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