Gut Feelings

It is interesting, the notion of a gut feeling. I searched online to find a definition this morning (don’t worry, no patient neglect – a week of annual leave), and found this: “an instinct or intuition; an immediate or basic feeling or reaction without a logical rationale”. We all experience gut feelings from time to time. Some ignore them, some never realise they are present, and some act on them with an almost religious vigour. The rest, including me, pick and choose when to act upon them – with some gut feelings stronger than others. Hollywood loves a gut feeling – often some hero or heroine making the improbably ‘call’ and saving the day.

Like in medicine is definitely less ‘Hollywood’ than this. Yet this week I have found myself relying on my gut feeling quite a lot. Amongst the string of viral colds, muscular aches and sprains, and medication reviews I came across three patients whom I was on the fence clinically – that is do them need further investigations urgently or sending straight into accident and emergency. As a result of sitting on the fence clinically, which is based on my albeit limited clinical experience to date, I turned to how I felt about the patient – what my gut feeling was.

Now to digress just briefly – in medicine, you have gut feelings all the time. As a ward based doctor before I went into my general practice rotations, I experienced them a lot. It is classically the ‘end of the bed test’; This is where you will quite simply look at the patient from the end of the bed and they just don’t look right – or they look different from yesterday – just something, something you can’t put your finger on, and that the vital sign observations do not reveal. You have probably experienced these at work, with family or when out and about – you look at someone, something, or a situation unfolding and your gut tells you it’s not comfortable and you need to alter what you were about to do. I am sure, in medicine, as we doctors gain more experience, that this gut feeling becomes better trained and more refined. It’s the skill that medical school, like breaking bad news of a death, just cannot teach you in real life clinical practice.

So back to my three patients in GP surgery this week – The first two were both children both under the age of 2 years (one was just 10 weeks old). They both had non-specific symptoms, a bit of a temperature but not much – but then mum was on antibiotics for a bacterial chest infection – and when I looked at these little ones, they just looked a bit drowsy, a bit too pasty – and the whole story just didn’t feel right. When I examined them (these are two separate cases by the way), both didn’t reveal anything floridly alarming, perhaps a few added crackles to their tiny chests, the 10 week olds of which was no bigger than the palm of my hand – my stethoscope was huge when compared to her tiny frame. Not happy, I picked up the phone, and for both discussed the cases with the local on-call paediatric registrar. Both conversations resulted in the same outcome – both patients were transferred to A&E for speciality clinical reviews. I am still awaiting the discharge letters to see what happened to them.

The third patient was a little different – a man in his 50s. He came to me with a sore throat. Now in cold and flu season this is not an uncommon presentation. When, however I looked at him, he had yellow (referred to as ‘jaundiced’) eyes that indicated potentially a degree of liver disease, and when I examined him mouth and throat he had thrush. Oral thrush in a 50+ year old man is not common. In fact, it is a worrying sign. My gut was telling me that something very bad may be going on with this patient. On further discussion he had lost weight (not deliberately), coughed up blood in the past, smoked a pack of cigarettes a day for as long as he can remember, and drank to dangerous excess. When I sat in front of this patient, my gut said this is a serious case, and once I had that clinical information it only confirmed my gut. This gentleman was sent urgently for specialty review under the cancer two week wait rule.

So there we have it, a week of being more aware of my gut than usual. It is a wonderful, unexplainable tool that we all possess. Sometimes it works well for us, sometimes it works against us. This week, mine had been an ally that’s for sure.

Have a great week everyone,

Dr Nick

Disappointment, Grace Jones and The Reality Check Needed

This week has been a cracker in GP. I have seen such a melting-point of conditions that I am have never been bored; from otitis media (that’s a middle ear infection) which I managed to diagnose based on the patient’s symptoms and (more excitingly) the bubbles of fluid I saw the other side of her ear drum – a first for me, to the young teenager who I am pretty sure may have something known as slipped upper femoral epiphysis (known lovingly as ‘SUFE’), in which there is slippage at the growth plate in the long bones of the legs. Now this was interesting because I saw this teen the day before and his symptoms were fairly non-specific so I initially attributed them to simple growing pains – but at 3am that night, I woke up and couldn’t shake the fact that SUFE can be so easily missed that I didn’t want to chance it. I arranged the hip x-rays for him the next day. You have to act on your gut sometimes, I’m learning in medicine, even if it turns out to a false alarm.

