THE CASE

Mrs P is aged 56 and has Type 2 Diabetes. Her HBA1c has reduced from 69 (8.5) to 58 (7.5) and her SBP has been reduced from 150 to 135. Her GP gets this discharge summary: Mrs P had surgery for a bowel obstruction caused by adhesions from a previous hysterectomy 5 years ago. On admission, she had been vomiting copiously and was hypotensive and hypoglycaemic so her meds were stopped. She is on codeine for pain and a benzodiazepine for her sleep which was poor while in hospital. Her wound is healing well clips out in 6 days please. Over the next 4 months, for a variety of reasons, she has at least 8 contacts with the practice team.

In this episode, Avril and James invite Rupal Shah, a GP and GP trainer in Battersea who also works as an Associate Dean for NHS-WTE, in the London Professional Development Team to help us talk about how high rates of consultation come about, what drives them and what we can do about them. We talk about the problems of fragmentation, “routine monitoring” and how to think about practicing with more curiosity and compassion. At the end we give a number of tips and suggestions that may help you, at least a little bit, be a more contented clinician.