Thursday, 13 March 2008

Are you my doctor?

I had a good day yesterday, and my evening surgery was particularly enjoyable. I say “evening” because it ran from 4pm until 6.45pm which is not really the afternoon, but it would not meet the Government's criterion for an evening surgery. Perhaps we could call it my “tea-time” surgery instead?

One major reason for feeling good was that, exceptionally, I had enjoyed a little spare time in the afternoon. This is a rare occurrence, but a happy coincidence of timetabling and lack of immediate patient demand allowed me to go home for just over an hour. I ate my sandwiches in peace, read the paper and did some piano practice. It should come as no surprise that a break in the middle of the day gives better results than working ten hours with no pause, save a rushed lunch. Except to the Government, who think it is a good idea for me to work another hour and a half immediately after those ten hours.

But yesterday I felt relaxed and on form. I did not feel rushed, and yet I kept to time. There were few patients with complex medical problems requiring assessment and review. By and large I saw people with single problems which we could discuss in some depth, placing it in context within their lives. One patient who came with palpitations has always appeared stiffly professional, but yesterday a tear appeared in her eye as she began to tell me about her major problems at work.

And I saw two new patients in their twenties. A young man had a relatively trivial self-limiting illness but the symptoms affected his ability to do his job, and after research on the internet he was seriously worried about his future career. I was able to explain what was going on and that he had no need to worry. After he left I wrote up his notes and then went to collect my next patient, who was the young woman sitting next to him. From their body language they were clearly “an item”. Again we had a friendly and constructive consultation, and towards the end she asked me “are you my doctor now?” I told her that under the new contract patients are registered with the practice rather than with an individual doctor, and that they can see who they like. Because we appeared to have a good relationship I went on to mention my fear that the Government was trying to discourage personal doctoring, so that in future care can be provided by any doctor (or nurse) sent to do sessions that day. Before she left she asked me to confirm my name “because my partner wants to see you again in future”. In other words, he wants me to be his doctor.

I have been asked the question “are you my doctor now?” before, but it was only yesterday that I twigged its real meaning: “please will you be my doctor”.

The recent dispute between GPs and the Government over extending surgery hours has seemed to be about two groups with different needs. People with health problems who need to see a doctor regularly, who want to see “their” doctor and are happy with the existing hours. And people who are generally well, rarely need to see a doctor, don't mind whom they see, and don't want to take time off work. The latter group is much larger than the former, the Government want their votes and are pandering to what they think are their desires. But my experience last night suggests that young and well people would still like to have a doctor whom they know and trust and whom they can see when illness strikes, as it surely will.


Elaine said...

Oh this really hits home. I am elderly (just!) and have multiple pathology (ie a lot of things arewrong with me.)

At my last practice I was registered with a doctor, nearly always saw him (apart from when he was on holiday, which I thought was a bit of a cheek! ;-) ) Over the space of two and a half years I was registered with him, I had to consult him many times - if I comment that I had at least 11 hospital admissions during that time you may get a picture of how often I had to consult him

We developed a good working relationship, with a bit of banter to lighten things up. He was very supportive throough difficult times.

And then I moved to another area.

Now I am registered with a practice rather than a GP and I feel that I see someone different each time I need to consult a doctor. Yes, they are all professional, and yes they keep good notes, but none of that is any substitute for knowing the patient as a person, rather than patient notes.

If any of them fell over me in the street, I don't think they would know who I am, and hardly better vice versa.

nuttycow said...

I would love to have my "own" doctor but sadly, living in London, it's hard enough to find a practice that will take me, let alone having someone who actually knows me.

Ho hum.

ageing student said...

I am registered with 'a doctor' at the surgery I have been attending for six years. There are 5 partners and a part-timer; I have seen all of them at various times except the one I am actually registered with. For the last four years I have regularly seen one of the other partners and, like Elaine, I have developed a good working relationship with him to the extent that whenever I am asked for my doctor's name I provide his.

Calavera said...

Aww, I'm glad that you had a good day! And it must be touching to be specifically requested as being someone's doctor - I'd be really flattered.

And yes, I've actually asked the same question to a GP, the same veiled "So... are YOU my doctor, now?" and I did indeed mean, "please please please can you see me instead of the other one from now and forever more, pretty please??"

It's good that you got to play some piano too. Which piece did you play?

Fiona Marcella said...

Despite their professed love of poly clinics and their apparent desire to have all medics working out of Tesco from 2009, the government actually expects patients to have "their" doctors. Just filling out a disability living allowance form, and it clearly asks for the NAME of the applicant's GP. Technically in this case, as per the health card from the FHSA this is "pooled list", but we've put good old Dr X down instead as don't suppose a "pooled list" would be very good at answering the questions of benefit officers.

Anonymous said...

I think it depends on what people are seeing the doctor for... for a minor niggle or flare-up of something in a healthy person (i.e. me, fortunately) that might need a prescription or reassurance I don't mind who I see.

For something "delicate", or ongoing, or mental-health related, or "life history related", or combinations of the above, I would want to see someone who knew my case, my file, and me.

I always thought a lot of practices ran effectively this system by using walk-in or "see whoever" clinics (first para) vs. book-ahead appts. (second para).

Mrs Dr Aust, who used to be a hospital general medic, is adamant that people with chronic conditions need to see the same (aka "their") doctor. "If you know the patient and their history it only takes you seconds to see if something has changed for the worse", is the way she puts it.

Dr Andrew Brown said...

Thanks everyone. Sorry I am late replying to this. Life gets hectic at times.

Glad to hear you are sympathetic to my views. But then presumably only people who are sympathetic will read the blog. :-)

Calavera - I can't now remember the particular piece, but I often play Bach.