The GP Inside

This week was the last of my 8 week community (GP) placement, given that my foundation years don't include a GP placement I might well have spent my last days in a GP.

When I started medical school the one thing I was sure of was that I didn't want to be a GP - under any circumstances. I'm not entirely sure why I felt this way, but I was determined, despite the fact that about half of us would ultimately end up as GPs, that I would pursue a career in hospital medicine. During my first GP placement in 3rd year my opinion changed for a few short weeks but this was mainly due to having a brilliant GP supervisor rather than me uncovering a hidden love for coughs and colds. My 4th year GP placements only reinforced my original thoughts that general practice wasn't for me. I was therefore dreading 5th year and its 8 week stint of general practice. 9 weeks ago, I was looking for any excuse to avoid as much time in GPs as possible, I volunteered for every meeting possible to avoid a morning or afternoon here and there. In fact, I'd rather have spent 8 weeks tied up, naked, covered in scorpions.

Why is it then, that I sit here 8 weeks later, rather sad that my time in GPs is over? Maybe its the dictaphones (I'm still not bored of them), or maybe its a new-found love of general practice. Perhaps love is too strong a word, but I've definitely mellowed towards general practice. Not so much that I'm not destined for a career as a GP but I can certainly see why the lifestyle appeals.

I've thoroughly enjoyed this 8 week placement, helped by the fact I was at a nice practice with a lovely supervisor but I think its more than that. I enjoyed having my own surgeries, my own patients and my own room, its a rather nice feeling when a patient comes back to see you when they're feeling better. Maybe its the novelty of having my own patients that made the experience so interesting and useful - a novelty that would rapidly wear off as 'heart-sink' after 'heart-sink' patient knocks on the door and sits down with a list.

I've learnt a lot in the last 8 weeks and it will undoubtedly be useful when I'm in the position of looking after my own patients in hospital.

I'm still fairly sure I don't want to be a GP but I can see it definitely has its benefits, and perhaps I shouldn't rule it out to the extent that I did before I'd even started medical school.

Next we have 4 weeks in A&E, something which i'm really looking forward to. So begins the last 8 week block of 5th year, where has this year gone?

Medstudentitis and Medstudentpartneritis.

Well it seems that between me and missbliss in the last 24 hours or so we've had more contact with medical professionals than ever before. You remember I saw my GP yesterday morning with a chronic sore throat that I’ve had since before Christmas, I didn't feel ill at all with it but the irritation is driving me bananas!

Anyway - I’ll start the story where the last one left off.

I picked missbliss up from work and we went straight back to the doctors, it was the end of surgery and they were running significantly late. I already had my own ideas about what was wrong with missbliss and fortunately the GP agreed. He looked up some protocol and considered admitting her for a millisecond, had she vomited, she'd have been spending the night in hospital apparently. He decided it wasn't quite that serious and instead gave her a prescription for antibiotics. This time I had got involved and said that I was a medical student which made the consultation much smoother in my opinion. The locum GP was very friendly despite his vibrating phone (which he later answered but was apologetic for) whilst examining missbliss. His explanation of a urine dipstick was also rather amusing, he didn't know I was a medical student at that point and told us all about the little sponges which change colour. Anyway, we went away happy, with some decent treatment and safe in the knowledge that my diagnosis had also been right - makes a change!

After deciding on an early night we tucked up in bed to watch some Buffy. At about 10:15 I woke up with a roaring fever, although I felt ridiculously cold and was shaking so much missbliss awoke thinking it was a repeat of our summer earthquake experiences. I'd never had a fever like that before; I also had an awful headache and felt really nauseous. I was actually quite worried, as was missbliss - I had no reason to have such a fever and it was very unlikely that I had the same thing as missbliss. I've never done so before but I had missbliss phone the out of hour’s service. I must say I was rather disappointed when a nurse rang back and told me to take paracetamol and ibuprofen in the most patronising manner possible. If I hadn't been slightly confused I might have explained that I was a medical student and wasn't stupid and that I was fully aware it was probably viral (although she saw fit to tell me it was definitely viral - no question about it!) So I laid there - awake for hours now burning hot despite not having any cover at all. There is no way I could have gone to my GP placement today so I phoned in poorly when I awoke this morning.

I kept myself dosed up on ibuprofen and paracetamol all day long and was beginning to feel better - although my chronic sore throat was taking its toll. But not long ago I began shaking again feeling awfully cold. I know it’s probably viral but I've never had such a fever before and it was pretty dam scary.

Meanwhile, missbliss has been looking after me all day bringing me food and squash, despite having an illness all of her own. Poor cherub.

Unless I'm substantially improved in the morning I don't think I’ll be able to manage driving to GPs tomorrow either, besides, I'll only infect my patients. Being ill sucks.

"Little Medic to Room 6 Please"

I went to see my GP today, and characteristically was a good 15 minutes early, despite the fact the surgery is 4 minutes walk around the corner. Anyway I'm quite happy to sit there and read my book until it’s my turn. My appointment was for 10:20 and the GP registrar was only running 10 minutes late.

The consultation itself was strange. I'm 90% sure the GP didn't know that I was a 5th year medical student and as such, I felt quite patronised at times. I used a number of medically related words which your average lay (or is it ley? I never know) person probably doesn't know, unless they've read in depth on the internet. The registrar was very nice, although a bit bamboozled by my presenting complaint. There isn't a lot wrong with me, it’s more a persistent annoyance than anything else but I thought it’s about time I got it checked out. I'm not quite sure what I was hoping for - perhaps that is why I don't feel particularly fulfilled by the consultation. I think the GP thought I was looking for antibiotics; although I made it quite clear I wasn't (must be a rarity in GPs). He promised he'd phone me back later with some more advice - although he hasn't yet.

It made me think about the complexities of treating medical professionals. I know some of my colleagues go in to see their GPs and tell them exactly what they want. Whether or not they get it is another matter. Some people say that they're a medical student, others prefer to remain anonymous. A fellow medical student came to see me during one of my surgeries recently and whilst it was only for a trivial complaint. I couldn't help feeling ever so slightly awkward. I remember witnessing a consultation between my supervising GP and a patient who was the young son of another GP. It worked very well, and was very professional, much more ethical than treating your own friends and family. I wrote about patients having their own agenda quite recently but what happens when that agenda is an informed one, from another medical professional. It must make things a little harder to deal with when there are differing opinions between the GP and the 'patient'.

Anyway, I'm going back the GP this evening with missbliss and her problem, which promises to be an interesting consultation. I have my own agenda based on my diagnosis (which is pretty barn door obvious to be honest), I know what treatment she needs, and I expect nothing less. Perhaps I’m wrong for doing so, but hopefully the GP will agree and everyone will be happy!

How Hard Is It To Be On Time?!

There is only one excuse for being late - being dead (ok, so maybe are a few more than that..)

How hard is it to be on time. A ridiculous proportion of my patients today have been late, 1 didn't even bother to show up at all?! I understand that GPs are often running late, but that is often unavoidable due to the 10 minute appointment system and it is certainly no excuse for patients being late. I have half hour appointments which are almost always concluded within half an hour so I'm never running late - that is until Miss X turns up at 10:15 and knocks me all out of kilter.

If I was a GP, patients being late would drive me bananas! If you've got a genunie reason, i.e. unforseen circumstances then fair enough but if you're just being lazy and or late for the sake of it then you may as well not bother coming at all. Although, if you're not going to bother coming, it'd be very kind of you to at least ring and let the surgery know. GPs should do what dentists do and charge for DNAs (Did Not Attend), that might make patients think twice about not bothering with their appointments.

I'm a lateness nazi as it is and I can't stand being late (note: this often leads me to be ridiculously early for things - much to missbliss's displeasure) but if I ever become a GP unless you've got a damn good reason for being late - you won't get seen. Simple as.

Just One More Thing

I don’t know what it is about Fridays, particularly Friday afternoons but nearly all my patients today had a list of 3 or 4 different things. Now for me, this isn’t as much of an issue as everyone who sees me has a half hour appointment but the GPs get 10 minutes, and very rarely do people book double appointments if they’ve got a list. It works quite well if they come and see me as they can take all the time in the world telling me their life stories and I can condense what they say into a short summary for the GP.

“Whilst I’m here...”, “Just one more thing...” are a couple of the favourites. Sometimes they’ll bring you a nicely written list. Either way, it can get just a touch irritating when patients expect all their problems to be dealt with. Oh well, its friday. yay.

Before I go - i've jus about finished ranking all 287 odd jobs in my chosen deanery - now I just have to click submit and wait patiently until the 20th of Feb to find out what my first job will consist of and where it will be.

Oh and just one more thing – I’ve made a rare post over at the real little medic, check it out if you’ve not already done so.

The Patient's Agenda

Any doctor, or even any patient will know that most people go to the doctors with their own agenda. A lot of the time they've got their own thoughts and ideas about what is wrong with them, sometimes they know exactly what treatment they want and occasionally they come in with the intent try and get something out of you which they don't deserve.

Its difficult to pick out these patients unless you know them and their history well and even then you can never quite be sure. Every doctor has their own 'heart sink' patients who persistently visit the doctor with chronic, often vague problems. What is their agenda I wonder? They've already been investigated up to the eyeballs, they've already tried numerous tablets with no effect, and there is little more that can be done. And so, a never ending cycle begins whereby these patients come for regular review, they're the ones that often take 25minutes even though very little can be done.

This morning I had 5 patients, and they all had pretty text book symptoms, they were all there on their own agenda and they had an idea what they wanted. I find it useful to ask what patients are most concerned about - this usually elicits exactly why they've come to see you and so you can actually help, even just by offering reassurance.

Sometimes patients trick you. I've seen this a couple of times recently. Firstly a patient came to see me and when I brought the doctor in to review the case, they denied everything as I presented their history to the doctor. I don't mean just picking up mistakes in my history I mean flat out denying that they'd ever said things to me, they ended up reporting an entirely different set of symptoms to the doctor. Why? Why would anyone do that? It made me look ridiculously stupid. I have an idea about why they did it, but still - bonkers. I seemed to remember this happened a couple of times back when I did psychiatry also, one of the reasons I despise it so much. Another patient came to see me. They seemed very unsure and nervous but I built up a good rapport and was able to find out all about the problem. I'd had a quick flick over the recent history on the computer and noticed a couple of previous visits with the same thing. So, I presented to the doctor who decided that they should be referred and off the patient went. Only after I'd dictated the referral did I take a detailed look at her past history to find that she'd been referred previously for the same thing. Shame that they'd neglected to tell me anything about their past history despite me asking specific questions about it.

So what did I learn today, well I learnt that patients really do often have their own agenda and they're often reluctant to deviate from it, so much so, that in some cases they even lie. How exactly do they expect to be treated then?

Perhaps this post is slightly hypocritical as in the past I've probably been quite selective with the truth to a doctor in order to fulfil my own agenda. That is unavoidable, I know too much about the system.

Bits and Bobs 2

My Portfolio meeting turned into a bit of a lame affair. I managed to waffle on for so long that the dean barely had any time to actually look through my portfolio so it didn't really matter what I had in it although he seemed quite pleased. In the past we've had some interesting debate about the course, PBL and such but yesterday was little more than a relaxed chat. I was left sort of unfulfilled because I usually enjoy moaning although I did manage to get in a few important things which the dean seemed rather concerned about.

New year's resolutions update: Well I'm not doing TOO badly really. Since the 1st of Jan, I've done some exercise and more work than usual. I've kept my car fairly clean but most impressively i've not had any chocolate, sweets, crisps or biscuits - I've almost given in a few times - so much so that I had a bag of wine gums in my hand but I forced myself to put them back. Improvements are still necessary though, more exercise and more work.

I'm still enjoying my GP placement especially having my own surgeries. Although its slightly annoying when people book appointments with me when all they want is a repeat prescription as I can't help them and it only takes 2 minutes.

Not a lot else to say really - will blog again later.

"How cool are dictaphones?" "stop", "new paragraph"

Today I had my first surgery at my GP placement. This means that I've got patients of my own, real...live...patients! I have my own room, my own computer, my own sign on the door, my own button on the computer to send in my own patients and all sorts of other cool stuff which I'll come onto later.

Throughout the last couple of years at other gp's I've always been able to see patients on my own before they see the GP but not to the extent that I can now. Now I have my own surgeries built into the computer system and the receptionists book patients in to see me... they must all be stark raving bonkers.

Anyway, it was great fun. That feeling I had from my elective where I felt like I was actually being a doctor came flooding back, although fortunately for the patients I'm still heavily supervised. My GP supervisor has slots in her surgery to come and check on me, make sure I'm not going to kill anyone and sign any prescriptions etc etc.

This morning I had 5xhalf hour slots - so the patients are actually getting a good deal, they get to spend 3 times as much time with me as they do with the doctor. Although most appointments don't tend to take that long, by the time I've worked out how the computer works and written up the histories (hopefully without referring them accidental for a vasectomy.) that half hour is soon gone. My first patient this morning was 40 minutes early, he must have been excited to see me.

It was an odd morning actually, 3 of my 5 patients went away with referrals to the hospital - 2 under the 2 week rule for the same thing. This of course meant that I had to do the referral letters - or more precisely I had to dictate them! This was by far the highlight of the morning, I'd always wanted to play with a dictaphone and dictate my own letters - it was unbelievably cool. So cool in fact that it took me about 40 minutes to dictate my 3 letters because I kept changing my mind about what I wanted to say and I kept recording over myself by accident. I used to sit in clinics and listen to consultants dictate their letters adding all sorts of weird and wonderful phrases wondering when I'd get my hands on a dictaphone. I kept my letters very professional - I dread to think what the consultants will think of them when they get them though - I'm sure I probably filled them with useless information about entirely irrelevant things but not to worry. Ok, I'll stop now, maybe I'm slightly too over-excited by this dictaphone thing, after all - referrals aren't generally that good for the patients.