So, yes, all in all a good week for me. However, that’s not what I really wanted to talk about in this week’s blog. This week I want to talk about disappointment and some re-grounding that I expect was needed for me. So for those of you who have perhaps just started reading my blog, I will just contextualise this a little for you. I, as a very junior doctor had some opportunities to be on a television programme about medicine. I jumped at the chance – simply because I love talking about health – and, yes, it was exciting! I have spoken about it a few times on my blog over the months if you ever want to track back and see the beginnings of how it came about.

This week however, the bubble was somewhat unceremoniously ‘popped’. Firstly, on Monday I learned that a VIP invitation that I had received to Grace Jones’s concert and dinner at Annabelle’s in London (a very swanky club that even my mum and nana remember!) with a host of celebrities, was indeed a mistake. It turns out that they thought they were inviting Nick Knight the famous fashion photographer!!! When I received the call telling me this (having of course told mum, invited someone very special to be my plus one, bought a fancy new tie and got my suit dry-cleaned), I have to say I did laugh! It was funny because I couldn’t shake the feeling that it was a bit odd…I mean seriously, why would I have been invited! Still, at least I avoided some horrendously awkward chat if I had actually attended – sporting a complete look of confusion as they tell me that they “love my work”…as I reply with “well, I just prescribe antibiotics, really”…! Needless to say when I told my mum she couldn’t help but cry with laughter. It was funny and I must admit when I opened the papers the day after the event to see Kate Moss stumbling out of the gig and Harry Styles with his shirt has off (or is that the style, I’d don’t know….), I did feel quietly relieved – that’s really not my scene. I smile as the whole scenario reminds me of when I mistakenly received an email from an Expedition Medicine company I used to work for who asked me to come out to the jungle to help teach the jungle course in Costa Rica. Of course, as a final year medical student at the time, I though that was a little ambitious! Turns out I was right, the email was meant to go to “Former Special Forces Doctor Nick”! At least I hadn’t booked the plane tickets…

So that was wake up call number one. Number two was when I learned that the television show I was on, and was being aired currently…has been taken off air. Turns out I may be too ugly for TV! Haha, no sadly, although that may be true, the fact was that the show was not performing and unsuitable for the prime time slot. It may well see itself on in a different slot…but I remain to be convinced of that. It was disappointing but I can take huge positives from the experience – including most importantly how I want to reflect myself as a doctor on screen (if I were to ever appear again). I also learned, even from this brief initial flutter with television that I need to develop a bit of a thicker skin when the people I know discover it and well, are not always positive. Criticism is something I have naturally never coped with well and I guess, at 31, maybe it is time to start working on that.

So two wake up calls this week. It hasn’t for a moment dampened my hunger to see if I can combine medicine and media – again, all for the simple reasons that I love talking about medicine and health – it touches us all in so many different ways, after all. However, while the slow wheels of media churn away, perhaps throwing up another opportunity in the future, I am very very happy. Currently I am having a bit of a love affair with medicine – I am enjoying being a doctor, made curious by my patients, am excited for a future in general practice – and, dare I say it, even looking forward to how much I will see and learning in the Emergency Department from December to March (even though that means working every one in two weekends!). The applications to General Practice training scheme opens next week so I am eager to get that submitted and start working towards the selection exam. Hmmm exam – sounds dull – but actually it is a great excuse to better my clinical skills even more…and the way that I am feeling right now – well, that’s no chore. Nothing is when you are passionate about it.

I hope you all enjoyed a particularly creepy Halloween as well!

photo

(My attempt on a quiet Friday Halloween eve!)

Have a great week everyone and try to fight any Seasonal Affective Disorder creeping into your days.

Dr Nick

I’m Back – Apologies for the Month Long Absence!

