Overslept this morning. Cold shower for 2-3 minutes, a jet of warmth then on the bike into work. Made a cup of tea.
One of the staff members has an issue she wants to talk to me about. Joint problems. ‘Stop smoking them.’ Not funny apparently. Will see her at lunch after clinic.
In the morning, first patient has a high cholesterol. According to his calculations he has a 22% risk of a heart attack or stroke and HE MUST HAVE A MEDICATION TO PREVENT THEM FROM OCCURRING. But I have a relaxed approach- I explain the risk to him, and explain that statins can help to prevent them but there evidence base is actually not miraculous in cases like his, and they come with a whole host of side effects that we rarely talk about- diabetes, muscle pains, tendon damage, liver issues, pancreas issues, memory loss, hair loss, even a life-threatening skin condition… yet we throw them around like smarties at faintest whiff of potential illness. He decides to try and start exercising and introduce more nuts, berries, seeds and apple cider vinegar along with some other dietary suggestions. We decide to review things in 3-6 months with statins remaining as an option on the table.
Then there’s a patient with a crumbling neck thats compressing her nerves. When I saw her last time she had started getting numbness in both hands. I referred her to the orthopaedic team but she cant get a scan for another 5 weeks even though it’s a red flag referral. Now her symptoms are worse, struggling to walk and weakness in her hands and arms. I tried to call the on call orthopaedic doctor but 20 minutes later and there’s no answer. She needs an urgent scan as it may start compressing her spinal cord which is a medical emergency as could leave her paralysed or worse, dead. The patient doesn’t want to go in to hospital as there are patients waiting 48 hours to get onto wards. I send an urgent request online for advice and print her records off for her to go to hospital in case things get worse in the meantime.
Some of the remaining patients from the morning clinic include a severe eating disorder, stress from bullying at work whilst caring for an autistic son, a heart rhythm disorder, vaginal bleeding, a 78 year old who hasn’t eaten since his 44 year old fiance broke up with him 3 days ago for delaying their wedding (that’s a massive red flag mate!) and a call from the paramedic to discuss a patient who is neglecting herself, won’t leave the house, is addicted to butane and being emotionally/financially abused by her mum and she has a possible urine infection.
After clinic, I catch up with the practice manager and discuss the scale of issues we have ranging from staff concerns, disciplinaries, organisational challenges, lack of processes in place, how we can solve the issue of lack of appointments/inefficient use of appointment slots, excess burden of admin on GPs. Overall a lot of progress in the running of the surgery but still a mountain to climb.
I see the staff member who has lung issues, heart issues, joint issues. She’s decided to retire. Fair enough, I might join her before it’s too late.
Next is a clinical meeting where the clinical director, a GP, discusses the organisational updates before we have an educational session. Some of the updates include being told a brand name for a drug has changed, being reminded to tell patients who have high blood pressure in pregnancy that they need to have yearly BP checks and that the threshold for treating a medical condition has been lowered. A symptom of a pathological fixation on granular issues and a system asking for more and more. I have big inner conflicts about the system and it’s hard for those outside of it to understand. Many GPs feel the same. But I like the patient contact. I like the diminishing part of the job that is actually proper medicine. And it pays well. Tricky.
In the afternoon, my first patient is a man who witnessed his friend murdered a few years ago. Same thing happened to his partner 6 motnhs later. She had stopped replying to his messages and then he read about it in the Evening Standard, page 2. He also had an art/photography business that folded after rent was tripled at the drop of a hat. He recovered from alcohol/cocaine abuse but now he has to deal with the traumas he was medicating himself from. We talk about how to regulate the nervous system, how creativity can be used to channel difficulties, referrals for therapy and processing his post-traumatic stress disorder. He’s not keen for medications. He has a good support network. He’s a kind man, gets a buzz out of teaching students photography and painting. Says a lot of them have gone to achieve highly- better than he has. He’s proud of it. We’ll touch base regularly. The clinic goes on but is quite manageable today- lots of infections which are easy.
At the end, the girls at the front desk come in and goad me for being a grandpa for using ‘out of date’ slang. And then more for eating 85% dark chocolate from my draw.
Mindful Medic 