Friday, 27 July 2007


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.


A. said...

I can appreciate how you must be feeling. I've been lucky, I suppose, to have had change forced upon me, possibly a little more often than is comfortable, but I've now been in my present job for ten years - and I've had enough.

My husband retired in his early fifties, cut off all his contacts, and now regrets it, but it sounds as though you would be able to work from time to time - a good compromise.

Watch out for tax regimes in whichever country you are considering. We can't stay more than 6 months a year in France or we end up in all sorts of tangles as far as my job is concerned. They would have to open a registered office in France and pay (swingeing) French social security for me to make it legal. So we're constantly on the move.

Good luck with whatever you do decide, and do keep us posted!

The Shrink said...

Neither we GPs nor the hospital doctors are happy bunnies at present.

Ain't that the truth . . .

I really, really enjoy the clinical work I do, the teams I am blessed to work with, the patients I am privileged to talk with and my GP colleagues who by and large are emminently sensible and supportive (and mostly eschew guidelines, edicts and protocols in favour of common sense).

Yet although the 'work' bit of things is good, the culture we're working within is shifting in most unhealthy ways.

I'd wholly agree with you that it's the organisations that are making it daunting, not our patients or the clinical work.

As you say, change is in the wind for GPs in the medium term.

Consultant training is being hacked to 1/3 what it was. Doctors are being pushed in to specialities rather than choosing ones they've a passion or flair for. Doctors in training almost can not fail to progress to become Consultants (we've been told that 95% must become Consultants and anything less than this is a reflection of our inability to train them, not their ineptitude).

In 10 years time will we have trained, motivated, effective and accessible GPs and Consultants?

Dr Andrew Brown said...

A.: It is probably good for people to make changes in their job from time to time. As a junior doctor my post would change every six months, then I arrived in this practice and haven't moved for over 20 years! Of course the job has changed, and I have moved into training and then out again. But the changes now in prospect do not look attractive and, like Monty Python, I would like to try something completely different.

Thank you for your good wishes.

The Shrink: Yes, the Government are not doing very well at present. But as Schiller said, "against stupidity the gods themselves contend in vain".

Many years ago when I was involved in training we had a number of "problem" Registrars with difficult personalities and attitudes. It was extremely hard to cope with them, but also hard to find grounds for not allowing them to pass and become GPs. After discussion we came to the conclusion that they should not have been allowed on the training scheme in the first place, and in an ideal world not allowed into medical school. So the most important part in the process is in the careful and rigorous selection of candidates. Which is what MTAS has signally failed to do.

But you have to laugh. There is Gordon Brown in the wake of the Glasgow Airport attack saying how important it is to screen all doctors before employing them, and then it turns out that MTAS has made it impossible to carry out that screening in time.

Alternatively you could cry, of course.

Anonymous said...

I've been thinking about what you said. I probably haven't thanked people enough myself, with people like doctors and teachers, you do appreciate them but many people never think to say so ... talking to friends years later you'll praise a GP or lecturer who you felt was excellent but most of the time all you said to them at the time was a slightly embarrassed 'thanks'. So, I'm sorry. And just because people don't say much doesn't mean they don't feel appreciative. (also you are often under some stress when you do see a doctor and tend to focus on your problem ... I've come out of hospital sometimes and thought, that bloke we saw was excellent, and never knew who he was even, nor bothered to find out and thank him)

Good luck with your future plans - but I hope experienced doctors won't all be moving on, it looks as though we'll need them even more soon.


Anonymous said...

GPs used to go on until their seventies. I know doctors who remember protests in 1990 when an age cut-off of 70 was brought in.

Now people are counting the days from 50 until they have enough pension contributions to take early retirement. Successive governments have a lot to answer for when doctors are burning out after 25 years in the job.

Dr Andrew Brown said...

Sarah: don't worry, it's a common failing. I also haven't thanked many people that deserved it. And although I am moving on it is largely for personal reasons. There are still a lot of dedicated and thoughtful doctors around, of all ages.

Anonymous: you are quite right. Tell your MP. :-)