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CAMHS won't see you now

Haslam's view: Am I having a good or bad day?

It's probably one of the hazards of being a part-time GP.

Many patients, as we all know, treasure continuity of care. They are not merely prepared to wait to see a doctor that they know, they would positively prefer to see their ‘own' doctor rather than one they don't know, even though they can be seen that day. And so patients who have known me for years, and sometimes for a whole lifetime, wait until I'm in the practice and present with their accumulation of cares.

Yesterday morning was a case in point. Nothing was straightforward. By coffee time I had seen a student who lived at the other end of the country but wanted to talk to a doctor he knew; a patient with a recent history of chest pain that I remain convinced was a mumps pericarditis; a man who was refusing surgery because of his fear of anaesthesia; a patient who had been assaulted by a spouse and was terrified of going home; and a child who I am certain has signs of Asperger syndrome.

That was a coffee break I needed, though, inevitably, I was running late and had to grab it on the run.

And then, yesterday evening, I was particularly struck by an email from a medical student, who told of teaching hospital consultants who were trying to persuade him not to enter general practice because ‘it's nothing but coughs, colds and sick notes'.

On the days when everything seems complicated and none of the treatment options seem clear, I am never quite sure if I am having a good or bad day.

It's a genuine puzzle. Am I struggling with diagnoses because the senile decay is kicking in and I have forgotten what to do, or because I'm being more sensitive than usual and am seeing how poorly the symptoms match the textbooks?

And then there are days when everything seems straightforward and relatively easy. And again, I find myself wondering whether this is because I'm on form and at the top of my game, or because I'm missing subtle signs and am successfully shoe-horning everything into simple, but erroneous, diagnostic boxes.

I doubt if I will ever know the answer, but I do know that sometimes I can be too self-critical for my own good. For example, I once had a patient who consulted me regularly. At each visit she would sit primly in her chair, hands clasped on her handbag, and after a minute or two a tear would appear in her eye.

I tried everything. Therapeutic silence. Gentle direct questioning with ‘and how are things at home?' Reflective avoidance of direct questioning. The full set of spanners from the consulting skills toolbox.

And so one day I plucked up the courage to ask her straight out.

‘I can't help but notice that you often seem tearful when you come to see me. What's worrying you?'

And she laughed, and explained that overflowing tears were something she had lived with for years, and that she was very grateful I had asked but she was fine, thank you.

Many patients would prefer to see their "own" doctor, rather than one they don't know

Haslam's view

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