Hello all,

I think the first thing that I need to do for the very kind dozen or so of you (including mum, of course) who read my blog is to apologise for my absence. I think that it has probably been around a month since I last wrote. Looking back on it, it is that classic cycle of leaving something one week, busy the next week, and then you think “oh, well, it’s been two weeks, what’s another week…” and so on.

Since I last wrote life has been a little bit of a whirlwind. Before we come onto the last month as a junior doctor in general practice (with enough drama and quiescence to keep me a balanced man), let me position it in the context of my life. Four weeks has seen me complete my advanced open water diving course (in a quarry in Wales, randomly), go to Prague for a stag do (and spend far far too much money), attend a charity auction dinner at the National History Museum and dine next to the T-Rex himself, attend the wedding of the century for my dear friends – and give a reading (Corinthians Chapter 14 verses 3-14) – that left everyone asking if I was an actor! (the groom asked me to add a bit of passion to the reading….so I duly went classically over the top), be invited to a VIP Grace Jones concert, and probably most happily, meet someone wonderful with whom I am rather smitten with. So there you have it – the last 4 weeks summarised.

Natural History Museum

(The natural history museum – with food and music. Just brilliant!)

scuba

(Yes, even while scuba diving, I managed to make it medical!)

Onto the medicine…..

I really love general practice medicine. I love the set up, the independence, the one on one nature of the consultation, and the way in which you can really help people. I also love the randomness of it. I mean it is a serious melting-pot of presentations from the utterly mundane and trivial to the life threatening. These too are all peppered in amongst each other. Take for example a few Monday’s ago – I sat down at 8.15am with a coffee (another perk of general practice is the endless access to tea, coffee and cakes), reviewed some letters and lab results, and called in my first patient. I was full of the joys of an ending summer, had a spring in my step and….BAM!

You see the first patient, comes in, sits down, and promptly tells me he wishes to hang himself. He has been researching it on the internet, has written a goodbye letter, and is just in a complete state. When someone tells you something so powerful and sad that life is so bad that they wish to end it, it is very difficult not to get caught off guard. However, there he was, sat in my consultation room – alive. If he had really wanted to do it, he would have done it already. That, as an aside, is the sad reality of suicide – we can put as many protective and supportive measures in place but in the end, if they are determined to successfully commit suicide (what we term “completed suicide”), they will. Thankfully this patient got a good amount of support and treatment thereafter but it was a rude awakening for an otherwise quiet Monday morning. I, in fact, went on to see him the last few Mondays as he came in to just chat to me and tell me how he was doing better – which was great to hear. He is still doing well today.

That is one extreme. At the other end of the spectrum you get the coughs, colds, sore throats trickling in by the dozens each day. That is absolutely fine as they are usually quite nice, straight forward consultations, spending most of the time explaining why antibiotics are not useful for viral infections and are for bacterial infections only….and no, you don’t have any signs or symptoms of a bacterial infections. People are often coming for reassurance and I think, particularly in primary care, that is part of our job. Health, after all, is TOTAL and consists of not only the physical but the psychological, spiritual and social facets of their health. We, as GPs, can help with them all.

gp leg up

(GP life…)

It’s funny when I reflect back on the past four weeks for it makes me wonder whether it is the interaction with people that I enjoy more than the medicine itself. Though, I should add, that is one to one interactions…I’m still not a fan of large groups. Now the reason I make this comment about the interactions is because some of my favourite consultations are the ones that are the most random. Now I could go into a whole host of ones that I have experienced over the past four weeks, including the 9 year old brought in nestled in a pram still, the gentlemen with a testicular ache as his presentation who actually turned out to be depressed, but my most interesting is the young man who was quite simply questioning the meaning of life. I am not joking readers, his presenting complaint as I entered it on my online records, quite simply was that time, and life, is going too quickly. No psychiatric component to this before you wonder – and trust me I wondered, with probing questions like “Do you think anyone is actually ‘controlling’ your time” and so on! He was simply a very nice young man who had perhaps too much insight into his life. They don’t teach you to prepare for consultations like that in medical school.

