Angry Patients

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A lot of GPs say that one of the attractions of general practice is that they don’t what’s going to come through the door. And it’s true. Every time I buzz someone through, I have a brief read through their records and wonder what symptoms or issues they’ll need help with. More importantly, I always wonder about the type of person who’s going to come through the door. The GPs might recognise the name and immediately recall who the patient is, who they’re related to, what they’re usually like. They have more background knowledge. I, on the other hand, have no clue what to expect.

For the most part, the consultations go well. There’ve been occasions where I would have liked a do-over. And once in a while, I’ll have a difficult consultation.

When it happens and I have an angry patient, usually male, sitting across from me (and on one occasion standing over me), I think immediately how vulnerable the situation is. I’m alone in a room, my back towards a closed door and only a corner of a desk separating me from an agitated person. On the plus side, I think to myself, the walls are thin, surely someone would come running if there was a scuffle. There’s also a safety alarm in each room. A rectangular red button encased in white plastic, is placed against the wall just underneath my computer screen. If the situation arose, I’d have to reach across to push it in full view of whoever I was afraid off. There’s nothing subtle about pressing a big red button.

Then I wonder, when would be the ideal time to press the button. I don’t want to blow a situation out of proportion, and have everyone come running from all corners of the building and descend onto my room. Embarrassing. Thankfully I haven’t needed to so far and the individual in question has eventually left. But in those situations, it’s like all my internal organs begin writhing around nervously. I feel uncomfortable and maybe, sort of threatened.

I sometimes get a twinge of discomfort when I’m supposed to go on a house visit. I might just have an active imagination. No, I know I have an active imagination which really helps me think up loads of ridiculous scenarios. For example, I don’t know if old Fred, who’s complaining of back pain, spent a part of his youth beating people up for money and has finally retired to his armchair but still has a mean left hook. At least in the practice I’m surrounded by colleagues but on a home visit, who knows what I’ll be walking into.

Like I said, active imagination.

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Another Meeting

Several weeks ago I told my supervisor I was feeling a little worn down. I wrote about it here. I was still feeling pretty disillusioned by the last 8 months in 2 bad placements. My supervisor wrapped up the meeting by asking to meet with me for another review.

Fast forward a few weeks and I sat down with her again. This time, I was in a much better head space and I was adjusting to GP. I remembered from our last meeting, she’d briefly mentioned the option of going less than full time. I already went into this meeting knowing in my head that I wanted to finish F2. But I thought it’d also be good to hear some options.

I let her know that I was feeling differently about medicine and she told me if I quit, it would all be a waste. It was the kind of encouragement I was expecting. I’ve learnt to keep my expectations low. I might have been a bit more disheartened if I genuinely thought that she may have answers for me. But from all my Googling I didn’t come up with any encouraging solution.  So again I wasn’t surprised.

I mentioned this on a different forum and someone mentioned that my educational supervisor was unlikely to be impartial. That makes sense, especially considering that I’ll also be working in her department for my last placement. Finding a locum to replace me would be hard, expensive and inconvenient.

But it just makes me wonder then, who’s looking out for me? It would be nice to discuss this with a senior colleague who genuinely cared about my best interests. I’ve found it difficult to form those types of relationships in medicine, what with the constant moving around. Even my current supervisor is new.

I’ve found a lot of comfort reading blogs online. The internal validation I get when I come across something that expresses what I feel or gives practical advice is helpful beyond belief. Which is part of the reason why I write: 1) because I enjoy it and 2) I hope someone else finds it even a little bit useful.

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Outside The Box

From recent posts, it’s clear I’ve become more unsure about my path in medicine. But as of yet, I have no plan, or really any solid direction. What I do know is that the idea of taking a break has become more and more appealing to me.

The journey to where I am now has been linear. I went from high school, to sixth form (college), to university, to working without taking any gaps. I’m really grateful I didn’t have to reapply to medical school and that I got the grades I needed. It’s been a steady trajectory to where I am now. And there’s the opportunity to just keep going. I could potentially apply for another training programme after F2, become a trainee, become a registrar and then become a consultant or a GP. Do the necessary exams along the way, jump through the necessary hoops. Knowing at each point what my next step is going to be. And there’s safety in that, having a plan for the next 10 years. But right now, it doesn’t appeal to me.

