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At the heart of general practice since 1960

Are you a Rottweiler or a teddy bear?

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When I was a bright-eyed teddy bear, I had a treasure chest of thank-you letters from patients. I still have it, but there is little to add to it these days.

I used this stash to reverse the emotional impact of those torturous working hours; reading heartfelt words would somehow make it all worthwhile. On top was a card from the family of the first patient who died on my watch; I cried with them, but I wasn’t crying for her. I was crying because I was a 24-year-old girl having to deal with death on a regular basis.

I needed an effective tool to ensure I was working with like-minded colleagues. So I designed one

My dedication continued through those hospital years and into general practice. As a newly qualified GP, I would regularly book patients at the end of surgery so I could consult with them for as long as I wanted – sometimes up to an hour. An Irish man who had lost his son in a terrible car crash, but didn’t want bereavement counselling. A Pakistani boy who was being pressured into an arranged marriage, but was having a secret relationship with a man. A devoted mum of five kids who was struggling with a drink problem. They showered me with verbal and material gifts, but I became emotionally drained and couldn’t keep it up.

When I moved to Bristol 10 years ago, I made a new start. I shed my cuddly teddy-bear coat and became more of a Rottweiler. In short, I became less dedicated to my patients and more to my life. When I became a parent, this became much easier; staying an extra hour to counsel a patient meant an hour I didn’t spend bathing my kids and putting them to bed. The dwindling number of thank-you cards was a by-product, but I found my self-esteem came from what I could achieve rather than the emotional dependency of patients.

Fast-forward 10 years. My roles now include training and appraisal and I see many GPs and trainees experiencing a dissonance between the type of GP they aspire to be and the way they are working. Others struggle with colleagues, as there is huge stress if you are a lone Rottweiler in a practice of teddy bears.

Last year, I entered a new stage in my life. I resigned my partnership and looked for a new practice to work in. But I realised I needed an effective tool to ensure I was working with like-minded colleagues.

So I designed one. These questions are best answered together with your colleagues. First: ‘A patient presents with a dental abscess for the second time in a few months. Do you offer pain relief or redirect them to a dentist?’ Or: ‘Your renal consultant has asked you to carry out investigations before a patient starts dialysis. Do you say “I’m not your house officer”’ or comply?’ Try out more questions below.

Obviously this is tongue in cheek, but I maintain it is worth reflecting on where you are on the Rottweiler-teddy bear spectrum and where you would like to be. The sad fact, however, is that you may find yourself becoming more dog over time. The NHS is gradually hardening even the cuddliest of teddy bears. But what comes after Rottweiler, you may ask? I hear it is retirement.

Dr Shaba Nabi is a GP trainer in Bristol

Quiz: Are you a Rottweiler or a Teddy Bear?

1. A college student comes to you asking for a letter because he failed his first year exams due to stress. He has not seen anyone at the practice for over two years. Do you:

a)    Tell him it doesn’t matter because a degree in hip hop isn’t going to get him a job anyway

b)    Tell him you don’t do these sorts of letters as you don’t have the capacity

c)    Apologise and explain to him you cannot write him a letter if he wasn’t seen for his stress, but offer him a review appointment to discuss his stress

d)    Type a letter within the consultation and give it to him without charge

2. A nervous first time flyer comes to see you for some diazepam because she is flying to Tenerife next week. Do you:

a)    Tell her she should cancel her flight and go on a cruise instead

b)    Tell her you never give out these sorts of drugs as they are harmful

c)    Sympathise and suggest stress management strategies but do not prescribe

d)    Give her the diazepam and put it on a repeat prescription for future flights

3. A well-known patient with alcohol dependence is kicking up a fuss in reception, demanding to be seen for a Librium detox. Do you:

a)    Ask reception to call the police – they can deal with aggressive behaviour

b)    Go out to reception and tell him you will not see him without an appointment

c)    See him in between patients, discuss his options but do not prescribe anything

d)    See him immediately and give him a prescription for Librium

4. A patient presents with a dental abscess for the second time in a few months and has not seen the dentist. Do you:

a)    Tell her the pain will stop when she will inevitably lose all her teeth

b)    Advise her you are not trained to manage this and direct her to the dentist

c)    Offer some strong analgesia and explain why you don’t feel confident treating dental issues and direct her to the dentist

d)    Issue analgesia and antibiotics and call the dentist for her

5. A man comes in to renew his sick note for back pain, which he has been receiving for the last three months. He is mobilising without any issues and you saw him at the supermarket last week carrying heavy boxes to his car. Do you:

a)    Shop him to the Department of Work and Pensions for fraud

b)    Decline his sick note and tell him he needs to go back on Jobseekers’ Allowance

c)    Discuss the fact that being off work has a negative impact on his back pain and negotiate a shared plan to get him back to work

d)    Write him a sick note for another 3 months

6. Your local renal consultant has asked you to undertake some investigations in primary care prior for a patient starting dialysis. Do you:

a)    Tell the patient to go back to the hospital and advise the consultant you are not his house officer

b)    Write back to the consultant and advise him you do not have the capacity to do this

c)    Communicate with the CCG, patient and renal team to clarify what the local policy is and why this request has happened

d)    Do all the investigations and offer to take on all the follow up bloods for this patient

