A day treating students
Dr Dominique Thompson describes a typical day at a university practice
Profile: Dr Dominique Thompson
Location University of Bristol Students Health Service
Roles Director of the Student Health Service, member of Avon LMC, and honorary secretary of the Student Health Association. Member of NICE eating disorders guidelines committee
Hours worked per week 35 at Student Health Service
Having dropped my six-year-old son at school, I like to be available to colleagues before morning surgery. I am frequently contacted by academic staff, wardens and other student support services, for example if a student is self-harming. Occasionally I receive calls at weekends if there is serious cause for concern.
Surgery runs for three hours although, as we always see anyone with a mental health concern the same day, it can go on much longer. Mental health issues are the presenting complaint in more than half our consultations. This morning I meet mainly new patients, as it is the beginning of the academic year and we will register more than 7,000 new students a year. In total we have 18,000 patients, treated by six whole-time-equivalent GPs. One in five of our patients is from overseas and will not have used the NHS before, and even our UK students can be flummoxed when presented with a prescription, having never organised their own healthcare. We endeavour to educate them about NHS resources and self-care. We’re open to hearing about their ideas, for example traditional Chinese medicine. Many Chinese students arrive with their own medication, unnamed in plastic bags, with instructions only for when to use it (‘for fever’, ‘for cough’), although we ask them to stop these if we are to prescribe.
Today’s surgery includes a patient with a first episode of mania, a student with type 1 diabetes who also has an eating disorder, a student with a kitesurfing injury and a possible case of malaria. Infectious diseases are not uncommon – every year we see malaria, leptospirosis, bilharzia, and once I saw leprosy.
We rarely have home visits, as we have a three-bed day unit where sick students can be assessed by our team. Today I grab my sandwich and attend a complex cases meeting with the heads of the counselling, disability and vulnerable students services, to discuss the most complicated students. If they are medical students they are referred to our occupational health team, and the fitness-to-practise (FTP) panel (set up between the medical school and the GMC) if necessary. Medical and dental students are, like their qualified counterparts, subject to FTP procedures if things go wrong. We have to tread a fine line between caring for them and protecting the public.
This afternoon is an admin session. I start by meeting the new students’ union welfare sabbatical officer, who comes to discuss his plans for the year ahead. The practice is involved with student-run campaigns such as Mind Your Head month, which this year included a mental health Question Time-type event. Our sexual health lead GP ran a campaign for Valentine’s day about avoiding chlamydia and gonorrhoea, called Love Hurts. I respond to emails on topics like meningitis awareness, sickness certification for exams and anti-terrorism policy.
I plan a meeting with our in-house psychologist to review our new service for students with emotionally unstable personality disorder. We are poorly funded though the NHS and the QOF, but are lucky to receive university alumni funding for this scheme. I also plan the launch of a student health app, developed with a local social enterprise, for young people looking after themselves away from home.
I volunteer on a hall of residence committee, which gives me an insight into life in halls. Students and staff consider issues ranging from the quality of hall food to the Christmas ball, and I enjoy seeing the students when they are not unwell, but fully involved in life.
Time to go home, reflecting on the satisfaction I get from seeing students arrive as anxious freshers, supporting them through often enormous challenges, and watching them graduate, hoping my team has helped them to achieve their potential at such a significant period in their lives.