I’ll Be There For You

As part of our training, we are taught that patients often have an agenda when they come to see their doctor. What that basically means is that the reason they say they have attended, isn’t the real reason why they’re there. They’ve come to talk about something else.

In addition to managing the patient’s symptoms and diagnosis, we learn to pick up cues in a patient’s dialogue and offer the listening ear. I learnt this week that you can sometimes pick up an agenda without any cues.

This was a week where I found myself being a part of some eye-opening relationships-both with patients and colleagues alike. In one morning session, I saw two patients in consecutive order, who were both having relationship problems. This included one lady in her 20s who was going through a divorce. Apart from treating her ailment, I didn’t feel like I did anything else. Interestingly however, she ended our consultation by saying:

‘I’m sorry I had to offload on you like that’.

Later on this week, a gentleman came to see me because his wife was worried that he was getting tired more easily. It’s an interesting pattern I’ve seen a few times, when patients will only attend the surgery if a loved one asks them to. He thought he was tired because of his medications, though he had been on these for quite some time.  On delving deeper, he eventually admitted that he was stressed with things at home. He was a full time carer for his mother and this would cause anybody stress and fatigue. It was only when he admitted this that he became teary, and I couldn’t help but feel sad.

The last patient who I want to shed a little light on today (there’s obviously more!) is an elderly lady I’ve been following up on for her diabetes. After discussing future treatment, she went on to tell me about her faith in God, how we are all connected, and how she always does her part to keep healthy. This last little bit is something called ‘shared management’. Doctors love this, becaue it encourages patients to take responsibility for their own health.

This lady then shared a story with me (which out of respect I won’t share here, as beautiful to me as it is). Maybe it was the way she told it to me, but it really got to me. It got to me so much that I tried to hold back my emotions. Usually I can do this. However this was the occasion I would do something I’ve never done before-cry in front of the patient. I tried to hastily wipe away my tears through my cardigan sleeve, but it was too late. I thought to myself…great. She has a cry baby for a doctor.

The patient had seen me weep and her smile turned to laughter. My tears later turned into laughter too, but an ugly site I’m sure! I didn’t know what to think of my reaction, so I confided in my mentor about it. We had a lovely heart to heart, which made me feel tonnes better about things.

If there’s one thing I’ve learnt, it’s the importance of being kind to people. Its a key skill Dale Carnagie talks about in ‘How to win friends and influence people’ and I try to always keep it with me. But I think this comes at a level. Particurlarly when seeing patients, I’ve read how doctors fall into the trap of getting ‘too involved’ in their patient care, to the point that it starts to affect them, and how they are around others. I don’t think that’s very healthy either, and I think it’s all about balance. One day I’ll learn how to do it.

In times like these I learn to find pleasures in simple things. I start to get more appreciative of the times around me. On the Friday evening after work this week, I popped into the supermarket and purchased a range of goodies for Halloween. This was my first time going trick-or-treating shopping 🙂 We never have sweets when children knock on the door so we thought we’d actually try this year!

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I was drawn by the ‘2 for the price of 1’ offer and didn’t really think about how I was going to give the clusters and brownies…wrap in cling film maybe? I decided that whatever I have left over I’ll leave it in the staffroom at work 🙂

HAPPY HALLOWEEN!

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The Growing Up Stage

I feel like a lot of things have happened these past few weeks. But at the same time not that much, isn’t it a little weird?

Work is getting busy. I’m now seeing more patients a day (about 20, which is a lot for me!) and I really felt the pressure this week when my time per patient was cut down. Because of the increasing number of people I’m seeing, I’m definitely learning more things. I just hope that I’ll get used to the time management side of things.

Sometimes I get little highs of actually seeing a difference in people I’ve been following up, such as a woman who is on the way to losing weight (using a technique I learnt called ‘motivational interviewing’), or someone who is recovering from post natal depression. I now find myself seeing individual members of families for different ailments, like a family doctor. I try to maintain that ‘holistic approach’ we get taught about in our training by building real relationships with patients over time. It’s nice to know that they like to see me, or at least that’s how I’m looking at it!

However because of the higher numbers I am seeing at work, it also means that I get my fair share of patients who aren’t quite as appreciative of our services, simply because they don’t know how overstretched we are as a country. Traditionally general practice was provided by small practices, run by just one or maybe two doctors looking after their local community. This model of care survived over 100 years, but is now being radically changed. Primary care has existed in the UK since 1911, and is right now going through a massive transition due to funding cuts by the government, the increased work load being transferred from secondary care to primary care, and the pressures of having to deal with (some unrealistic) patients’ expectations. All in all this is making me feel very exhausted, and I feel this most towards the end of the day.

Though nothing is set in stone, I can’t help but wonder if I should move abroad. I know some others who have done the same and they are much happier now. They get treated with a form of respect from authorities and patients alike, which we don’t always get here. For all the years we spend studying medicine, (6 years at university and 5 years training in total to become a general practitioner), is it all worth it if we’re not content? The other option is to go FastLane. I just wonder.

On another note I turn 30 in November and though I am reminded that I still have at least a couple of weeks in my 20s, I couldn’t help but feel strange about it all. On looking back on the decades maybe things are slowly getting better, but at the same time there’s a lot more I still want to do and I fear I’m not reaching the milestones I want to achieve. Don’t worry I won’t be listing them all here, that’s for another time. In the meantime I will be tucking into a chocolate cookie dough dessert, that’s what grown ups do.