They also don’t prepare you for the side of general practice that can make you feel truly awful. The unexpected death is never nice for the families of those that die. If you are the doctor who last saw that previously fit and well patient and they then drop dead 3 days later, you cannot help but churn it over in your head. The question you ask yourself is – did I miss something? This, very sadly for a very nice 61 year old gentleman, happened. I saw him three days earlier. I won’t go into details of the case as that is obviously confidential and it is beside the point – which actually is the way in which we cope with that pressure. I don’t believe I did miss something but in a career of 40 years, seeing 15 patients in the morning for 10minutes each time, and 15 patients in the afternoon week after week, it is very likely that something will be missed. I was very lucky that I had great GPs in the practice and that they supported me through that acute phase as I had to speak to the coroner’s courts and the police. They all, incidentally, told me their own similar stories and that it never gets easier.

With the Ebola crisis still growing, my parting discussion on Friday afternoon with the GP partners was to clarify the policy in the GP practice if someone were to present with symptoms and a clinical history suggestive of Ebola. Sobering thoughts. I watch the news on this crisis with such interest. A lot of very brave people tackling it.

So there you have it. That is my snap shot of the last four weeks. What is on offer for the next couple of months? Well, I have 5 weeks of general practice left before making the jump into Accident and Emergency. Oh and of course I was going to go scuba diving off the coast of Brighton to a wreck called the Indiana….how it seems I spent too much on the stag do in Prague. Oops.

Have a great week everyone and speak to you next week.

Dr Nick

Am I non-verbally leaking with my patients?

As I look at her sat across from my desk I am mentally willing her out of the door. She has been in the consultation for 18 minutes now…that’s nearly double the allotted time. This means too that my stake of patients that are waiting is growing and my morning is fast going from pleasant coffee-managed jaunt to a strained sprint. I nod as she continues to demand more and more. Here hands are raising up and gesturing towards me and in response my arms are now crossed. I never cross my arms (it shows off the hairiness too much). Oh no, I am putting up a barrier! I remember this from medical school, from every argument I have ever had! Am I really having an argument with my patient? Surely not…

You see that day words were heard but the non-verbal communication between us was much much louder. In essence, I didn’t want her there any longer as it was unnecessary, counter productive and my coffee was fast reaching that undrinkable temperature. I should add too that I had already treated, prescribed and managed her specific ailment. I’m not that cruel.

Non-verbal communication is a huge, if not over-riding component of our global communication with other people. It was first commented on back with Darwin who felt that all animals and humans expressed cues about their emotions and feelings through facial expressions and body language. Today the science of non-verbal body language goes beyond that of just body language but includes, use of voice (paralanguage), touch (haptics) and distance (proxemics).

This all got me thinking about how I interact with people around me: my friends, work colleagues, patients, complete strangers in the street. Am I different with each group? Well, I guess to a degree we all much be – particularly when we factor in how comfortable we are with them. I know with the above patient that I was probably had a very negative set of non-verbal signs – my arms were crossed, my face tense, my voice a little slower and deeper (not Barry White slow and deep mind you – – I wasn’t trying to seduce her!). These are aspects to my interaction that I can definitely improve upon, make me a better doctor and make my interactions more successful. When I think about my non-verbal communication in general I have to say though I am happy with it overall – I have always felt that I’m a happy, open, positive person and I take a certain pride, I guess , in helping someone I am talking to feel comfortable. That may be to make a new friend, impress a girl(!), put a patient at ease who is nervous or just make someone smile. This is clearly important as a large part of our “first impression” when we meet someone, in any setting in life is framed and made largely by their body language and non-verbal communication.

It is clear though that for me, when body language and non-verbal communication becomes key is in a negative situation. That is when everything is highlighted and accentuated. Perhaps it is as my mind focuses more on the words that I am saying and less on my body that my body then starts to do its own thing and naturally displays that I am annoyed and frustrated or feeling defensive. This is maybe highlighted with my case patient I have been describing through a concept called ‘non-verbal leakage’. This is essentially where you body displays how you really feel and is in complete disagreement with your verbal communication. For example, as I ended up standing from my chair and gesturing to the consulting room door and I say “no of course not, we always have time to hear every single detail of our verruca’s progression of symptoms over the past 12 months”…I am indeed massively leaking non-verbally. In fact I am flooding.

