. In fact, I went to the eye specialist this morning and it turns out my GP has given me the wrong medication 4 times over the last few months and could have, in fact, made my eyes worse. I now have the correct medication and specific instructions on what to do next and in future to avoid further problems.

    So, not only was he giving me the wrong advice/medicine, but didn't want to refer me either. Bloody old Quack.

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    Re: Financial rewards for Doctors who don't do their job properly

    Quote Originally Posted by Double Trouble View Post
    I know you must be seriously disappointed that I've started a thread about something serious/boring and feel the need to make a joke of it and bring you back down to your comfortable dumbing down level.

    I thought it was interesting and might have been helpful for anyone visiting a Dr who needed a referral.

    I'll put serious/boring DT back in the cupboard shall I?

    Well in response to you original question - I think the answer is (sad to say) "yes" - it's very likely that some people will simply accept the word of their GP - until their condition reaches a crisis point.

    I think this is particularly true of a certain generation who accept whatever their GP says as the indisputable truth. The newer generation of internet savvy, 'I'm a customer' type people will handle more like you have....

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    Re: Financial rewards for Doctors who don't do their job properly

    Here's a non-Daily Mail link:

    BBC NEWS | England | Oxfordshire | GP referral bonuses 'ridiculous'

    Yes, this does seem to be based on finances rather than on health.

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    Re: Financial rewards for Doctors who don't do their job properly

    I'm feeling sad, angry & discouraged after reading this thread.
    I’m a GP & attitudes like this sometimes make me wonder why I bother.

    General practice is a challenging career. Medical knowledge is expanding rapidly & patient expectation is rising accordingly. In general, this is a good thing, but it has its down sides.
    It's impossible to know everything & the trick is to know enough so that you are safe & can do the best by your patients. We all have strong & weak areas of expertise. There are some specialties that I will refer to more often because I have less knowledge in that field. There are some things that I am comfortable managing myself. I hope I know my own limitations.

    It would be wonderful if we could make unlimited referrals & have more people managed in secondary care, but there just aren’t the resources available. More & more is being passed back to primary care. We do our best.

    It's also useful to have a doctor who is general & looks at the patient as a whole human being, not just within the context of a specific specialty. A holistic approach is important to patient care. When I worked as a hospital doctor I occasionally saw thing being 'missed' because the specialists were focused on their own area. Having a GP who can tie things together is important.
    Quote Originally Posted by Double Trouble View Post
    Usually, when I have a medical problem, I don't seek advice from my Doctor...I simply go to him for a referal to a specialist. GP's do what they say on the tin - They are "general" and therefore, generally don't have a clue about any specific complaint.
    I’m sorry that you think GPs don’t have a clue about specifics.
    I’m also genuinely sorry that your eye condition hasn’t been well managed & I hope it improves soon. I can understand you being angry about it. But does it really mean that all GPs are useless??
    Of course, we make mistakes. Of course, there are some bad doctors out there. But most of us are doing the very best we can under increasingly difficult circumstances.
    I'm not suggesting that you never disagree with, or challenge your doctor, if you feel that they haven't understood something or that treatment isn't working. But we do have medical degrees, postgraduate qualifications & considerable experience in looking after sick people.. so writing us off as only good for writing a referral letter is insulting.

    Quote Originally Posted by Double Trouble View Post
    Surely you can't structure or second guess how many referals any one GP should be making? The town I live in, for example, is like Gods waiting room. I imagine a higher level of referals would be required than the average. Is anyone monitoring this bonus scheme?
    Reading about this, I imagine that GPs in that area are as unhappy about it as patients.
    Believe it or not, most of us are in medicine to take care of our patients. If we wanted to make lots of money there are far easier ways to do so.
    The media frequently reports that doctors are being given financial incentives. In reality, it is often a case of taking money that we had already been allocated & saying that ‘next year you can have this amount if you jump through this hoop’. It is more about controlling our practice than giving us extra money!
    It is my belief that the average GP partner’s earnings have not gone up, in real terms.
    However, as I am paid sessionally, I can’t be sure of that.

    Quote Originally Posted by Trouble View Post
    Doctors (gp;s) are ****. They are only good for one thing.. referal. Once you have it you then have to decide of the person they have referred you too is good enough. If not.. make waves and get referred to another. I hate the NHS.. im dealing with them at the moment with some problems im having and i have ended up dealing with it myself privately. They were going to put me into hospital to have a procedure done that i have just had done without any anaestetic or overnight stay. Wankers the lot of em IMHO of course
    I'm struggling not to take this personally.

    I'll ignore the blanket insult & address what you say about the NHS..

    It strikes me that something has gone wrong in your discussions with your GP &/or specialist if you feel that "they were going to put you into hospital".. We don't have the power to do that, except in cases of severe mental illness.
    Investigation & treatment should be as the result of a shared decision between the patient & their doctors.

    The NHS has many faults, but it is far better than what we had before its inception.