Medicine can be rigid, particularly in a training programme. There’s not much control over where you go and what you do. Do you want to move to Bristol? Tough, you have to work somewhere else instead. It’s a constant juggling process: work, family, life in general with medicine always coming up as a top priority. You need to make sure accreditations are up to date, keep up with exams, portfolio all the while bouncing between night shifts and day shifts.

Ultimately, what is the rush? Do I want to be a young consultant? Not particularly. I want to have experiences that go beyond the allocated days I have for annual leave.  I wonder what it feels like to be in control of my own schedule, choosing what I want to do and when I want to do it. Taking risks, going out of my comfort zone. Taking the time to learn new skills, or live in new places

And it honestly feels like it’s not possible to do all those things alongside medicine.  At least right now. So, at the moment I’m taking tentative steps and looking outside the proverbial box. Just a peak to see what the world outside has to offer.

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Stop.

Photo by Nathan Anderson on Unsplash

Sometimes, I see patients and for whatever reason I get flustered. There might be a few complicating issues, the symptoms aren’t clear, my mind is thinking of possibilities A, B, F, K, and Z, the clock is ticking and the floor is on fire. I feel under pressure and I can’t think straight. And when this happens and I don’t know what to do, I realise that I need to just stop, take a breath and start from the top.

Last Thursday, I had a difficult morning. I started the day with a complicated patient which set the tone for the rest of that morning clinic. My first appointment was a lady with known mental health issues. Midway through, she suddenly flipped and demanded I stop asking questions. She’d been getting more and more agitated and I think she’d just had enough. It put me in a bit of a bind. I examined her but I felt the safest thing I could do was refer her to be seen to rule out a blood clot. This was another mission. By the time I saw the next patient I was just all over the place. Add that with a complicated, slow computer program, that knows exactly when to act up and I started to jet steam from my ears.

Stop, breathe and start from the top.

I get like that occasionally, more than I’d care to admit. Here is another example. More often than not, I know what to do if I just slow down and take a minute to process everything. I know I add on a lot of pressure on myself and I get frustrated. I worry I might be judged by others. Judged by my colleagues or judged by patients for taking too long. I can’t control what other people think of me, but it seems like my own self esteem relies heavily on it. It’s a work in progress.

I was recently listening to an interview by the author of The Subtle Art Of Not Giving A F*ck. I’ve not read it yet, but that book sounds like it was made for me.

But until then:

Stop.

Breathe.

Start from the top.

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The Phone Interview

Photo by Alex Holyoake on Unsplash

I recently applied to be a volunteer at an upcoming ACW event. I had the interview and I got the role. I’m not sure exactly what I’ll be doing, but I’m just excited that I’m going to be a part of it.

Lately, I’ve been thinking about my options which means spending my time Googling. I’ve found myself on the Medic Footprints site quite a bit, especially their blog section. Sometimes, in between patients, I take a quick break and just read through some of the articles. I like reading about doctors who’ve forged new careers for themselves or who’ve adapted their careers in some way to suit their lifestyle.

I find it difficult to openly talk about the possibility of leaving medicine behind. For some reason, it feels like a taboo subject. I know medics are a dedicated bunch with a strong sense of duty, but I sometimes wonder when this starts to become our weakness as well as our strength. It’s still a bit unusual to hear about doctors leaving. I can’t really speak for everyone else, but I do feel obligated to not tread the beaten path, to find a lifestyle that suits me. I’m looking forward to being around other like-minded people who share some of the same internal struggles that I’ve been facing.

I’ll probably be limited to how much I can see and do because I’ll be helping out. But it’s better than nothing. The event takes place in London, over the course of two days. I’ll have to get there a day before, to help prepare.

