This evening the patient I saw with erythema multiforme last week consulted me again, much better and full of thanks. “I am very grateful to you for pulling out all the stops last time, so late on a Friday evening. I though you might just reassure me and send me away. I felt so much better after seeing you.” I very much appreciated these remarks and told my patient so.
But overall I remain disenchanted with general practice. I am in my early fifties, I've been in this practice for over two decades and although we don't have a “senior partner” I am the closest thing we have to one - but I don't feel as settled and happy as I thought I would at this stage of the game. As mentioned earlier, I've been through my bout of depression and have more or less emerged on the other side. But I still feel stressed and unsatisfied at work. I've been trying to work out why this is.
Certainly the job is difficult to do well, and our best efforts are not always appreciated. I do get positive feedback from time to time as happened this evening, but it doesn't happen often enough to support my morale in the face of other problems. Don't get me wrong - I don't expect all my patients to be effusively grateful for every little thing I do for them. Many of them have paid for the service through taxation so I need not expect their thanks as well. And of course many patients do say “thank you” in a polite way, rather as I say it to the driver when I alight from a bus (on the rare occasions that I use public transport). But on reflection I feel that I am giving quite a lot of myself in many of my consultations, thinking hard about my patients and what may be in their best interests. Sometimes patients are aware of this and give me proper thanks, as happened this evening. But usually they are not - and I would not expect them to be. I think this is part of what is meant by vocation, that you will do your best for others and not expect recognition for it.
Much more damaging is the lack of thanks and support from the Government, which has slowly declined over the past two decades. There is also a lot of uncertainty around and the pace of change is unlikely to decrease. No-one knows what will happen to GPs in the medium term and we fear that our contracts will be given to private companies and we may be shunted into “polyclinics” with poor rates of pay and working conditions. I feel constantly undermined from a number of sources: the Government and the media who keep sniping at us, being increasingly monitored and manipulated by the PCT (the local organisation of the NHS that deals with GPs), and by the GMC breathing down our necks requiring us to prove repeatedly that we are up to the job. Neither we GPs nor the hospital doctors are happy bunnies at present.
I am certainly not happy, and after more than twenty-five years working for the NHS I am not looking forward with eager anticipation to polishing my trousers on the same seat for another ten. A change is as good as a rest they say - so what is that change to be? The current plan is to leave my practice in about eighteen months, sell up and live abroad, returning from time to time to do short-term work. I will keep you posted on progress.