Some time ago I received a letter from my GP inviting me to to attend a ‘long term conditions clinic appointment’. I haven’t responded, yet, it’s been a busy time. It seems, however, that my practice will not take ‘no’ (or silence) for an answer, so, I received a ‘second invitation’.

Let me tell you how I see the context. I received a letter asking me to attend the review (here is my post about it). As it happens, I want to attend the review, I think it might be beneficial to attend the review. But as it also happens, I’ve been busy over the last few weeks and, to be completely honest, I just didn’t want to be bothered with phoning, negotiating the appointment and then waiting in the surgery etc., etc. I wanted to leave it for a quieter time, which will come soonish. For me that’s just life. As much as my GPs might wish otherwise, my life doesn’t revolve around making an appointment with them. However, I do understand also that people forget things and need to be reminded about them. I tend not to forget things about my health (forgetting about other things), but others might do.

And here we come to the letter. No, it’s not a reminder, the tone of the letter has changed. And the nice invitation has been transformed to something quite different.  And it all happens in the  first paragraph (I preserve the original text):

You may remember that we wrote to you several weeks ago to invite you to attend a long term condition review at the surgery. As we explained in our earlier letter, a long term condition is one that required medication and/or monitoring for life. Review is important as it will help reduce any risks associated with the condition, and it will also ensure that we are prescribing any medication safely.

Let me just consider the basics.

1.  If your first letter was an invitation, then I’m not certain why I receive this letter. Invitations can be declined and as you didn’t include the RSVP clause, I remained silent. So why don’t you make up your minds whether you invite me to attend or tell me to attend?

2. I find it very presumptuous on your part to think that it’s all about the ‘review’ and yourselves, as if I had no part in ‘reducing the risks’. You know, with greatest respect, it is I who decides and takes the medication (or not). So, please, how about stepping down from your pedestal, just occasionally, and joining us, mere mortals?

3. I find it scary that the current medication I am on might not have been prescribed safely! If it is only after the review that you will find that out, I’m not entirely certain I actually want to be prescribed anything by you.

After this you would hope, there is not much more to say. Alas, here comes the best bit. You see, I think that the reference to safe prescribing is what this paragraph is all about. It’s supposed to scare me. It’s a pressure tactic which will send me flying to the phone and making the appointment. All of a sudden the current medication stops being safe and the doctors offer me the opportunity to make it so! All of a sudden, I don’t go for a review of my long-term condition, I go for an appointment to make sure that I am safe. Wow! Of course, the tactic relies on the assumption that I will not think too hard about what has happened so far, but it’s  probably a safe assumption.

A digression. Quite a few years ago a doctor decided that I needed a change of medication. Within a second I was in, thinking that the future is even brighter, but then, stupid, stupid me, I asked the doctor: So what was wrong with the current medication? Nothing, he said, it’s great. The new medication would simply get better outcomes, results. And I bought it. It was much later that I realised that the conversation was just bizarre. It’s like my current medication is fantastic, ideal, optimal, but I can now get medication which more fantastic, more ideal, more optimal (no, it doesn’t make sense to say it, but I still do). It’s always progress, we move on reaping from the new wonders medicine offers, always going ‘more ideal’. End of digression.

Why I don’t like the pressure tactic? Well, it’s not even that it is supposed to scare me, actually. Paradoxically, it’s  because it does more harm to you than me! Do you not realise that such a sentence undermines both you, yourself, and our relationship? Is it really more important to scare me into attending the appointment than to preserve my trust? I am very disappointed that it seems it is. Indeed, under the previous post, an ex GP practice manager wrote:

The real reason for the letter is due to the GPs getting paid for your attendance under QOF.

Is it true? I don’t know, but this is the context I need to understand why such pressure is applied. My attending is so much more crucial than anything else, including all the silly talk about empathy, shared decisions and whatever else. It’s my bum on the patient’s seat that really matters. No words of understanding, encouragement or other niceties. Attend or you might be taking wrong medication. Yes, I’m sure that will focus the mind.

Before I conclude I would like to make a suggestion. If you write:

Please have the blood tests done as soon as possible

don’t write two sentences later:

[the blood tests] are only recommendations.

because it’s just silly. I mean, really, it’s just silly.

To be honest, I started wondering about waiting for the third letter. What will I be threatened with? After unsafe medication, I guess, you have one option left.  And after all, you really don’t want patients at your practice who are highly non-compliant with your polite invitation, do you? What else do you need to do? Snap your fingers or something?

I want to finish by labouring the same point I’ve been labouring for a long time. There are no offensive words in the letter, there is nothing to campaign against. And yet, I’m really disappointed with it. It’s the first time, I think my doctors are making a fool of me. And I started wondering who exactly I will see when I make the long-term appointment. Because it will not be the person I’ve seen all these years. I will look at you differently, doctor.