Dr Mary McCarthy: Guidelines for GPs can be adapted

As a GP, you have to follow a lot of guidelines about prescribing for patients and for good reason, to ensure the safety of the patient.

As with most things in life, however, guidelines can be adapted.

My many years of experience as a family doctor have taught me that one size does not fit all.

The best thing, where possible, is to tailor your treatment to suit the needs of the individual, what we often refer to as a holistic approach.

We know more than just what is on a patient’s medical record.

We know of social circumstances, their work situation and their family life, all of which impact my decision on what kind of treatment to prescribe.

It is important to consider a person’s psychological and physical constraints.

Guidelines deal with recognised best practice for a huge range of conditions and for a broad population. In most cases, GPs deal with an individual patient who they know well.

This was highlighted in the media recently concerning the treatment of diabetic patients. In young and middle-aged patients, it is really important to keep both blood sugars and blood pressure within definite targets to reduce the risk of complications in later life.

Priority

However, when the patient gets to later life, the risk and benefit ratio changes a little.

Avoiding complications that may take 10, 20 or even 30 years to develop is a sensible precaution in your twenties, thirties, forties or fifties.

It may not be such a priority in your eighties and nineties.

In fact, as I explained to one patient, who I have known for many years, the very targets that increased your safety in your youth may be a positive danger as you get older. Low blood sugars a young person can tolerate may cause dizziness, confusion and possibly a fall in an older person that could result in a broken hip, or some other fracture.

Doctors and nurses have to explain carefully that, if a patient has achieved an advanced age, targets of treatment can be relaxed.

Some drugs can also be removed and the removal of medication that is no longer needed may well make them feel better, brighter and more energetic.

Treatment should be modified to suit an individual patient.

This principle underlies family medicine at its best. We need to protect this.

* Dr Mary McCarthy has worked at Belvidere Surgery in Shrewsbury for more than 20 years. She is chairman of the local medical committee and represents Shropshire, North Staffordshire and South Staffordshire on the General Practitioners Committee of the BMA.