Right, I must  go now – time for a coffee and a walk to put into practice some of non-verbal communication skills and perhaps practice my non-verbal leakage before my morning GP session tomorrow.

Have a great week everyone.

Dr Nick

The Perfect Consultation

As I sit and write this, two days after this consultation, it still makes me smile.

You know, for many interactions in medicine, there are fault lines which run through them – not enough time, you are tired, the condition is complicated and full of challenges that pressure you, the patient is unhappy with the plan, and so on. This is part and parcel of medicine and of being a doctor – and in fact it is those fault lines which make us learn, adapt and evolve in our practice. After-all if everything was easy we would never get better – the same way that muscle needs to be stressed in order to repair and then develop stronger and more prepared for the next insult.

Of course in all walks of life, we always welcome those instances whereby there is a nice simple event and everyone enters and leaves it happy. I had one of these on Friday.

consultation room

(The above photograph is of my current GP practice consulting room)

The last patient of the day is called into my GP consulting room. My coffee is cold as the last few patients were so challenging that I didn’t even manage the odd stealthy sip! So I am feeling a little tired now but did not expect what came next. In bounce two energetic little girls probably 5 and 9 years respectively – puzzling since I am sure the patient I am expecting is at least 40 years old – though soon rectified as I hear the mother coming up the stairs. The two little ones had clearly gotten a head start on her…and judging by their energy, I doubt that it was the first time.

As they all come through the door, I stick my hand out and shake their hands respectively, introducing myself and getting their names. The look very proper as they shake my hand with their tiny one and giggle, the youngest looking up at me like I was a giant! Then, once mum is in as well, I draw up three chairs and they all sit around me.

“Right, what can I do for you?”

The mother describes her issue with the two little girls kicking their legs away under the chair while at the same time having a fixed gaze with interest at the conversation. Before mum has finished the story, the youngest blurts out:

“I want to be a fairy when I grow up!”

I looked at the girl and said, “Well, have you been to fairy school?”. “Not yet” was the reply. You have to love a child’s imagination! I explained that in order to get into fairy school, you need to pass normal human school really well first – as they only take the cream of the crop. She nodded, taking mental note of this fact.

The consultation goes on and it as it was it turns out that the patient had nothing to be concerned about.

“I want to be a doctor when I grow up!” the older girl suddenly says – with her younger sister looked annoyed at being gazumped! I knew more about this than becoming a fairy, so…

….what followed was such a lovely 10 minutes in which I showed that little girl my stethoscope (after of course it had been thoroughly cleaned), let her listen to her mum’s heart beat with it, and showed her lots of other bits of equipment around the consulting room. This, occasionally interspersed, with conversations about fairy school and that, I had, unfortunately left my fairy wings at home today. The mother looked on with such pride at her children as they confidently chatted with me. I would have done so too if they were my children.

As this was my last patient for the day, I had no time pressures, so let hem ask me questions and explore the room to their hearts content. But when it was time to go, they both said:

“Can we come and see Dr Knight again, please mum?!!! Pleeeeaaase!”

And then on the way out the door both gave me a very unexpected hug.

There is no big medical message this week, just a recollection of a wonderful consultation that, well, melted my heart a little.

Have a great week all.

Dr Nick

The Greener Grass? Life in Primary Care Medicine

As I type this I can only describe a ‘buzz’  about me; physically and mentally I feel pretty good right now. I don’t mean to sound smug when I say that but rather just that I feel I have been on quite a tortuous journey with medicine and how it aligns with my way of life and desires for the future. I am more relaxed, happier, driven and my old self again – after probably 3 or 4 months of losing those aspects a little. Even my family tell me this – and as we are all aware, probably the majority of families know their children best.

So what’s changed?

The short answer is that I have moved out of secondary care medicine (that’s hospital medicine) for 4 months and am now working in primary care (that’s general practice). Life is very different for a doctor in primary care. Now although I am still very wet behind the ears in general practice, being stumped by how to treat Mrs Smith’s achy joints, or little Jimmy’s sore red toe after his swimming lesson – for I am used to patients with severe sepsis, widespread infections, acute heart failure, and massive strokes – I never had to worry too much about the less acute side of medicine.

