So far this week we seem to be coping with two doctors away (one on holiday, the other on sick leave) and I'm not working a lot harder than usual. Martha has kindly volunteered to do some extra sessions, which has been extremely helpful. In addition, our receptionists are negotiating with patients so that routine problems are postponed for a week or two and we are just seeing the urgent problems. This is not something that can go on for a long time, but the help of our receptionists is appreciated.
However we had “significant event” at reception this morning. Early in my surgery I had a gap because two patients had not turned up, so I got on with processing lab results on the computer. I then received a phone call from reception saying that one of these patients had been in the waiting room all along but had “failed to check in”. I don't think the receptionist who dealt with the patient could have been very diplomatic, because the poor woman was in tears throughout the consultation at having been “told off”. She has a depressive view of the world and her place in it. So I had to deal with her tears, apologise and explain, in addition to sorting out her symptoms (which were largely psychosomatic) in double quick time as I was now running late. Further enquiry revealed the reason that she had not checked in was that she had made the appointment only fifteen minutes earlier and then gone outside for a short walk. She had not thought to “check-in” again as it was the same receptionist sitting at the desk. I was particularly annoyed because an almost identical event occurred about a month ago. I have asked Myrtle our practice manager to have a discussion with the reception staff about it. One solution I can see is for them to remind patients that they should check-in when they make appointments, particularly if it is for the same session.
Following the excellent advice from some of my blog visitors I stepped outside the guidelines today – and it did me good. I was asked to see a charming but fairly demented and immobile lady with advanced cancer who has had a swollen calf for a week or so. On balance it is probably a small DVT, but I thought the hassle of sending her up to hospital, being given heparin injections, starting on warfarin, going back to hospital for a venogram and then having regular blood tests for warfarin monitoring were not worth the trivial theoretical benefit of reduced risk of death from pulmonary embolism. She looked so happy and comfortable sitting in her armchair with her family around her. How could I send her to the busy, impersonal, inhospitable hospital? I got her to agree to this plan of action, but more importantly I got the agreement of her family who will be still be around after she has died.
Perceptive readers will have noticed that I tend to lack self-confidence, which is a bit odd considering that I'm well into my third decade of doing this job. But “I yam what I yam” as Popeye used to say (and maybe still does). Usually when I see my list of patients for a surgery I do not know what they will be coming for. In theory I can cope with anything and in practice this almost invariably turns out to be true, but I find the uncertainty of that bald list subtly worrying. However, this evening a receptionist told me in advance what one of the patients was coming about, and I realised at once that I would be able to cope with it. This somehow made the whole surgery seem less daunting. You may think this a trivial observation, and so it is, but I make it anyway.
And in one final burst of self-flagellation I mention a consultation that I misjudged. It was towards the end of evening surgery and I anticipated something fairly simple. So when my patient asked me how I was I permitted myself a small gesture that indicated that I was a little weary. Mistake! Although her presenting complaint was trivial she clearly wanted to talk about the stresses that were behind it, but felt unable to do so. The consultation fizzled out in some banal advice for the complaint, but I felt that a lot was left unsaid. Perhaps she will return at a later date in the hope of finding me a little more energetic?