Seeing patients face to face is only one aspect
of general medical practice. Behind the scenes, we have to write
referral letters and read correspondence coming back from hospital.
Because I was feeling that the volume of correspondence
was increasing, I asked our data entry clerk to search our computer
records for records of letters sent and received by the practice.
We are fully computerised, and the data is reliable.
The chart below shows the results of a search
on correspondence activity between 1997 and 2003.
(c) Richard Lawson 2004
There is a significant increase in activity in
the 6 year period. The trendline shows a 30% increase in incoming,
and 60% increase in outgoing mail.
There are probably several reasons for this increased
activity, but I suspect that it reflects raised standards of clinical
governance, and a need to work to protocols and guidelines. We
will order investigations like endoscopies (putting inspection
tubes into holes to look around inside) routinely nowadays in
order to be sure that there is no possibility of cancer, in cases
where years ago we would have simply prescribed an antacid. This
is good for the tiny proportion of cases where a cancer is found
earlier than in days gone by, but it represents a huge amount
of increased effort - not to mention discomfort for the vast majority
of patients where cancer is not found.
The bottom line is that it is all very well for
the government to require us to work to higher standards, but
the amount of time and energy available to doctors is finite,
and it cannot be expected that we can safely increase our activity
year on year indefinitely.
Richard Lawson 30.10.2004