I was a bit low at the start of the week and found it quite difficult to face my patients on Monday morning, with a hint of anxiety below the surface. I've been catching sight of myself in mirrors or shop windows lately, and see an ageing chap who looks both weary and worried. I suspect it's a mixture of the empty nest starting to “hit home”, one of my children giving me a bit of worry at present, and the realisation that I've only got one third of my life left (if all goes well). Tout passe, tout casse, tout lasse. But at lunchtime I had a very helpful chat with the partner who was recently off work with stress, and has recovered enough to take an interest in my problems and make some sensible suggestions. And fortunately my evening surgery was quite light and had some “interesting” patients whose problems I found intriguing rather than stressful.
Then this morning my first patient was a refugee from a war-torn country. She is about my age, has just joined the practice, and was accompanied by a translator and a support worker. She presented a number of physical symptoms that appeared unrelated, but what was immediately evident from her demeanour was that she was depressed. Sure enough, on simple questioning she recounted a full house of depressive symptoms, and she is deeply worried about her children who are in danger back home and whom she cannot help. I thought that I handled the situation reasonably well, talking to her directly rather than to the interpreter, explaining what was likely to be going on, and arranging treatment and follow up. The whole thing took nearly half an hour, which made me late for the subsequent appointments (although I managed to catch up a little by the end of the morning), but I felt that I had done a reasonably good job and that what I had done was worthwhile. These things are good for morale.
Another thing that is getting me down is the approach of my next appraisal, due in January. I was cheered up a bit by an article in this week's BMJ by an ex-appraiser, who described appraisal as a “half-baked, halfway house”, and by comments made by some fellow GPs at a Principals Group meeting I attended this evening who see it as irritating and pointless. Their words, not mine.