Working on the frontline

There are times when working in primary care can feel like a battle. It can feel like we are fighting a losing battle against workload, demand and bureaucracy. When this time of year comes round it can feel doubly worse due to the end of financial year strains created by QOF. Even with the best laid plans, templates and protocols getting QOF right can feel, well perhaps it sometimes feels just a little bit like this parody of Wilfred Owen’s Dulce et Decorum est, one of the most famous war poems in the English language:


Bent double, like our patients with sore backs,

Inwards we curse, observe but never judge

As we treat symptoms, paper over cracks;

Our tiring, caring hearts won’t budge.

Not having time to explore the roots

Of patients’ existential pain, and so half-blind,

Drunk with fatigue; searching for any shoots

Of change, or words that seem a little kind.

QOF! QOF! Alerts flash! — Prompting quiet mumbling,

Asking the clumsy questions, just in time;

To someone still not finished with their grumbling,

And we flounder like fish caught on a line.

Squinting hard through misty eyes in artificial light,

Thrown by the incongruity, I saw him frowning.

‘Do your asthma symptoms bother you at night?’

He answered me, spluttering, joking, clowning.

Too many measurements to keep up with the pace

Of change in evidence, and in politics mixed in,

With the science of counting and giving chase

To markers of performance and all the points we win;

Once we’ve ticked all the boxes that we could,

Begged forgiveness for the QOF-corrupted wrongs,

Realised the patient’s more than flesh and blood,

But a product of the community to which he belongs,

A warning cry, before ordering another test,

To GPs ardent for yet more QOF glory,

Lest you believe: sticking to this soulless quest

Completes the patient story.

First published in: British Journal of General Practice (2013); Vol 63:208

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