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At the heart of general practice since 1960

Take heart. The pain could be so much worse

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I can tell you the precise moment that the 17-year-old me resolved to work hard, get my A-levels, go to med school etc etc. I was one week into a summer job which, to a teenager, had sounded wonderful: working in a factory that made record-player pick-up arms. The reality was that this involved me pulling, then releasing, a lever, which put a drill through some metal. Up, down; up, down. The whole day. After an hour I was bored out of my skull; after a day I was bordering on psychotic and after that first week I’d have gladly put my head where the metal was.

I’m glad someone does it and I’m glad it’s not me

That was when I decided that my future career had to involve some challenge and some stress. And I guess that’s why, many years later, I find myself working as a GP.

So, careful what you wish for.

But look, for all its current complete crock-of-shitness, general practice isn’t so bad. After all, it does still involve medicine, and we’d all agree that’s quite fun, even if that mainly means syringing ears or handing out statins.

Besides, even within medicine, there are jobs that are far worse than being a GP. Like working in A&E, for example. Imagine what fun that must be at the moment. Or being an endocrinologist: spending all day doling out skiploads of drugs to increasingly dejected and decreasingly well-controlled diabetics. Or being an anaesthetist. Okay, yes, there are certain patients I would like to render unconscious – just long enough, say, for me to leave the country or change my identity. But still.

Then there’s the worst job of all. The job that has me waking each morning and thinking, even if it’s a Monday and the next 12 hours are going to grind my gonads to dust, at least I don’t do THAT. And THAT, of course, is working in a pain clinic.

I can take heartsinks, TATT, patients who want antibiotics, CQC inspections, appraisal, revalidation, micromanagement, pay cuts, complaints, avoiding unplanned admissions DESs, the recruitment crisis. Even sodding 8am to 8pm, seven-day working. But I could not take one morning of seeing patients whose sole referral criterion is that the GP has not been able to control their pain.

After all, it’s not like we GPs are pain management morons: it’s pretty much our bread and butter. I diagnose and manage the cause, prescribe analgesics if necessary and job done. Trickier cases might need something stronger, a sprinkle of co-prescriptions and a side order of psychological tweaks. So by the time I’m penning the letter to the pain clinic, the implication is I’ve hit one hell of a ‘something must be done’ brick wall. Which means that the person really being treated, as I offload my intractable backs, fibromyalgics and medically unexplained pain, is me.

So good luck to the ‘pain experts’ is all I can say. I’m glad someone does it and I’m glad it’s not me. I presume they must be sadomasochists who enjoy the transference of pain from patient to specialist. If not, I genuinely wonder how they make it to the end of each day. But hey, if it gets too much, there’s this job in a pick-up arm factory.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield 

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Readers' comments (12)

  • Doesn't wash I'm afraid. ,I do not want to spend the next 35 years of my working life taking solace in the fact that my job is not the worst out there...I actually want to enjoy my work, well at least more than 49% of the time

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  • 10:05 is absolutely correct. Is it ok to chop of your hand rather than your arm? …the GPC approach is to roll over and take it, it could be so much worse. The RCGP would say there has never been a better time for complete amputation and do nothing to stop it, but would volunteer all trainees to undergo it at great expense (they are obviously above this option themselves) and there is the alternative, do something you enjoy, where you are not a doormat to the world's s*&t and you are not blamed for all the world's wrongs and avoid the scalpel completely.
    GP, thanks to all those College types is a complete pile of steaming horse dung. Finish training if you must but get out as fast as you can.

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  • Perhaps we need a whole new breed of specialists,welcome the Royal College of Heartsink Physicians. We would have to let them retire at 35 with a full pension though...

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  • Stunned by this read Dr Copperfield ! Your ability to week by week so accurately express the feelings of so many of my GP colleagues and I, has I realise strongly this morning, given huge amounts of comfort in my "predicament" as a GP. Your excellently written words, expressed humourously with usually just the right amount of bite, conveying the too often reality of GP life, has so often made me feel not alone, resulting in a bigger spring in my step so often desperately needed. This morning however, sadly in these few paragraphs above,I feel as though all your previous "truths" have been undone. I hope you are OK though as I find myself even Wondering whether you actually wrote this . I hope the stress we are all under and which you have always so eloquently described has not finally got to you. In an attempt to emulate your great sense of humour, often black, I hope your Olanzapine dose wil soon be adjusted to bring you back to yourself and reality. Dr Copperfield we need your voice.

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  • Dear Copperfield,
    I DO sympathise with you, REALLY I do !
    BUT, there's an EVEN WORSE situation to be in ! Try being a patient who is in relentless intractable pain which renders your life a misery, like thousands of people in the UK alone !!! All because not many GPs heeded the warnings of the MHRA to safely restrict coproxamol prescriptions prior to 2005 & also did not emphasise the BENEFITS of this wonderful drug & the flaws in the Hawton & Wang Po medical papers in 2004 ! All of which has eventually led to an insane near global ban on the manufacturing & distribution of this wonderful analgesic which, like all opiates, IS SAFE when taken responsibly in controlled circumstances like in Australia !!
    I assure you that relentless debilitating pain is MUCH worse AND AVOIDABLE than the options you mention !

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  • To anon at 10.24 am
    Yes it is me and no I've not had a lobotomy.
    All I'm saying is, OK, life in GP land may be like sitting on a spike, but I'm able to take my mind off the pain by (ironically) reminding myself that I could be a pain specialist.

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  • Dear Dr. Copperfield,

    Or even a patient who is suffering appalling CNS & gastric side effects without adequate analgesia !

    Count your blessings !

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  • Dear Tony,
    Reassuring re your neuro anatomy, but may I adjust it by making your head swell a little (with pride) ,not that I would want to make any other part of your anatomy swell.As a veteran of 34 years 10 session weeks, your column sustained me through many a dark hour.
    Incidentally, were you required to do a Two Cycle audit of your hole punching for your Annual Hole Punching Appraisal?
    Just asking....

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  • Well put, I feel better about going in on Monday.
    If life gets really really S*itty and imagining life in a pain clinic doesn't work theres always Psychiatry and finally Rheumatology (they are the ones that deal with ME these days aren't they -- what the hell as long as it's not me).

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  • As always - cheered me up. Most GPs cope by acknowledging that it could all be even worse.

    I frequently remind myself that trying to treat Mrs Public and her myriad of complaints may be difficult, frustrating and unrewarding - but is a feather bed of well-paid pleasure compared with teaching her offspring.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder