Dr David Turner takes a moment to reflect on the ‘mammoth task’ of being a GP, and how its time others start to recognise it
Trainees at our practice are frequently amazed at the number and complexity of problems we deal with in 10-minute appointments. As GPs we work like this all day every day, and so have come to think of this as normal. But sometimes it is worthwhile stopping to reflect on what an amazing job we do.
A recent example was a patient who came in about hand arthritis. I discussed their blood results which had excluded an inflammatory cause. I advised the likely diagnosis of osteoarthritis and the treatments available – including a steroid injection done by me, for which I outlined the pros and cons. While the patient was there, they also mentioned urinary problems, chronic constipation, and I performed a rectal examination. As a parting shot, they also mentioned blocked ears which I checked and confirmed ear wax was the cause and discussed oiling and syringing. This package of care was delivered in eight minutes.
Another feature of our work that our trainees do not often fully appreciate until they experience it, is the difficulty we have referring patients to secondary care.
A certain case springs to mind. I can’t discuss the actual case due to patient confidentiality, but for a moment let’s imagine that you were trying to refer Nelly the Elephant to a Pachyderm consultant with a special interest in mastodon luggage arrangements. Lets then imagine that the aforementioned specialist refused the referral, asking the GP to try out some special elephant tablets first (which we had already tried by the way) and you would get some idea of how appropriate the referral was, and why their resistance to the referral led to an outburst of profanities that would make Malcolm Tucker from ‘The Thick of It’ blush.
The fact we deal with such an eclectic range of issues in such short consultations dozens of times a day is nothing short of a Herculean feat. The fact that we also do this amongst a background of clunky software, computer glitches and pointlessly burdensome referral forms, might mean, one would think, that we are held in something akin to messianic esteem. Yet for me, it often feels like I am trying to complete a thousand-piece jigsaw puzzle, blindfolded, outside in a thunderstorm, while someone randomly pelts me with excrement.
As GPs we do complicated medicine in patients with a multitude of health problems, in impossibly short time frames, often in suboptimal conditions. If our waiting rooms look empty it is because we have a screen full of phone calls and administrative tasks to do – not because we are sitting with our feet up. If we zip through 12 patients in an hour in emergency clinics, it is not because it is easy work, it is because we have years of training and experience behind us.
I do not want praise (or claps) from anybody for doing a job I am trained for. What I do not want though, is snide comments from the Government and general press about us being lazy and hiding behind computer screens, when the reality is far from that.
For far too long, our image as GPs has been painted as rather cosy, accommodating, and unassuming individuals who will always go the extra mile for patients without complaint. Admirable as this attitude is, it has too often been abused by those ‘in charge.’ I think it is time we stand up and blow our own trumpets about what we do – before too many more of our herd pack their trunks and slip their iron chains.
Dr David Turner, GP in Hertfordshire
All in one day because who could work as an NHS GP for more than that?