The secret life of a GP: a family doctor is there for everyone else’s before their own

https://www.theguardian.com/commentisfree/2016/oct/17/secret-life-gp-family-doctor-patients

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There are several qualities you need to have in your doctor’s bag to survive as a GP. Professionalism is of the utmost importance. As is keeping your cool even when you are being shouted at by someone who is intoxicated or under the influence, as happens every few weeks; or being threatened, or put in a position where the patient is trying to make you complicit in their fraud. The doctor’s surgery is similar to the confessional. Only if it leads to a safeguarding issue can you break the confidential code.

Resilience is invaluable. No matter what happened in that last appointment, it cannot affect those still to come. Empathy is vital. People come to see you terrified: that their headache is a brain tumour; that they are going to lose a loved one; that you are going to judge them.

These aside, the quality that you really need is a sense of humour. Without it, the job would be simply impossible. And frankly it’s difficult to keep a straight face when you ask a patient for a urine sample, hand them the small white-topped tube and they start undoing their trousers in front of you, until you politely point out that there is a loo around the corner.

On a typical day, 30 appointments are offered to my patients and I am fully booked for the day by the end of morning surgery – and that’s without any urgent walk-ins that are spontaneously thrown into the mix. That means at least 30 10-minute sessions; 10 minutes to welcome, introduce, glean, triage, diagnose, reassure, comfort, investigate, refer, treat, prescribe and follow up.

No two 10-minute slots are the same. You never know what will be coming up in the next appointment. Is it a quick case of tonsillitis in someone who’s not too poorly? Or is it someone who takes 10 minutes of going on about their bunions and general gripes before revealing that they had an episode of crippling chest pain last night, by the way?

A patient goes on about their 'terrible tittyness' (tinnitus) while I try not to smile

Is it a new psychiatric patient? I’ll never forget the consultation in which a patient asked me how many doctors it took to tile a bathroom – apparently it depends how thinly you slice them (this is the sort of moment when you quickly check access to the door).

Is it someone who will test my professionalism by going on about their “terrible tittyness” (tinnitus) while I try not to smile? Or someone who tells you their symptoms and by the end of the consultation you are 95% sure that they have cancer? Or a grieving widow who discloses that she and her late husband never consummated their marriage and that she is, in fact, an 80-year-old virgin?

Then there are the phone calls. An average day probably involves 10 or so calls to patients who are invariably not at the phone when you find the time to ring them. So ensues a telephone ping-pong match until you’re both in the right place at the right time. Meanwhile there’s all the paperwork to get through, including reports and results. There are so many of the latter that I am constantly terrified of actioning an abnormal result as normal. Over-investigating is on the rise in this age of increased litigation.

Working in an elderly-dense population, home visits are required daily and can range from two (quiet) to eight (hideous).These can be a real eye-opener: from palatial splendour to sticky and stained carpets. In between dashing here and there, I will try to catch a colleague to mull over a blood result I’ve kept on the back burner, not knowing quite what to do with it.

The best thing by far about the job is the patients. The privilege you feel to have them trust in you and respect your decision-making (albeit not 100% of the time) is immense and hugely rewarding. Being able to fix their problems and make them feel better, control their pain and provide some comfort is extremely gratifying. As is being allowed into people’s homes to relieve suffering in a dying patient. And making sure that when the time comes, they can die where they want, before supporting and guiding the whole family through this painful but inevitable time. At moments like these it is the best job in the world.

And the worst things about it? The passive privatisation of general practice. The daily doctor-bashing in the press. The promises from government that you will be able to see your family doctor from 8am until 8pm, seven days a week. As you can see from the plight and strikes of the junior doctors, we do not have government support right now. Instead, we are vilified and made out to be money-grubbing if we complain about our working conditions. We have all gone through years of training as junior doctors to become GPs in the first place and urgently need the next generation to stay in the health service. It is getting increasingly difficult to recruit and our roles are continually changing, which is deeply sad because it is without a doubt a vocation: you simply wouldn’t do it otherwise.

It is hard missing out on your own family milestones – first days at school or the nativity play – because surgery can start at 7am and go on until 7.30pm, when your children are already in bed, where they were when you left for work that morning. Ironically, being a family doctor means you are there for everyone else’s before your own. You know all of your patients’ family members by name, often their extended family too. You are there at their sides to help them through some of the most momentous events in their lives, whether that is bringing new life in to the world or easing the pain as another life leaves it.

It is an honour and a privilege to be a GP. We can’t let the government destroy that.

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