Anyway, I didn't kill anyone, and even managed to come up with decent management plans. I really enjoyed myself, hopefully I didn't scare the patients too much.

Afternoon surgery starts at 4pm this afternoon, is it really bad that I hope somebody needs referring so I can dictate another letter?

What Is Wrong With Me?

Missbliss and I have not been too well the last few days but as part of my new years resolutions we went swimming this evening. It was good fun and good exercise. But that isn't the most remarkable thing about today, we came home afterwards and had a salad for tea/dinner (depending on whether you're from the North or South). Yes, that's right, a salad! I've not had salad, on its own since....well...ever really! I enjoyed it too, it was crunchy in all the right places and was followed by an Asian pear which was also scrummy. I've never been this healthy - ever. Perhaps even more shocking than me, Little '5 kit kats' Medic, eating salad and doing exercise is the fact that I've not had a single sweet, crisp, biscuit or any chocolate at all. Not the tiniest bit since New Year's Eve, More than a week! I've been tempted and oh so close - so close that I've had 2 malteasers in my hand having been offered them by an unknowing friend, so close that I've been in a shop with a bag of sweets in my hand only to put them down and run away. I can't quite explain just how difficult this is for me, it might sound pretty easy but it aint.

I even did some revision which completes my 4 realistic resolutions for today, go me, I'm going to go away and do a bit more work too. No, really I am. I promise. Seriously there must be something wrong with me.

My GP placement is even going well, I'm quite enjoying myself. I get my own surgery Monday and Friday morning and afternoons starting this Friday, good for me but not quite so good for the unsuspecting patients. Thursdays are half days because the surgery is closed, Wednesdays have PBL in the afternoon (hey, every silver lining has a cloud) and Tuesdays are study days - hell yeah, 4 day weeks are the way forward!

The Start of a New Year

Today was my first day back after the Christmas break, which I should add, seemed to go ridiculously fast. You might have remembered that I'm now doing an 8 week GP placement and I've not exactly been looking forward to it. In fact I've been dreading it, I don't know why because sometimes when I get into it I quite enjoy my GP placements. Nevertheless, I wasn't feeling very enthused when I awoke this morning.

I arrived at the GPs early and was met by friendly reception staff. The surgery is split over 2 sites, one of which was briefly my own practice. I met my supervisor who seemed really nice, I have a feeling she is going to work me hard and expect quite a lot but that is no bad thing I suppose. I spent the morning with her, although it didn't exactly go to plan to start with. 3 of the first 4 patients refused to have me in. Fair enough I suppose. The rest of the morning was surprisingly quiet, there was only a trickle of patients and about the most interesting thing was an ear with raging otitis media.

All in all it wasn't the most interesting of mornings but I'm pleasantly surprised and slightly more optimistic about the next 8 weeks. I'm also fairly pleased with my timetable, it potentially looks like Tuesdays might be all-day study days which would be fabulous, 4 day weeks are just what I need. Perhaps I will enjoy it (at least a bit) after all. It will get a lot more interesting next week when I get to have my own surgery with half hour appointments of my own! I hope the patients know what is about to hit them.

The rest of the day was taken up by my favourite thing in the whole entire world, yes that's right - PBL. The groups have changed, although 4 people out of 8 didn't make it today, apparently they are still on holiday - how bloody nice for them!!! The process itself was just as boring as ever. I even spent half an hour trying to write a poem about PBL but I was so dispirited that my creative juices were flowing like treacle up a hill.

Back to the real world, here we go with 2008 - Happy New Year!

New Years Resolution Update: Today I went to the post office and they have these amazing wine gum things that I usually eat by the crate full. I had such an urge to have 'just one packet' but I didn't I managed to resist. I almost cracked by the chocolate machine too but will-power prevailed and so far so good, i've not had any sweets, chocolate, crisps or biscuits. COME ON!

Good News

I wrote recently about an elderly lady who I'd been to see, I suspected some sinister pathology and the GP referred her under the 2-week rule for urgent investigations. I followed her up today and was pleased to see that her tests had come back. Other than a bit of oesophagitis the tests were negative, oesophagitis doesn't really explain her symptoms but its a much better diagnosis than what it might have been. I was really pleased that she is ok.

It was my last day at my GP today and I'm sad to be leaving. I've learnt a lot. It was a great placement with a great GP. Much much much better than the previous placement which was nothing short of a disaster. Now I have to pick an 8 week community placement for my 5th and final year, unfortunately none of the good GPs I've been to seem to be offering placements. Tits.

In other good news - only 5 days left of obs and gynae!