We all know that the quickest way to finish your annual appraisal is to tick all the boxes, complete your PDP and reflect sufficiently in the right places. Does it help us be a good GP? I’m not so sure.
But opportunities to learn are all around. Here’s a few of my own. Give yourself a point for each one you’ve done, and do feel free to suggest your own:
1 Sit up all night with a child who has acute otitis media until their ear drum perforates. It’s crap. No amount of analgesia helps, and while I know antibiotics won’t do anything in most cases, I will now be considerably more sympathetic when explaining this to parents. For bonus points, do it in a hotel room abroad.
2 Have at least two acute admissions: one that turns out to be nothing (trapped wind is a good one), and one that results in a hospital stay of at least 48 hours. The first one is because it is what all patients fear. The second one is because the helplessness of being unwell and away from home makes you realise that the smile and kindness of an HCA makes so much more difference than the cleverest imaging or consultant.
3 Try one dose of everything you prescribe. Now I realise there are some minor GMC issues with this, but when the opportunity arises, seize it. For instance, tramadol is proper nasty. Anything designed to replace food can be substituted with a slice of fruit cake and glass of full-fat milk for the same calories. Metronidazole/co-amoxiclav is worse than the original infection. The sugar-free flucloxacillin suspension tastes genuinely hideous – screw your kid’s teeth. For bonus points, eat hospital food for 48 hours. Anyone I admit now, I advise them to take snacks.
4 Have at least one unpleasant examination. A smear for ladies, prostate for men. Some form of endoscopy is enlightening too (lesson – always take the offered sedation). You will still refer patients for them, but with more compassion and some practical tips.
5 Breastfeed. And bottle feed. Preferably with a normal baby who doesn’t know how to do either, while you are horribly sleep deprived. I’m ignoring gender issues; you should damn well try it. Remember this when new parents come with what seems like a daft question.
6 Take a course of antibiotics without missing a dose. You can’t, can you? It’s impossible to remember them all. Now multiply that difficulty by 15 and look at the next 85-year-old you see. Time to de-prescribe.
7 Have headlice. And scabies. Then try to treat them. Lessons – prescribe a shedload more of the treatments than you think you need to, and expect lots of mess, towels, and weird smells.
8 Have constipation. And piles. Check what you are prescribing actually works – your patients will love you forever.
9 Ring NHS 111 with a straightforward problem. UTI is a good one. Then wait until common sense is overridden by protocols and you are blue-lighted to a tertiary centre.
10 Cope with losing a loved one. The vulnerability both personally and professionally. Learn that being a medic doesn’t prepare you for this. Nothing else reminds us of the difference a GP can make quite like needing one ourselves.
Dr Zoe Norris is a GP in Hull