General practice doctors are true generalists – and I envy their knowledge. It is so broad, so encompassing, that they have to know a little about everything – both the chronic conditions, such as Dementias, Parkinson’s Disease, Chronic Heart Failure, Diabetes, and the acute conditions such as recognising meningitis in a sick child. To make this all more challenging – they typically have about 10 minutes per consultation to take the history, examine, diagnose, and make a plan – whether that be for further investigations or management. And they do it all without the support of investigations on their doorstep – you can’t get a ‘quick X-ray’ or ‘blood test’ or’ MRI scan’ to see if they do have a disc prolapse. You have to use your intuition and experience.

This week, as it is still part of my ‘introduction’ phase of my rotation as an FY2 to general practice, I am doing joint sessions with a GP before getting my own patient list next week. This means that we are both in the consultation room, and take it in turns to sit in the ‘hot seat’ and lead the patient consultation with the other watching in the corner. This is great fun! However, what is beginning to wear a little thin is, during the times when it is my turn to sit in the corner and observe, the patient walks in and says “oh, you’ve got a medical student with you”.

I AM NOT A MEDICAL STUDENT!

I have to just smile, and usually say nothing and bite my lip. My poor lip – it has taken quite the beating this week.

I really enjoy the set up of general practice too – you get a nice big office which, as Louis from X-Factor would say “you can make your own!” and super-comfy chairs. And SO much tea.The training scheme too is more condensed that hospital medicine (though I do appreciate for the ‘patient’ that this may be a less than favourable situation) and so you are qualified much sooner – with a lot more flexibility.

Now I have spent a lot of time reflecting this week about that word – flexibility. I know that I my ambitions are slightly skewed compared with many junior doctors for I not only want to be a good, safe doctor first, but I want to write about health, do some sports and exercise medicine, get more into media work (for the love of talking about it not the public eye status, I should add), and also some expedition medicine. This globally is within the context of having a family – most importantly for which, I have time for. General Practice is the ONLY career path (beyond leaving medicine altogether) that would allow me to do this. I will stand to be corrected on that…

That is food for thought and something that I need to mull over in the lead up to choosing my career route. The deadline for that decision, out of interest, is this November – so not long to go. I feel I know what is the most natural decision to make but I will talk it over with my family first – they are often my voice of reason!

This week I also got a better understanding of what a GPSI is. Now, pronounced “GYPSY” , I never really quite got why all these GPs had such a strong affiliation with the Gypsy community…and then I discovered that is stood for GP with Special Interest. Oh. As my mum would always (and still does in fact) – for someone seemingly smart, I can be very stupid. I cannot disagree. In the practice that I am at currently, we have GPs with special interests in maternity, diabetes, genito-urinary, musculoskeletal, and dermatology. I could be a GP with a special interest in Sports and Exercise Medicine.

I like the sound of that.

 GP

Needless to say after a relaxing weekend seeing friends, going to the cinema (Expendables III, oh dear), and some reflective walks through Battersea Park, I feel very good about things. I am looking forward to hitting the GP practice tomorrow for another good week. It’s a busy week too – I have to finish another article for the Independent, and I am doing my final filming session for the Discovery TV show called “What Have I Got” – more on that perhaps another time. All in all, life is good.

Have a great weekend everyone,

Dr Nick

Motivation

Now, when I looked up the definition of motivation it read something like this, “a reason or reasons for acting or behaving in a particular way.” That seems pretty obvious doesn’t it – we act because look for a result in something –  a person, task or thing. The reason I got thinking about motivation is not some complex, deep-rooted philosophical question that requires all of our combined cerebral white matter. Instead, I was walking back from the gym this morning, having watched people, to varying degrees exhaust themselves on machines and with free weights, some looking happy, some looking sad, and some well, looking like I would definitely cross the road in the street if I saw them and their face all distorted with grimace and grunting. It them continued as I left the gym, having just about motivated myself to complete my workout (but feeling the effects of a processed, synthetic take-away pizza the night before that was not quite in harmony with my gut as of yet), to find the rain pouring down thanks to Hurricane Bertha, and a huge stream of cyclists racing along the Chelsea Embankment as I walked home. They looked wet, tired and showing off far too much in all that lycra.