It’s weird, I knew this was a yearly event so I’d been waiting a while for the event details to be released and then when they were, I was initially hesitant: a) it was in London which meant I’d have to travel down and stay overnight, which is costly b) the ticket prices were more than I was expecting. On its own, I could probably have bit the bullet and paid for them but adding accommodation and travel and no doubt all the other costs along the way meant that I was going way over what I was prepared to spend. Just as I’d made up my mind not to go, I came across a small ‘volunteers’ sign.

I had to do a quick interview over the phone, which I tried to fit into my lunch break. And halfway through morning clinic my phone just turned itself off. Cue: mini frantic crisis. Literally, no warning. Just turned itself off and wouldn’t come back on again. The battery wasn’t low either. I wouldn’t have minded if this had happened on any other day, but seriously, a couple of hours before I’m waiting for a call. Sacré bleu! Long story short, after a lot of troubleshooting, panicking and Googling, I was able to have the interview, wow them and start afternoon clinic on time.

The idea of networking makes me nervous, but I guess that’s not necessarily a bad thing. It’s a skill I don’t have, might be useful to get out of my comfort zone and learn it. If anyone is interested in the event have a look at the Medic Footprints site and I’m also helping to sell some tickets as well here. I’ll probably write a piece afterwards as well to let you all know how it went.

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Medicine – An Art?

Photo by Mike Petrucci on Unsplash

I recently had a long consultation with a patient. He was struggling with a variety of symptoms which he’d been investigated for and despite multiple scans he hadn’t received the answers he’d hoped for. This had started to affect his mood.

He talked about his career briefly and how much he enjoyed his work as a mathematician. He felt it suited his personality as he found comfort in knowing that there were set outcomes for every question. A complex equation could be brought to a definitive answer. Unlike medicine, where often symptoms were left unexplained and the only option was to learn how to cope. All the while wondering: will it worsen? Will it ever improve? Will it become something else?

He said something else that caught my attention, ‘I guess that’s why they say medicine is more an art than a science’. I’ve come across that phrase a few times and I’ve never stopped to actually think what it meant. But after he said it, I felt this dawning realisation. Like the feeling of suddenly working out the answer to an exam question the day after. Just talking to the patient in front of me, and watching him almost crumble under the weight of several uncertainties, it reminded me yet again how important it is to have these open conversations.

Treating a condition goes beyond just treating a part of the body. Every time we try to help, and we dive in with good intentions sometimes we cause more issues. Some therapies don’t work and sometimes there are side effects. So, we trial different treatments and hope for the best. But there has to be a balance, an awareness of the impact that this might have on an individual. I think good doctors are the ones who truly put their patients at the centre of decision making and try to maintain that balance whilst juggling the multiple other issues each patient brings (family, job, finances). That is the art.

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Liking GP?

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Since the beginning of F2, I’ve felt tired. Not the kind of tiredness that goes away with sleep, the kind of tiredness that requires two weeks in the sunshine. That’s the issue with being in a training programme, you just keep ploughing on and on and savour the few days that you get off.

I appreciate being on GP right now and I’m liking the slower pace. But it’s still really hard to get up in the morning. I feel like I have to emotionally psyche myself up and then drag myself to work.

But weirdly, as I start settling into afternoon clinic and I’m between patients, I start thinking that it’s actually not that bad. And it’s happened more than once that I’ve caught myself thinking that.

No one is more shocked than I am. As a student, I found GP placements boring. Sitting in the corner and staring, as people come in and out. Not fun. Now, I see my own patients. I have to think on my feet, but at the same time I feel supported and I feel like I’m learning. And I feel like I’m helping. I have time to talk things through with people.

Before we get carried away, I’m still only a few weeks in. Even though it wasn’t my plan, I’m happy I had this placement first. I’m looking at my A&E rota for my next placement and it looks dire to say the least. 10 hour days, 8 in a row. Eugh.

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A Really Bad Week

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Last week was a series of lows.

I can’t even describe it. It was a case of the proverbial faeces hitting the proverbial fan. Multiple times.

I started the week feeling incredibly tired from the weekend. Nothing unusual, just a tad more Monday blues than normal. But I didn’t think anything of it.

