Monday, April 13, 2015

Why good intentions aren't always enough


 Back when I worked as a GP partner I was in a tiny village surgery. I liked the surgery and the patients, it was genuinely a privilege to look after the lovely people registered with the practice.
 Working in a little practice has a lot of advantages. You get to really know your patients and their families, it's easy to get to know and get on with all the staff and you feel like you are making a difference.
 The downside to being little is that you can feel indispensable. As a GP you are always 'duty doctor' dealing with all the emergencies and queries, but you are also trying to deal with the routine stuff, admin, meetings and management at the same time.
 In a practice with only a couple of doctors, it is hard to take time off for annual leave or sickness when you know your colleague will have to work on their day off to cover you.
 Small practices also earn less money. So I found myself working 9 sessions a week (a session is a half day, and a full time GP is considered to be 8 sessions in most areas) to earn less than I did as a trainee. However the practice was close to home, and being somewhere I liked outweighed the financial shortcomings.
 My husband spent a good proportion of each year overseas. I raced each morning to get our children up and out of the door, straight to the surgery and dealing with queries, then at the end of each day raced home to get them fed, washed and to sleep. A balancing act familiar to any working parent.
 Sometimes the children would be ill, and luckily would be packed off to my parents nearby for the day. Sometimes if it was minor they would spend a morning in our staff room with a handheld games console.
 Sometimes I would catch their illnesses, and shuffle into work full of Beechams or anti-sickness medication, knowing that my partner was away and a locum would be near impossible to find at short notice. Not the best option but I felt I was truly doing the best for my patients.
 Then one winter I was behind reception when the wife of one of our patients came in, desperate for a home visit. I didn't know them very well but knew they were prone to being a bit dramatic. I was desperately trying to get ahead with work to get out to a hospital appointment at lunch time, having been cancelled due to snow the previous week.
 Her pleas were that her husband was desperately ill and dying and the doctor needed to come out at lunchtime.
 I sat behind the screens and told reception to tell her if he was that bad he had to go to A&E straight away. I still don't know to this day how much of that decision was actually clinical and how much was avoiding the visit because I was anxious about my own appointment.
 My appointment confirmed that I had to be admitted for treatment. I asked if it could be postponed for a few days so I could be admitted over a long weekend.
 A couple of days later I saw the computer-generated report from A&E diagnosing him with anxiety and shrugged it off.
 The next day they phoned for a visit again. My partner was in as well as me that day (most days we worked alone) and I asked her to do it. Maybe not wanting to face them, maybe just worried about my upcoming treatment.
  My partner admitted him to the medical ward where he was diagnosed with terminal lung cancer.

A couple of weeks later I met with the couple. They wanted to let me know how disappointed they were that I didn't visit on that first day. I hung my head and apologised for not seeing them.
 You could argue that the choice to go to A&E was appropriate, and you could argue that it didn't affect his prognosis.
 But, my biggest learning point from this is how we as GPs have a responsibility to make sure we are performing at our best.
 We might think we are heroes for working when we are ill. We might think patients would credit us for working through heartbreak and emotional distress.
 But really our patients deserve to be looked after by someone who is at their highest competency.
 So take annual leave, take the sick leave you need and not what you think will cause the least disruption. by looking after yourself, you will be caring more for your patients than you think.

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