7. A nurse from the pre-op clinic calls you about a patient. His swabs grew MRSA and she wants you to treat this before his surgery next week. Do you:

a)    Tell the nurse to go and disturb her consultant’s lunch break instead of yours

b)    Advise that you do not have the capacity to take on pre-op work and that the hospital is paid to follow up these tests

c)    Arrange a prescription for the patient as an exception because he is elderly and discuss this issue at the next CCG meeting as you recognise it is not your role

d)    Offer to do a home visit and drop off the medication

8. A GP colleague has asked if she can be excused from on calls whilst she is pregnant because she is suffering with severe fatigue. Do you:

a)    Tell her pregnancy is not a disability and to ‘man up’

b)    Advise her that you are also exhausted with the demands of work and three kids

c)    Sit down with her to identify which parts of the day she finds most difficult and try to adapt her working day around this

d)    Do all her on calls for her throughout pregnancy and the first six months back from maternity leave

Interpretation

Mostly As You are a Rottweiler in disguise. You are obviously very good at looking after yourself but need to think a little more about others. Do you think you are in the right career? If not, have you considered a career in politics?

Mostly Bs You are very good at managing your workload and are likely to get home in time but are you getting any job satisfaction? Getting each patient out of the door as quickly as possible may not be the most gratifying way to practise. Give a little more of yourself and you may feel more nourished.

Mostly Cs You are obviously hardworking and committed to good medical practice. You are principled but also caring and show empathy. Be careful though. As workload increases, you may find it difficult to sustain this and you may need to cut yourself a little slack.

Mostly Ds You are a cuddly teddy bear and probably have a cardigan in each colour. You hate saying no to anyone and you are probably working 14 hour days. Your deep rooted need to be liked means you are as dependent on your patients as they are on you. Safety alert - you may not be able to sustain this beyond a few years.

 

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Readers' comments (10)

  • An excellent way of analysising characters/personalities suited and unsuited for a GP career. Rather thought provoking!

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  • AlanAlmond

    A perfect analysis of how it is to be a GP written as someone observing from aside like the french angel in the film "a matter of life and death". Very well written thank you - this kind of article gives me hope that perhaps I am not quite as mad as I feared.

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  • Really really smart

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  • Excellent article. What worries me is the vastness of the spectrum mentioned above. We are not pulling together are we?

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  • I am a Rottweiler by instinct, but society wants me to be a teddy bear. Tedious complaints about the perception of disinterest about a cold or IGT have made me, slowly into a compliant robot and I hate myself for it. I am now eighteen months from the end of my career, and can honestly say I no longer treat patients, I appease them. I am defeated. Yes, of course, mr smith, an MRI for your 2 years of cervocgenic headache sounds like an excellent idea. Absolutely, Mrs Brown, your 48 hours of loose stool warrants an immediate paninvestogram and a 2ww scope. Oh, I know..you can't be too careful, I quite agree.

    Then I go home and chop firewood and slap the punchbag in my garage to ameliorate my self loathing.

    Stil, 18 months and I'm free. That last day of consulting will be fun.

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  • the last post talks about the mounting self-loathing of being a doormat day in day out...it is a TERRIBLE feeling. Just spiriti crushing and vaporising your self esteem over many years.

    Worst mistak I ever made=going into GP
    Best decision I ever made ...= getting the F out of GP c.2009.

    If I ever was FORCED back into the tyranny of 10min consults wiht a waiting load of patients I would literally self-harm

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  • what is most stressful is when colleagues in a practice vary in their views. I got mostly C's and a couple of B's. Some colleagues would get solid D's and you can feel the disapproval if you don't do the same ....

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  • Interesting article, but makes me think how different GP is to bigger organisations in managing inconsistency in such areas. Whether there is a role for developing and implementing practice policies here - for example, a leaflet about accessing out of hours and local dental services for patients for anyone presenting with a mouth/suspected dental problem may stop the patient getting an appointment in the first place. All GPs to sign off being aware of and complying with such policies annually at appraisal??? The teddy bears get to "blame" it on the system which might make saying no easier... Could be an interesting springboard topic for next practice away day!

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  • A Rottweiler in a field of teddies can run riot, and savage a few teds, but watch out if you're standing in a field of Rottweilers - that won't be any fun for anyone!

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  • Locums are sort of Rottweilers but nice ones in that we always sighs post the patient to their friendly neighbourhood teddy ....(Sorry....:-()

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