Friday, 27 April 2007

Jaw jaw

We had a productive partners' meeting this afternoon, I thought. We seem to be getting better at speaking up and saying what is bothering us, even when we know that it won't be well received. In the past I have found it hard to tolerate conflict, and tried to paper over the cracks as fast as they appeared with a torrent of persiflage. I am getting better at letting people express themselves.

This afternoon there was a conflict between the generations. Neil the keen young partner is the only one who usually keeps to time. Because the patients with emergency appointments are pooled at the end of surgery he often finds himself doing the lion's share (or occasionally all) of these. What was just a niggle to begin with has slowly built into a degree of resentment. One of the older partners feels strongly that we should work closely together for the common good and not seek to “work to rule” (the doctor running late must ipso facto have had more demanding patients) and has a growing resentment that Neil tends to leave before all the visits are allocated. I made some remarks which tended to support Neil. Another partner said that they could see both sides of the argument. And the marvellous Martha made some very insightful and soothing comments. In the end we agreed to try allocating the emergency appointments to individual doctors, but also to discuss the visits properly every day.

Even more important than reaching this compromise was the fact that two partners had been able to ventilate their strong feelings on the issues, and that we had all been able to listen to them. It also allowed me to recount one of my favourite aphorisms: if you don't think you are working harder than your partners then you are doing less, if your spouse doesn't think you are working harder than your partners then they are plotting to get rid of you.

Jaw jaw is better than war war.


eryn said...

Hi dr brown,
I just came across your blog today and enjoyed reading about your patient encounters. Im a medical student hoping to become a gp in the future. thanks for offering us a look into your work. look forward to reading more of you,

Dr Andrew Brown said...

Thanks, Eryn.
This blogging is a new thing for me, so I'm really glad to hear that you have enjoyed what I've written so far. I don't know how long I shall be able to continue - there will be a constant supply of raw material of course, but I may start repeating myself with my comments. When I think I'm becoming tedious I shall stop.
Best wishes for the future - and I hope the blog won't put you off general practice if that is what you want to do. :-)

Calavera said...

I agree. At least you can sit down and talk properly about issues, instead of just exploding one day...

By the way, may I please add you on to my sidebar of links?

The Angry Medic said...

Good Lord, Dr Brown, slow down! Your posting regularity has kicked the rest of our reputations into the mud. Even lazy-arse students like me with plenty of time to blog can't keep up with you :)

And congrats on the BritMeds mention! Told you you'd make it in easily. Your stat-counter explode yet?

P.S. Believe it or not, I'm also considering general practice now. Maybe become a Harry Hill or a Phil Hammond.

Dr Andrew Brown said...

Cal: it sounds very easy and obvious, but in practice relationships and communication between partners can be very tricky. We do fairly well in our practice, but even we have problems at times.

I'd be delighted if you would list this site on your sidebar.

Angry Medic: Sorry, I've been a bit enthusiastic. I'll try to slow down a little! Yeah, the stat-counter suddenly burst into life after the mention on the BritMeds, which was most welcome.

We need good men and women in GP, so you'd be most welcome. But they're also needed in the hospitals as well, of course. Phil Hammond is a bit of an all-round hero, isn't he.

Ms-Ellisa said...

Hi dr brown!...
I don't really understand what the job of a GP is - because in Greece people say that there are too few of them. Children visit pediatrists and grown people pathologists (which in Greece means internal medicine).
PS.I sat Cardiology today,and concerning the ECG they really did just ask for the basics :-) thanks again...

Dr Andrew Brown said...

Elli - are you Greek? If so, your English is extremely good.

What do GPs do? Well, "GP" (general practitioner) is the term used in the UK for what is called "family doctor" elsewhere. We work in "primary care" and provide the initial assessment and treatment for all patients (except people who go straight to Emergency Departments). Many cases we deal with ourselves, but when necessary we refer to a "secondary care" doctor in the hospital. So an ill child will first be seen by a GP, and then sent to hospital if necessary.

Advantages of the system are that the GP will (probably) take a generalist and holistic approach, rather than a specialist and reductionist approach. Each individual episode of illness is seen in the context of the patient's life and social situation. The GP may well have known the patient and their family for a long time. And research suggests that the larger the proportion of family doctors in a country, the better the health outcomes.

Apart from that we don't do much. :-)

Congratulations on passing your ECG exam. And let me give you a piece advice I obtained from a very wise hospital consultant: do the simple things well. I'm sure you will.

Ms-Ellisa said...

Yeah I'm Greek...! But I lived in the States for 2 years (7-9 years old) and I went to an American school where no Greek was ever spoken, so I had to learn English like kids do - almost as a first language. On my second year I hardly spoke Greek so my parents had a new rule of never speaking to me in English so I wouldn't forget Greek. When I came back my English got worse actually :-) At least that's what my parents say.
Thanks for the advice :-)
I don't know if I have passed yet - but I do now I answered the ECG questions correctly..

Dr Andrew Brown said...

Of course you'll pass, Ms Elli!

Fascinating to hear about your bilingual background. Your parents were quite right to speak Greek to you at home, and you should do the same if you have children.