I’m a GPeeee!

Yep, I’ll admit it. Part of the reason I’d been looking forward to my GP placement is that GPs sit down all day, right? And they start late and finish about 4 o’clock, right? And they drink loads and loads of tea.

Uhuh.

I’m halfway through the placement now, and the day goes something like this.

Wake up, jump on bike, arrive at GP, weave through epic crowd of patients, walking sticks, pushchairs etc in waiting room, hoping that none of them are already on the lookout for me. Find consulting room, log onto computer, find GP supervisor, scan first patient’s records, call in first patient, listen to description of sore back/palpitations/cough/noisy neighbours/insomnia/incontinence/unemployment/divorce/pregnancy/itchy toe, ask semi-informed questions relating to symptoms, rack brains to check for obvious missed things, smile, examine back/chest/abdomen/toe, write in notes, ask about ideas concerns and expectations, check BNF, discuss options, ask questions, explain medications, call doctor, present history, write in notes.  See next patient, do neurological exam, explain difference between tension headache and migraine, try to allay anxieties about medication side effects, calculate BMI, check appointment list, apologise to next patient for lateness, listen to chest, look at tonsils, take temperature, print diet advice, call the doctor, breathe. Feel a pulse, take patient for ECG, diagnose atrial fibrillation, discuss management with doctor, explain different anticoagulants to patient while doctor writes referral, pass tissues, make small talk about patient’s son who is training to be a doctor. Think about that cup of coffee. Join doctor on home visit, take blood pressure, write in notes, play with the dog. Drive back to surgery, grab lunch, mainline coffee just because I finally can. Return to consulting room, call in next patient, repeat.

The thing is, I was looking forward to this placement a lot; I always thought I’d like GP and I was interested to see how the days would be. I like people’s stories. I like that every patient has a social or psychological side to their presentation, and that that stuff matters to the GP. I like that I have responsibility here – my own list of patients each day who I see on my own. I like that when I say I’m the student doctor people actually nod and stay in the room, and even listen to what I say. I didn’t realise how crazy busy it would be though. I take my hat off to GPs. The job is phenomenally grinding and complex and they work their socks off. I don’t know if I could do it forever, I don’t know if I have it in me to care enough, in ten-minute slots, about every sore foot and infected finger and sleepless night that walks through the door, and then to be on-the-ball enough to pick out the cardiac arrhythmia, the sick baby, the case of cancer and do something in time. It remains to be seen if I can do that.

The thing is though… here’s the thing: when I get home each night, and stop to think about it, I have had an awesome day.

The limits of medicine?

It occurred to me today that perhaps one of the best things about medicine is the way you’re authorised to be incredibly nosy about the lives of total strangers. I’m a pretty nosy person really; I love gossip and I’m curious about people’s lives. What on earth could be better, then, than having licence to ask people the most personal details about themselves in the name of work?

Before coming to medical school I spent a few years volunteering with the Samaritans. Set up by a vicar, Chad Varah, in 1953, it’s a (secular) charity that provides emotional support to people who are suicidal or in distress. Samaritans volunteers take callers on the phone, face to face, or via email, letter and text message, and by listening in a non-directive, non-judgmental way, aim to simply ‘be there’ when people are going through the hardest times. You could be old or young, lonely, ill, self harming, bereaved, depressed, perhaps even in the act of taking your own life – but pick up the phone at any time of day or night and a Samaritan is there, holding out a hand in the darkness. It’s a real person and they’ll give you all the time you need. I’ve always thought that’s a bit of a miracle really, in a world where most of the time when you pick up the phone you get a computer saying ‘Press 1…’.

When I came to medical school I had to leave the Samaritans – there just wasn’t enough time – and I was incredibly sad to do so. But being at the GP today was surprisingly similar (although now I’m allowed to ask far more nosy questions). I was talking to a patient with abdominal pain that turned out to be caused by the stress of being a carer for a sick partner, looking after a young family and having constant money worries. How often do we normally get to learn this much about someone in half an hour? As the medical student I was supposed to be taking a medical history, so of course I asked about the pain and the treatments and scans and so on. But the issues were so clearly more deeply rooted than that, and really the best I could give was my time, to listen. I’m no expert on that patient’s life and no amount of medical knowledge can help me advise someone when they have to choose between spending time with their daughter and helping their partner go to the bathroom. I can only listen.

I suppose that’s why I find medicine – and particularly general practice – interesting. You can know everything in the world about the causes of abdominal pain, but sometimes your medical knowledge will get you nowhere. And yet the patient is still sitting there in front of you. It’s humbling. Should I say I can do nothing because your pain can’t be reached by my drugs and scans? Or should I try to be there anyway, offering support in the best way I can because I’m a doctor and you trust me?