Back to work after my week off, and things didn't go too badly. I usually find that the beneficial effect of time off lasts for anything up to ten days, during which time it is easy to keep calm. My staff looked after me, and there wasn't a large pile of paperwork to deal with except for the financial stuff which is my pigeon, but which will keep until later in the week.
Other partners are now away and today was the day after the four-day Easter bank holiday, so the morning surgery was quite busy. I saw 19 patients, which would be light for some practices but is heavy for us. My average consultation time was 14 minutes which is rapid by my standards but as mentioned before I am trying to consult more efficiently. Overall I was consulting for 4.5 hours without a break, which is quite hard going. My pet theory is that overall demand for consultations is less because we give more time to each consultation.
I saw one of my favourite patients this morning, a retired university professor. I confess that I see her more often than is strictly necessary because she is subtly flattering and also extremely perceptive. This morning I was trying to hurry things along a bit, and as we got to the point where I thought most of the business was finished she asked "do you make signs to show people it's time to leave?" I realised that I had just firmly clasped my hands across my slowly-enlarging tummy. We both smiled wryly, and she told me that she used to shuffle the papers on her desk into a neat pile to indicate the same thing. Sometimes I go a bit further and stand up, while physically showing the patient to the door is a fairly robust sign that the consultation is over. Only once in two decades do I recall gently pushing a patient out through the open door, and she was still talking as I closed the door between us.
I find it especially difficult to end consultations with foreign patients, particularly when seeing them for the first time. I always thought that this was because they didn't know what to expect from the NHS, and usually expected too much, but perhaps failure to read my non-verbal cues also plays a part.