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At the heart of general practice since 1960

Letting the chain take the strain

Take the hassle out of home visits by getting

on your bike, writes Dr John Green

am told there are GPs who after work like nothing better than to forsake their families, dinner, social life and Eastenders and drive to the gym. I also hear some find pleasure in getting really familiar with the trim on their dashboard while listening to the

The Archers. I guess a traffic jam is a wonderful opportunity to practise those relaxation exercises we're always recommending to panic-attack patients. Or, it can be a chance to re-examine that association between forced immobility and deep vein thrombosis.

Sadly my GP partner Mike and I are too time-, cash- and energy-poor at the end of the day to go to the gym and too frazzled for traffic jams. Instead, we get our kicks cycling to visit our patients.

Cycle path to Damascus

My road to Damascus revelation over transport came on the Hammersmith roundabout at the end of the 1980s ­ long before medical school. I was trying to get back up North to my mum and dad's for the weekend when I missed the turning. Two hours went by and I still wasn't back where I'd started. Later something awful happened on the M6, and it was four in the morning before I got home. The next weekend I went home by train (pre-privatisation) and brought my bike back with me in the guard's van.

As years pass, the pressure to conform mounts. Poor medical students are expected to have bikes. Even so, there are enough cars provided by parents concerned about the dangers of traffic to make cycling to even a slightly distant attachment seem an eccentric choice.

Junior doctors are expected to treat themselves to new cars as a reward for the inhuman long hours, only to risk instant death as they fight to stay awake on the drive home at the end of a shift.

It becomes harder to cycle everywhere as you undergo that gradual metamorphosis from young, free and single to middle-aged family man. It takes perseverance to persuade your hot date that a bicycle is an acceptable way to get to that nice restaurant: love me love my bike you say.

Randomised trials have also shown it impossible to go to Ikea on a bank holiday to argue about furniture if you do not have a car. You give in and buy one. After all, you can still cycle to work...

During the transition to general practice my trainer was very considerate when I mentioned I wanted to cycle everywhere, bending over backwards to find me proximate visits and pleasant cycling routes.

An elderly gentleman in a residential home told me: 'Doctors generally come in a car, you know.'

When I emerged two years later from my hospital VTS, my first visit was back at the same home. It was a fine spring day so I walked. The patient I went to see was unfazed. She told me: 'Why we once had a doctor come out on a bike, you know.'

Now I'm a partner in the provinces. A cyclist here arouses the same ire and mirth as they presumably did in London 20 years ago. The traffic is faster too, and the distances greater. But the houses are cheaper and my wife's family is local.

My practice is wonderful: friendly, dynamic and dedicated. But the primary attraction was its closeness (cycling distance) from where we were living.

At the interview, I mentioned how keen I was on cycling of course, but I may have underplayed the fact it was an absolute obsession.

They said that 'sounded very nice', probably imagining it would last a couple of weeks until I could afford one of those new-partner four-wheel-drive follies. Both sides colluded to gloss over the size and rurality of the practice area.

I'm still on two wheels, and far from it causing a problem, one of my partners has also started cycling to and from the surgery and to visits. I'd love to say we do it to save the ozone layer or fulfill a national service framework requirement to promote a healthy

sustainable lifestyle, but of course we do it because we love it.

Who's mad?

After a night at our local out-of-hours

co-operative a telephonist tells me she how sorry she feels for me having to cycle home on a cold spring morning. While she's queuing to join the M20 I am, quite literally, cycling past lambs gamboling in fields.

We're regarded with a mixture of pity and awe. However, it's not us but the rest of you that are mad.

So do not ask for whom the bicycle bell tolls: it tolls for thee.

At my interview I may have underplayed the fact cycling was an absolute obsession~

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