It wasn’t until halfway through the afternoon session that I had to move the toy box, kindly put there by the cleaners, from off my examining couch, in order to lay my hand on someone’s abdomen. That day I may have used my stethoscope three times and my otoscope a few times more.
So what do I spend my time doing?
Debating with a patient whether I should write a letter for the council to state that he was disabled, so he could get a lift put into his house for free; doing extension of sick notes for patients that normally see my colleagues who were on holiday; listening to patients grieving for their recently deceased relatives. I’m sure there were flotsam and jetsam of actual medical decisions to make, amongst the flood of other things.
It seems to me that the dam of common sense, self care and community-based wisdom has developed irreparable cracks – perhaps even crumbled away in places. The reservoir of human need that has previously been held back, is now starting to flood primary care, with nothing to stand in its way. The snowmelt of screening, media scare stories and the mentality that ‘you can’t be too careful or catch something too early’ would swell the reservoir, even if the dam wasn’t bursting. The waters keep rising.
At some point I’m going to run out of fingers to stick into the dam, or run out of individual advice and education for my patients. I shall have to run for the hills, moving to higher ground or clamber into a lifeboat and set sail for warmer shores. The waters keep rising.
Others are trying to redirect the flow of need to the other more appropriate streams of social care, pharmacy and family. Some of my colleagues are already drowning in need, others are slipping and sliding in the resultant muddy mess around them. The waters keep on rising.
Dr Samir Dawlatly is secretary of the RCGP’s adolescent health group and a GP in Birmingham.
