Duncan, the 22-year-old whose relatives and friends keep dying around him, is back. I can’t believe it. His grandfather fell and is now paralysed. He keeps having panic attacks—one triggered during his therapist’s consultation, another when his mildly abnormal blood results set off his health anxiety. He’s coping quite well despite this. Recently, he spent some time watching videos of family members who died to help process everything. He’s been crying a lot—a recent activity of his—so it seems he’s releasing a lot now. He’s reading loads of books and has started meditating. Encouraging to see him taking responsibility for his own health. In my experience, meditation is a vital tool for progress because it fosters the foundational skill of awareness. One can only change thought, emotional, and behaviour patterns when they become conscious of them. I set him a target to do this every day for a month.
Good lad. Still a bit worried about this ongoing contact time with someone so cursed.
Robbie has insomnia and is spiralling. A bloody book about sleep made it worse. Now he’s anxious about not sleeping, which of course keeps him awake. He hasn’t slept in 68 hours. Poor bugger. I give him a few sleeping tablets to use sparingly (with a warning about addiction) and tell him the about the paradox of sleep—the more you chase it, the further it runs. He needs to let go of control. Sleep isn’t something you do, it’s something that happens. And it only happens when you’re relaxed and not trying. So he has to learn to be relaxed about not sleeping. .
I’ve never been a great sleeper, so I feel his pain.
A lady asks for her lansoprazole for acid reflux to be put on repeats. I explain the medication is safe but increases the risk of brittle bones and nasty gut infections in the long term. Acid reflux is often diet-related. I send her a link to common dietary causes of reflux. Without changes, the medication often stops working at some point. Often, with the right communication, people are receptive to lifestyle advice. Pain in the arse saying the same thing over and over again, though.
A mum wants her son diagnosed with ADHD or autism. Join the ridiculously long queue, love. It takes years to get a diagnosis these days. Around 5% of children are diagnosed, a lot more are waiting or undiagnosed, and this number is growing at an impossible rate. Maybe society needs to change instead of medicating children for life with amphetamines??
Hope, a 15-year-old with migraines, is up next. Parented by a single mum, and history of exposure to an abusive home environment. We Hope, indeed. She’s been getting severe migraines and has been off school for a week. Mum wants a scan—I do a thorough neurological exam, assure her it’s migraines, and tweak her medication. She’s not convinced, but we come up with a plan that works for everyone.
Today, it’s just me and our mildly challenging advanced nurse practitioner (ANP), Helen. She’s been downgraded from severely challenging. When I started here 9 months ago, the place was chaos. Some people fall apart in uncertain environments… but things are a bit calmer here now. More on this later. Anyway, a recurring complaint from management is her inappropriate blocking of appointment times. Today, she’s blocked off 75 minutes to do admin (signing scripts, which normally takes 15 minutes) and 15 minutes to drive between the two sites (reasonable, given we’re split across two sites).
She walks in to my room, at lunch, her usual exasperated self shaking her head. As she groans like trapped air in a radiator, I observe her facial movements and see how her recurrent thought patterns have etched themselves into a permanent expression of heaviness. In the early days of working together, I was quite irritated, and wanted to shake her about to wake her up from her delusions of self-grandeur. But now, at least more of the time, I feel for her. Our relationship is preserved, for now anyway. I zone back into the contents of her complaining drivel as she concludes… ‘These patients, honestly!’
She then asks advice for a few patients:
- One has a very slow heart rate (35 bpm) and needs an urgent cardiology referral.
- Another needs bloods for a rare condition called Sjögren’s syndrome.
- Four more queries—tough clinic.
Clinically, she’s actually quite good. She asks me to do a referral for her. I push back and ask her to do it. She sighs: “I’ve no idea when I’m going to be able to do all this admin.” Hmm. Try the 75 minutes you’ve blocked out.
✔ 160 repeat prescriptions
✔ 55 blood results
✔ 40 medication queries from patients and staff
✔ 6 additional reception queries
As I finish lunch, the practice manager comes in to give me an update on moving building sites. There are obvious problems with the new building layout, but the bosses don’t want to delay things further, as funding may be pulled by the Integrated Care Board due to national cuts. Better to move with problems than remain split across two sites.
I start my afternoon clinic late. After my first patient, someone comes in to ask me about a nursing home query. Then, I get a pop-up screen message to sort out two more urgent queries. Midway through writing a letter, the shitty IT system pops up with a non-urgent ‘urgent’ alert, which automatically stops me from typing until I click three buttons. I whisper “fuck off” to the computer.
Deep breath. ×3.
In GP land, it is hard to find flow state. Sometimes, it feels like I’m in a training program for the development of Attention Deficit Disorder. Constant interruptions from staff, fractured IT systems, and an endless stream of patients needing fresh focus—it’s probably why general practice has such a high burnout rate. Plus, you’re sat in front of two bright screens all day without moving. How did that become normal?
Nevertheless, I find aspects rewarding and there are things which keep me here. Being a source of support for people who don’t have a role model. It is an amazing skillset to develop and the training we receive in this country is (maybe was?) World Class. Even if I disagree with the system and the direction it’s going in.
Plus, I see it as a source of inner growth. I’ve learned that the less time we spend in negative thought patterns—frustration, anger, sadness—the more energy we have, the healthier we are, the more productive we become, the more fulfilled we feel. So I see work as an opportunity to alchemise the negative. Hard process but working on it. I’m trying to see negative emotions as an alarm bell—a signal to reframe, process, or let go. Most of the time, they’re unnecessary when you really look at them. Like my urge to hurry up—most of the time, I finish on time anyway. If not, I run 15–30 minutes late. It’s hardly the end of the world.
Yet, my conditioning is deep, and I still get frustrated when I running late and the interruptions come.
At the end of the day, one last interruption. The ANP pops in and tells me she’s asking the bosses for a pay rise. No words.
Mindful Medic 