"Rapid Access Cardiac Clinic"

I saw my GP after an episode of chest pain which responded to GTN. Although I am low risk, this was textbook cardiac ischaemic pain. GP (eventually) referred me to the rapid access cardiac clinic.  There I saw a nurse, albeit a specialist nurse. They were very nice, but not a diagnostician. The history taking was of the scripted variety, akin to an early stage med student, but without the underlying understanding of physiology etc. Questions were often irrelevant, and repetitive.

I found the examination pointless- cardiac auscultation performed standing up! The whole exercise took 40 mins. At the end of which they agreed that I justified further tests - although these were not explained. No verbal or written information about the procedure was given, and no mention of safety netting advice. They were unable to answer questions, or indeed appear to understand why I was asking them (eg significance of a widened pulse pressure in someone over  60, or the CNS effects of beta blockers). I had some specific questions and asked if it would be possible to speak to a doctor at some point. The nurse looked horrified and no, but agreed to ask.

All-in-all I felt it was a pointless exercise. I had already been assessed by a qualified doctor - a qualified diagnostician of at least 5y experience (+5y at med school), who judged further investigations were justified.  I cannot see the input of the nurse added anything to this process.

As someone who would have I love the NHS tattooed over my heart (if I were a tattoo short of person), it is painful to admit the gross inefficiency that has befallen it.  I fully understand how this has happened: in part due to shortage of highly qualified staff, specifically doctors, then some bright spark decides that their routine work can be delegated to support staff.  This is not the way to go. I believe that doctors should be involved at each stage of a patient's journey, but highly supported at each stage by admin, nursing and other staff. I think that delegation to non-doctors just adds another layer, takes time, costs money, and often results in over or inappropriate investigations.