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A GP in Notts

13 May 20

"COVID-19 has shaken everything up and will permanently change the face of General Practice"...

It’s the patients I most enjoy about my job. Most GPs would say the same thing. It’s the feeling of making a difference: when you get to the bottom of what is going on, when the treatment you give really helps someone, when you support them through a life trauma, when you make people feel better, when you stop people from dying or when you allow people that are dying to die peacefully. The patients make sure that life as a GP is never repetitive, because no two days are ever the same.

People often ask how long it takes altogether to become a GP. For me it was eleven years, which I think is fairly typical: six years at medical school, two years as a junior doctor and three years in GP training. I am from Nottingham and love it here so I moved straight back after uni, and have worked in the same GP surgery for eight years now. It is great to stay in the same place as you really get to know your patients and go through such a lot with them.

I love the challenge of trying to find out what is in a patient's head. For example, people often think they have a brain tumour when they come and see us with a headache, but they are very reluctant to admit that. You have to really refine your listening and communication skills to get the full story. Sometimes, you just don’t know what is going on with them. It is rare to see a textbook presentation of a condition and everyone is very different. The great thing about General Practice is you can really follow things through. If you have a sudden thought about what to do with a patient, you can just phone them back.

Usually, we don’t know who is coming in. It could be literally anyone: from homeless people to affluent people, from men to women to transgender people, from one day old to over 100 years old. It could be a medical or surgical emergency requiring hospital admission. It could be someone who is depressed and suicidal, who we are very cautiously following up week by week as they don’t meet the criteria for a Psychiatric referral. We may identify child abuse and have to have very difficult conversations around that. We have an ageing population which means that people are living with several different medical conditions at the same time, and may be taking a double figure of medications. I once even had to climb through a patient’s window while wearing a skirt during a home visit. The type of patient that we see is becoming increasingly complex, and the variety is one of the amazing things about General Practice.

But as the complexity of the patients has increased, the time we’re allotted to see them has been reduced. Ten minutes is not enough time for a consultation, and I find it increasingly impossible to stay on time. I automatically greet everyone by saying “sorry to keep you waiting,” to the point where I’m even saying it when I’m on time. Certain newspapers will paint the picture that we are work-shy and over-paid, but I’ve never met a member of the public who believes that. Amazingly, most people are incredibly understanding of how challenging General Practice is.

Reflecting when things go wrong and when you get a complaint can be quite soul-destroying, I have learnt to not be immediately defensive about this and to try and understand things from the patient’s perspective. People are people, and there is usually a good reason behind them being upset. I think understanding and communicating effectively about things helps to diffuse complaints massively.

Certain newspapers will paint the picture that we are work-shy and over-paid, but I’ve never met a member of the public that believes that

At the moment things are very strange. Coronavirus has forced us into the 21st century, so we are now regularly video-consulting which I never would have thought I’d be saying at the start of 2020. Nearly all of our appointments are telephone consultations, although we are seeing people face-to-face when we need to, wearing personal protective equipment. Even the PPE feels weird – it is strange trying to strike up a relationship or have a difficult conversation with a patient when only your eyes are visible. 

For someone who is quite empathetic, there is not much more rewarding than listening to people and helping them problem-solve, so at the moment I dislike not being able to see people face-to-face. I am finding mental health consultations quite tricky; I think you need a human in front of you to be able to truly open up about your feelings. And it’s a time when so many people are really struggling with their mental health. I am also worried that people are just not phoning us up about their serious problems. It might be that they think it seems trivial, that we will be inundated with coronavirus-related consultations, or that they don’t want to come in as they are socially distancing. But we want to hear from them! People will still get cancer, still develop serious conditions like diabetes and angina, and we need to be able to diagnose them at an early stage. Before all this I’d see about thirty people face-to-face on a daily basis, as well as completing home visits, additional phone calls, doing prescriptions, actioning hospital letters and teaching GP trainees. 

As with many aspects of the NHS, General Practice needs more funding to continue to function. There are not enough GPs, and new GPs don’t want to become partners, which worries me about the future of the small GP surgery. You need someone to take the lead on things like staffing and premises.

A.I. is becoming more and more important in medicine. Some of this is a no-brainer – if you had a programme that diagnosed skin cancer from a photo more effectively than the naked eye of a GP, I think we would all go for it. But you will always need a human to tease out the patient’s story as it is not really a tick box exercise and people will open up to a human in a way that they will not to an anonymous computerised system. But COVID-19 has shaken everything up and will permanently change the face of General Practice. It makes me wonder what will happen in months to come. Will people be sitting on their problems, feeling reluctant to come in? In some ways, that won’t be a bad thing – self-care is very important and as a society, we are not as good at it as we used to be. I also wonder whether the opposite will happen, and we’ll be inundated with things people have been saving up for when social distancing lifts. Time will tell, I guess. 

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