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Survival strategies for the extra swine flu workload

When one of the Jobbing Doctor's salaried GP colleagues catches the flu, the practice can't just shut up shop.

When one of the Jobbing Doctor's salaried GP colleagues catches the flu, the practice can't just shut up shop.

Down the years many GPs have bemoaned the fact that people in Government and authorities do not really understand general practice.

Indeed many hospital doctors do not understand a number of things about UK general practice either - for example that we are self-employed, and run small businesses, and that the buck stops with us. We pay employer's liability insurance. We pay our own medical indemnity insurance as well, and often own our own premises.

I was reminded about this the other day, when one of our salaried doctors rang in about an hour before morning surgery to announce that he had the ‘flu', and would not be in for the rest of the week. This does happen. In the middle of a swine flu epidemic, it is very likely to happen, so we need to be aware of this.

The trouble is, with an open access system in place, we can't just shut up shop. Some people have been waiting for a time to see a particular doctor at a particular time for a particular discussion. If they are just sent away, then they will get cross. So the work has to be absorbed. This means a busy day becomes frenetic, people get delayed (I can't actually consult with two people at a time) and Jobbing Doctors get exhausted.

We are all encouraged these days to consult in a patient-centred way. I am guilty as the next educator in encouraging this style of clinical practice, and make no apologies for that. The trouble is that patient-centred consulting is both time-consuming and exhausting. It is also more difficult if you are seeing another doctor's regular patients, as you don't have a feel for their issues and concerns.

So the Jobbing Doctor ended up seeing 40 patients in morning surgery and not 23, and about 30 in the afternoon, and not 17. That is another 30 patients in a day (as a few were able to be postponed). Allow 10 minutes per consultation and that is, well, potentially an extra 5 hours' work.

It can't be done, so sacrifices need to be made. The first thing that happens to the Jobbing Doctor is that I remove all the odd 30 seconds or so of polite chat (how's the family, is the new job going well? etc).

The second thing that happens is that I switch in doctor-centred mode (I can do it, and it is like flicking a switch): gone are the nice open questions and reflecting answers - ‘you tell me how you feel about this'. I hate consulting like this, but sometimes it needs to be done this way.

Thirdly, I reduce my thinking time, and make clinical decisions quickly, and possibly brusquely.

Finally, you use exit strategies to get the patient out of the room - the handing over of the prescription, the decision to order tests, or even suggesting that you don't actually deal with all the problems presented at one go.

I tried all these, on the really bad day, and it went alright until I had a new psychiatric patient who was heading for crisis. He needed 40 minutes, and that meant that the waiting room looked like the first day of the sales.

Of course, this would not happen in hospital clinics because they would be shut and patients rescheduled.

Mind you, there are certain areas in hospital medicine where they cannot close the doors, like Accident and Emergency. They wouldn't turn people away, would they? Or keep people waiting in ambulances outside of the department, would they?

Except, I know that happens.

The Jobbing Doctor The Jobbing Doctor

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