I ran a few errands on Monday and Tuesday: sorted a few things out on eBay, put off writing a blog post, some running. I was slowly beginning to feel a bit overwhelmed with all the things I was juggling. And to top it all off, it felt like I was coming down with something. And instead of really tackling those issues, I found solace in lying in bed watching Youtube videos, just something to take my mind off everything.

Then came Wednesday. I had my morning clinic and then went on a home visit to review an elderly man with back pain. The symptoms had resolved by the time I got there so I made my way to the hospital for the weekly afternoon teaching. I grabbed a Subway on the way, even though I’d been avoiding buying lunches because I am trying to save. But I’d been so tired, I hadn’t prepared anything to bring in to work and eat, I must.

My supervisor grabbed me as soon as I arrived, so that we could have our mandatory introductory session (which we have for the start of each placement). She asked me how I was and all of a sudden I just offload a tsunami of emotions, mostly about how deflated I felt etc, etc. She gave me a funny look: concern/surprise/worry and told me she wanted to see me again in two weeks. I caught her off guard but to be honest, she caught me off guard as well. Saying it out loud made it all seem a bit more real. I’m not sure why it all came spilling out like that and I kept thinking about it, all the way through teaching.  I had some idea in my head that the medical postgraduate team were going to put me on red alert or something and start watching my every move.

By 8, I was fast asleep, I was just too tired and achy to fight it any longer.

I got to work Thursday morning. Settled into my clinic. First patient didn’t arrive and I’d left my GP bag in the car (the one I use on house visits and that I had taken home with me the day before). I quickly went out to get it before the next patient arrived. I couldn’t find it. Weird. I called home and asked if someone had taken it out of the car. No one had.

I looked all around the car, panic rising. Where could it have gone? Eventually, I ran out of places to look and I had to walk back to my supervisor and let her know. I felt so responsible and stupid. I’d only been there (at the GP practice) for 2 weeks, and this really wasn’t the way I wanted to form an impression. I felt like I let them all down.

I went to the police station later on that day. My expectations were low; I knew it’d be unlikely they would find an unmarked generic black bag, but I needed to report it. The policewoman I met made me feel 10 times worse. She had a really accusing tone. One of the questions she asked me: “how do you know the bag was stolen” left me dumbfounded. I stared at her confused, I looked at my mum, and then back at her. I didn’t understand what she wanted me to say. There were other things she said that again made me feel like she was judging me or making assumptions about me. The whole experience was uncomfortable and unnecessarily so.

So, all in all, not a great week.

 

 

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General Practice

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We had a lot of exposure to general practice (GP) during medical school. Usually, I’d have one day a week based at a practice and sometimes a couple of four week blocks would be allocated for general practice alone. So I’ve seen a fair share of different practices, some were better than others. But overall, I felt like I had a better appreciation of what it would be like to be a GP.

Throughout medical school we were told that at least half of us would be GPs. On its own, the statement doesn’t sound bad, but in context, a lot of the time it felt like we didn’t have much choice in the matter. 50% of us would be GPs regardless of whether or not we wanted to. Some people took offense, I didn’t particularly, even though at the time I thought wanted to be a paediatrician.

A few years later, now a F2 on my GP placement, I can see the appeal. 9 to 5 every day plus one afternoon off every week. I don’t have any night shifts or weekend shifts. There’s 30 minutes to see each patient, all the while sat down in a room with plenty of opportunities for tea/coffee breaks. I know this isn’t fully representative of an actual GP but it’s generally a much better working environment than what I’ve experienced so far working in hospital.

So part of me wants this to be it for me. Do GP, have a great work life balance and be financially stable. I really wish I could fall in love with it. At the moment, it just doesn’t excite me. Some of it does. I hear a lot about GPs who have more unusual working patterns, that go beyond seeing patients in a clinic. But if I go for general practice, I want to be really for it, not just the good bits. It’s like buying a cake but only being excited for the icing. And then throwing the cake away when all the icing has been eaten.

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