Monday, 1 October 2007

A long day

Today was a long day which began an hour early at 8am with a “section” (Mental Health Assessment). I hadn't been too keen when the social worker rang me on Friday, particularly since the patient has only recently joined the practice and none of us had seen him. It is preferable but not essential for the second doctor at the Assessment to have known the patient beforehand. However, since I didn't know him there was no particular reason for the second doctor to be me except (the social worker's) convenience. The main reason we were doing the section at that time was that the patient usually goes out during the day, and was rarely in when the various mental health “teams” called on him.

I wasn't much impressed with acumen of the social worker as we stood bleary-eyed by the side of the road waiting for the psychiatrist to turn up. A dishevelled man came out of the house and wandered away down the pavement. I said to the SW “is that our patient?” “It might be” he admitted, “I've only seen him once”. But he didn't seem inclined to do much about it. So I set off in pursuit of Mr Dishevelled, discovered that he was indeed our victim, and persuaded him to return to the house. When the psychiatrist arrived it turned out that she had also only seen him once. The team member who did know him well had rung in sick with a tummy bug that morning. So we had our little chat and it turned out that he recognised that he was not coping and was very willing to be admitted to hospital informally (i.e. without coercion). If the teams looking after him had been doing their job properly there would have been no need to get me involved. But he was in the process of being transferred from one team to another, the only person who seemed to be responsible for him was this strangely passive SW, and the “outreach team” had evidently been unable to keep an eye on someone who preferred to go out during the day rather than sitting like a cabbage at home.

The day proper began at 9am and just didn't stop. One of our partners is still off sick due to stress and a different partner is now away on holiday. We have managed to engage a locum to do the absent partner's surgeries, but the locum does not see extra patients, deal with prescription queries, ring back people in the message book, read and take action on the post, or do visits. So whereas the absent partner and I would normally have shared these duties, I had to do them all myself. I tried to be as efficient as possible while ploughing through the “extras”, keeping things short and to the point. Then a man of my age walked in and said “my wife died on Saturday”. I didn't feel that I should cut that particular consultation too short. After four and a half hours' consulting it was time to start on the prescriptions and the message book. I took ten minutes to eat my sandwiches because I have found that if I rush these I get nasty indigestion. Then out to do two visits. I arrived at the second house just as the concerned relative was ringing the surgery to find out why I was late. By what I hope was clear thinking and judicious expediency I got everything sorted out and back to the surgery only five minutes late for my evening session. Clearly I ought to have rushed those sandwiches. :-)

By a stroke of good fortune there were no extra patients at the end of evening surgery, so I was able to go straight into dealing with the post and the late messages, doing my referrals for the day, and writing up the visits I had done this afternoon, the section this morning and my emergency late visit after Friday evening surgery. By this time it was 7.30pm and I decided to go home. There was still one message in the book, marked “not urgent”, but I feel that I should stop work after eleven and a half hours unless there is something very urgent that still needs to be done.

Fortunately (for I am a fortunate man) not all my days are like this, and we all have to pull together when a colleague is unwell. I know that my other partners are working equally hard. And there is light at the end of the tunnel, for the citalopram appears to be working and my partner's very organic-sounding symptoms are gradually fading. I was pleased that I managed to keep self-pity at bay today, even though you may detect traces of it in this posting. It was actually quite good fun juggling all the things I had to do and seeing whether I could get them all done in the time available. There were no shipwrecks and nobody drownded. Many of the consultations were satisfying and a number of patients paid me direct or indirect compliments. One particularly knotty problem sorted itself out because the patient knew me and trusted me and was prepared to take my advice over the phone even though her mental health is not good at present. And of course the staff were helpful and brought me numerous cups of (mostly lukewarm) tea.

And when I got home I ate a leisurely meal, consumed 1.5 units of alcohol, talked to my wife, played some Bach on the piano, rang my children and wrote this blog. Whereas a Proper Doctor would have done medical reports, reflected on his Educational Needs, and Instigorated the necessary Knowledge to meet them. What a lax character this Brown is! But there can be little doubt that he is human. And he is getting pretty good at playing the English Suites.


steph said...

"What a lax character this Brown is! But there can be little doubt that he is human".

And very normal!

Who wants a 'proper' doctor when you can have an all-rounder like Dr. Brown?

The Shrink said...

As a slight sweetener, for attending a Mental Health Act 1983 assessment to give a mdeical recommendation at the request of the Approved Social Worker, you do still get the fee for this work even thoguht your patient was managed informally.

It's no longer centrally set and can be individually negotiated but locally it's been agreed to be the best part of £180 that GPs get for this.

After almost 12 hours toil, if CPD was on your mind I'd be reckoning it was you we should be assessing, for such thoughts would be utter folly :-)

janeway said...

Sometimes I think wisdom is knowing when good enough really is good enough


btw - for 'the shrink' - interesting icon (avatar?) you have there

ageing student said...

I have nothing but admiration for GPs. Contrary to the opinions voiced in the "popular" press regarding the hours worked by them, I know that most provide an excellent service. My own is one of these - the only price we have to pay is that he does tend to run 10 - 15 minutes late. I am quite happy about this though, as the first time I took my daughter to see him, he spent over an hour with her - fortunately she was the last patient of the session! And no, I didn't think you sounded self-pitying; quite the reverse in fact - pleased with yourself for coping with everything the day thre at you.

Harry said...

The first thing I wanted to do today when i got back from med school was play my guitar until my mind was empty.

God knows what it will be like in 5 years time!

Dr Andrew Brown said...

Thanks everyone for your comments.

The Shrink: I shall certainly claim the fee, but round these parts it is a long way from £180. About £51, if I remember correctly.

Harry: yeah, keep playing the music!