Wednesday, 7 November 2007

Monday blues

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.


Elaine said...

Oh Dr Brown, I am very sorry to hear you are having an attack of
"the blues" again and hope it passes soon. As for that appraisal, I always thought that that should be nothing more than a boring formality for an obbviously (more than) competent reflective doctor like yourself.

Do take care, you have a lot of friends out here. :-)

orchidea said...

I'm sure your patient found the attention you paid her and her plight more than comforting, and I'm doubly sure the universe will forgive the delay caused to your other patients. ;-)

A cyber hug, if allowed. (((Dr B)))

orchidea x

The Shrink said...

Good to be dealing with the real agenda, not just the physical symptoms she proffered. A shame a Registrar or student wasn't learning from that!

Appraisal, grrr. Mine is next month. So far I've spent a full day and 3 afternoons getting things together for it with about half of it done, now. It fills a lever arch file. And by fills, I mean I seriously considered having to get a second one. Appraisal is a tedious and mostly futile process in Primary Care. At least it's not as onerous as it is in my corner!

Dr Andrew Brown said...

Thank you all very much for your support and hugs. I never say no to a hug!
Things have improved as the week has gone on, as you may have gathered from my burst of blogging yesterday.
I am doing my best to look after myself, and I have a lot of support in my practice, at home, and from friends. Including you lot here. I am indeed a fortunate man.