Abstract
As I am approaching the age of 40, with nearly 8 years of general practice behind me, this column can no longer be called ‘From the newly qualified GP’. It has been renamed ‘From the coalface’ – a reference to the great city in which I live, but also a description of the medicine I practice. The majority of my work is clinical, being the first point of contact for patients who present to their own GP or to our local accident and emergency. I chip away at a great wall of preventable disease, social inequality and minor illness. I swing a random pickaxe at unexplained symptoms and incurable disease.
So why am I still here, at the hard, grinding coalface? Why do I stay in a job that leaves me drained at the end of 12-hour days? What is it (apart from a mortgage and two children) that keeps me firefighting in situations that need detailed picking apart? Why do I keep pushing against social ills that will take generations to resolve? It’s certainly not the reasons I gave in medical school interviews when I was an idealistic teenager all those years ago.
Partly, it’s my workplace. I respect and like my colleagues. I understand the systems in place locally and at our practice and feel I make a positive contribution to what we’re all trying to do. I’ve made my room my own and find it a calming refuge.
The main reason though, is my patients. They are endlessly fascinating. I’ve now travelled long journeys with many of the people I see regularly. Major illness, fertility issues, personal crises, the death of loved ones – these sit in the back of consultations and add weight to the opinions I proffer. These relationships are at the heart of what I do and keep me striving to be the best I can be.
One particularly tough day recently demonstrated the drama and the drudgery of my work. We were thin on the ground and I was on call. My morning included a dehydrated child and an alcoholic patient who wanted to detox. I didn’t finish until well into our theoretical lunch-hour. I ate at my desk and was cheered to see the regular pair of bullfinches visit the feeder I have placed outside my window. My first house call was straight forward and to a nice lady who is always pleased to see me after I diagnosed her polymyalgia a few years ago. Unfortunately, I then got lost (unusual these days) and realised, after my second house call, that I would not make it back in time for afternoon surgery if I went on my final visit. I decided to head back and deal with it later.
My afternoon surgery was even busier – with mental illness and unexplained symptoms galore and a few extras thrown in for good measure. Halfway through I spoke to someone at the care home I should have visited at lunchtime and was told that, although the patient was apparently not unwell, the family had been waiting to see a GP since lunchtime. I promised to visit after surgery.
When I arrived, just before 7 pm, I quickly realised she was the most acutely unwell person I had seen all day. I apologised to her and to her family for my delayed appearance, explained that I had been busy, misinformed about her illness and, ultimately, made the wrong call in deciding to postpone seeing her. Everyone present was incredibly gracious – they said they understood and actually thanked me for my care and attention.
I arrived home mortified, humbled, exhausted and strangely elated. I had done something clearly worthwhile, received some (perhaps misplaced) gratitude and used the skills so proudly learnt at medical school.
I’d made the wrong call, but I’m in the right job. I’ll keep chipping away at the granite and occasionally I’ll mine some coal.