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My time management tips

Dr Jane Bowskill owes her GP consulting style to her early days as a nurse

I wasn't accepted for a medical school place when I applied, before A-levels, back in 1971. I hated school by that stage. It was a girls' grammar run on traditional lines, and although uniform for the sixth form had just ceased we were still hidebound by petty rules: skirts or dresses only, of a certain length, no trousers ever, no bare legs or sandals in summer.

I was a bit of a rebel and probably didn't get a brilliant reference, so I reapplied the next year, was rejected again, despite two Bs and a C ­ quite adequate then ­ and I accepted a place to do an accelerated nursing course at St George's in London.

We were interviewed at Hyde Park Corner ­ very smart ­ but dispatched on arrival to Tooting, which was not smart in 1973! I was delivered there by my father, whose only comment was 'well, come home if you don't like it'.

The first six weeks was spent in the classroom, with occasional ward visits, learning the basics ­ beds, bedpans, blood pressures , dressings, stitch removal and so on. Then we were let loose.

Well, not quite. The ward sisters really were quite stern is those days, and tasks were allocated by seniority. On Saturdays everyone had their urine tested, and there were no dipsticks, just tablets, test-tubes and protocols. I spent four hours in the sluice.

We were apprentices and learnt quickly. I was shown how to lay out a patient who had just died, while on my first ward, aged 19. No support was given nor expected ­ you were just to get on with it.

The doctors' rounds were terrifying ­ shades of James Robertson Justice booming his way round with a trail of doctors, students and the trolleys for notes and X-rays. But they acknowledged the ward was sister's domain, and interference with the way it was run would not be countenanced. The round finished with tea in the office for sister and senior doctors only.

As I became more senior I did ward rounds. They actually weren't that terrifying. We knew far more about the patients than any of the doctors, and my main job was to go round again and explain things like what was happening and why, when the operation would be and what would happen, how long their stay would be.

I think this ability to communicate with patients at their level has stood me in good stead ­ and I think explanation and reassurance is appreciated by my patients. Doctors never were good at reassuring or explaining simply and I like to think I can do this well.

Working under pressure, such as in A&E at night, certainly improves organisational skills. I always tell patients that having been a nurse makes me extra-bossy, but I do think we are in danger of losing the ability to reassure and advise while trying to offer patients choices and cover ourselves medicolegally. And my consulting style is more traditional in this respect.

The nursing was helpful for house jobs. I was quite used to approaching patients and I knew where nurses 'hid' things in the treatment room. I also routinely remade beds after examining patients, which was appreciated.

I had also had a lot of experience with ill patients, having worked in recovery, coronary care and ICU and so had a head start when assessing changes or deterioration.

I found the pharmacology a lot easier than many of my contemporaries as the drugs were mostly familiar.

In one house job I had a very camp male charge nurse, for whom everything was always too much.

Admittedly the surgical team didn't help with their changes of plans, ward round schedules and so on. One day in exasperation I replied 'Really, Mr....I always used to manage!' which had the rest of the nurses stifling laughs.

More recently I did some A&E GP sessions, and I found myself automatically going into staff nurse mode ­ can we have a porter for room one, where are cubicle two's results, this one can go to the ward now and so on.

I also routinely tidied up again as I went along, did the odd small dressing ­ I cannot leave an unemptied urine bottle or used trolley with dressings to this day. Needless to say I was invited to come back.

I certainly don't regret my time spent as a nurse and the extra skills it has given me in understanding and treating patients.

My nursing registration has long since lapsed. I recently called on a friend, known since nursing days, and now very senior, who was in bed with recurrent sciatica.

I offered to blanket-bath her (this is how to wash someone who is bed-bound) but she insisted I was no longer qualified to do so!

Jane Bowskill is a GP in Kingston upon Thames, Surrey

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