    I suspect that much of the dissatisfaction felt by people today is caused by poor communication. There are many factors that contribute to this.

    Personally, I will keep doing what I can to look after my patients to the best of my ability within the limitations that exist both in the NHS & myself as a human being.

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    Re: Financial rewards for Doctors who don't do their job properly

    Quote Originally Posted by David Bailey View Post
    Here's a non-Daily Mail link:

    BBC NEWS | England | Oxfordshire | GP referral bonuses 'ridiculous'

    Yes, this does seem to be based on finances rather than on health.
    Do we really need a non Daily Mail link ?

    Anyway potential mind field this one

    Lets also not forget GPs are human as well

    I can picture Wayne from Portsmouth Council estate having her GP in a head lock as we speak as her 12 kids watch on

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    Re: Financial rewards for Doctors who don't do their job properly

    Quote Originally Posted by Double Trouble View Post
    I know you must be seriously disappointed that I've started a thread about something serious/boring and feel the need to make a joke of it and bring you back down to your comfortable dumbing down level.
    Would U like cream with ur slice of irony?

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    Re: Financial rewards for Doctors who don't do their job properly

    It's odd how some people see things in opposite ways.

    I see this as rewarding GPs for doing their jobs.

    What would you think of a mechanic if he always said "this job is too big for me, I'll have to get an expert to work out what's wrong with your engine and fix it for you". You'd probably find another mechanic.

    There are occasions when a mechanic might get an expert for something like electronics or paintwork but you'd expect him to be able to deal with routine repairs and on-going care.

    It's the same with GPs. I see this move as encouraging them to do the work rather than referring thier workload to the hospital. The benefit for the patient is that they get a quicker diagnosis and faster treatment from someone who knows you better than some stranger at the hospital. The benefit for the hospital is that they get less work and have shorter waiting lists.

    Just like the mechanic in my example there are specialist treatments that you need to get from the hospital. But I would expect my GP to treat most conditions. And where I'd been treated by the hospital I'd expect my GP to monitor my condition once I'd returned home.

    I see this as an encouraging move and GPs are constanly moving into larger and larger health centres offering more facilities. Therefore I'd expect them to offer more services that were once available only in the hospital.

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    Re: Financial rewards for Doctors who don't do their job properly

    Claire - great post. I'm at work so just wanted to pick up quickly on one thing you said...

    Quote Originally Posted by Claire S View Post
    does it really mean that all GPs are useless?
    No, of course not. I did say this in an earlier post..

    Quote Originally Posted by Double Trouble View Post
    GP's are human, like the rest of us, which means they aren't all "good".
    My GP is a bit of an old quack and I've had lots of negative experiences, but I don't tar you all with the same brush at all. Sorry if it came across like that.

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    Re: Financial rewards for Doctors who don't do their job properly

    Quote Originally Posted by Andy McGregor View Post
    It's odd how some people see things in opposite ways.

    I see this as rewarding GPs for doing their jobs.
    The point is, there's a structural financial dis-incentive to refer to a specialist.

    And, with the best will in the world, that means that a lot of doctors may have an incentive to compromise their clinical judgements. Which is, at the least, a potential for a conflict of interest.

    Isn't that conflict obvious?

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    Re: Financial rewards for Doctors who don't do their job properly

    Quote Originally Posted by Claire S View Post
    It strikes me that something has gone wrong in your discussions with your GP &/or specialist if you feel that "they were going to put you into hospital".. We don't have the power to do that, except in cases of severe mental illness.
    Sounds like they were within their power then

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    Re: Financial rewards for Doctors who don't do their job properly

    As a hospital "specialist" I feel the need to say something here.

    GPs in general do a bloody good job, mostly for no thanks. So thank you GPs

    The vast majority of GPs appropriately treat the vast majority of their patients, providing the holistic link in their care that hospital specialists cannot. They're not experts in everything (despite most having specialist interests and training with hospital specialist in these areas) so they refer appropriately and patients get the treatment they need.

    Doctors aren't daft, we know when a GP has been pressured into making the referral by a dissatisfied patient who is being managed appropriately (usually because the GP writes as much in their letter). Think about the time you waste when someone else with a genuine need to see a specialist could have been sorted out, never mind the GP's time to write the letter and so on. The NHS is a finite resource, and if you really feel the need to go private to get what you want (as opposed to what the person with ten years plus of training thinks you need) that's fine. The people most in need of healthcare are often the ones least able to finance it themselves, so get out of their way.

    GPs, like all doctors and everyone else are human. We all make mistakes and miss things but as Claire put very well, there are much easier ways to make much more money than in medicine. Anyone worth their salt in medicine gets quite upset when they miss something important, but also learns from the mistake and doesn't let it happen again. I know not every doctor is like that, but they are far in the minority.

    The fact that anyone continues to read the Daily Mail says something for their ability to critically appraise a story presented to them, so I don't expect my wee rant to change much, but I feel better

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