So the question is not what is motivation but why do some of us feel more motivated than others? Why do I, for example, currently spend a good few hours of my weekend reading up on medical issues encountered in General Practice now that I am on my four month rotation as a GP? Is it fear, low confidence, or more positively a drive to be better, enjoy what I do more if I am armed with knowledge – or perhaps I just have nothing else to do?! Personally it is a combination of all these things I am sure. I could also put my feet up and watch some TV (I am sure I will later) but instead I am sat here typing this blog. Why? What motivates me? Again, I expect it is a multitude of factors but one of the most pressing being that I find it deeply rewarding and enjoy it – two of the best motivators.

Albert

Health and how we look after ourselves is also driven by motivation. Some feel motivated to look after the one body they have – they choose to eat well, exercise, get plenty of sleep, and to not abuse their body too much with all the vices that flow through modern living. Others on the other hand either fail to be motivated to do this or are motivated to other aspects of life such as sitting and playing video games, alcohol, late nights with friends, and so on. Now I realise that the majority of people do fall somewhere in the middle, and as I have said before, there are such a huge multitude of factors that effect motivation that we could be sat here all day. This blog entry is merely a ‘pause for thought’ on the topic, I suppose.

Now in general practice, my motivation has changed. This is largely thanks to more sleep, less stress, and the pressured feeling that I was having in my last rotation now being off – at least for now. Now, as a result, I feel much more motivated and driven, my mind clearer on my goals such as working hard on this rotation, revising for the next exam in January (because I forgot to submit my request to sit the exam in September and the deadline has now passed! Dropped the ball there, Nick), get into writing more for the Independent (which I am still on cloud-nine about), and see what other adventures and opportunities open up. It is also interesting in General Practice to see what motivates patients to come into the practice – often it is the result of something they have seen on TV, the start of a new relationship and they want that bit of acne magically removed, or they just want to chat. I suppose my point is, it is not necessarily driven by a desire to improve their health but to make them feel better. That’s fine as we can sort them both out at the same time hopefully.

So going back to motivation, yes, it is a complex beast. It may have its roots in physical, psychological, social or culture factors, or be driven my a general desire to optimise wellbeing and total health. Perhaps, on the other hand, it is driven by a specific desire or goal such as to get that better job or better image you crave. Now the theories of motivation are in the dozens, and I am sure you don’t want to hear about every one of them. But let me just tell you about the simplest way to thing about motivation:

Intrinsic Motivation:

This is driven by an interest or enjoyment in the task itself, and exists within you rather than relying on external pressures or the search for reward.

Extrinsic Motivation:

This is driven by the attainment of an outcome, and not whether or not there is intrinsic motivation. Positive extrinsic motivation includes rewards or showing the desired behaviour, whereas negative extrinsic motivation is the threat of punishment if the task is not met.

Sadly nowadays there is a lot of negative extrinsic motivation – especially within the workplace with nearly every market becoming so competitive and peoples jobs resting on a hair-pin. I know personally that my intrinsic motivation is a double-edged sword for in drives me immensely in some aspects such as the pleasure of practical medical procedures or treating an acutely unwell patient; in other aspects however I am negatively intrinsically driven by my own internal barometer of how well I should be doing – and if it isn’t met, then I blame myself. As for extrinsic motivation – for me, I tend to do what I do because I enjoy it – I don’t feel a need to please the powers that be just so they can pat me on the head…

So there we go, something to think about for a while. Motivate yourself and more importantly (as it will come full circle to you) motivate others. Let’s keep it positive as well, no good really comes from motivation through fear – it certainly has no longevity to it.

Oh, and last time I’ll do this, as if you follow me on Twitter, you’ll have seen this re-tweeted to death but I am over the moon the have my first ever media article published in the Independent online – it even made the front page! I have put the link below in case you have an interest to read it. Now, that is a great external motivator to compliment my internally motivated love of writing them!

http://www.independent.co.uk/life-style/health-and-families/features/your-liver-walks-into-a-bar-the-science-of-alcohol-9646319.html

Have a great week all.

Dr Nick