Well what can I teach you about general practice then?
Let’s start by learning how to perform a left handed rectal examination on a confused patient lying on a sagging sofa, with Jeremy Kyle blaring out from the corner of the room and a truculent Scottie dog snapping at your ankles.
A home visit is like trying to fix a car in the fast lane of the M25 at rush hour in a thunderstorm
I’ve recently started teaching medical students again, one of the rare gems of fun studding the steaming pile of ordure that general practice is becoming. It is a pleasure and privilege to introduce these young and enthusiastic minds to the rough end of the trenches.
The experience of assessing a patient in general practice has about as much in common with assessing a patient in hospital as Jeremy Hunt does with a rational, reasonable human.
The hospital has patients tucked up under fresh sheets in a bed set at working height. By the time they are in hospital a patient will have given their history several times and like a well-rehearsed actor, can often give a fluid performance.
This is a world away from the chaotic ramblings they will have treated their family doctor to – yes they really didn’t think it was important to mention to us they had just spent six months in Central America, what relevance could that possibly have to their fevers? (Yes, ok I know, we should have asked.)
I think the home visit is the true rite of passage for a medical student.
Home visits are often compared to fixing a car by the side of the road instead of in a garage. Around here I’d say a home visit is more like trying to fix a car in the fast lane of the M25 at rush hour in a thunderstorm, with the owner of the car repeatedly slamming the bonnet lid down on your fingers.
No nursing charts and plumped up pillows, but plenty of profoundly deaf octogenarians slumped in stained arm chairs with only well used incontinence pads to protect their modesty.
Perform urinalysis? Good idea, where?
The kitchen sink with the defrosting chicken in seems to be the only place available.
Wash your hands after? Excellent, now you have a fragment of fossilised soap and a towel that a microbiologist could write a PhD about to assist you with that task.
I’m not sure my students will necessarily want to join the ranks of Hunt’s 5,000, but they will certainly learn there is more to general practice than signing forms for parachutists.
Dr David Turner is a GP in west London
