Diary of a GP 18: From Reception to Resignation?

Frontline Receptionist: The View from the Other Side

It’s both important—and humbling—to spend time in other people’s shoes. This morning, the service manager, Andy, asked me to start the day on reception—to feel the heat where it often burns brightest.

Patients treat receptionists very differently to doctors. Probably because we hold the keys to the good stuff—appointments, solutions, DRUGS.

Courtney’s Call

My very first call:

30-year-old Courtney says the pharmacy haven’t issued her asthma medication properly. She needs her Uniphyllin by tonight as she’s run out—along with two other medications. She says she’ll end up in A&E without it. Sounds dramatic, but could be true.

I check: we issued the correct script 10 days ago, covering a full month’s supply. She insists the pharmacy only gave her a small amount. I mute the call and check with Jemima, the receptionist, on the process. I explain that the pharmacy have charged us the full whack for the prescription and ask if she can double check what’s happened when she next picks up a prescription—which we can re-issue once she submits a written or email request.

As a one-off, I text her a quick link to facilitate the process.

She kicks off:

“I can’t do it. It’s your fault. Just sort it out now for me.”

“Unfortunately, we can’t issue it—it needs to go to the doctors, who will do it when they have time. They’re with patients.”
(She doesn’t know I’m an undercover GP acting as a receptionist.)

“My husband is in hospital. I don’t have time to f*cking do it!”* she spits, viciously.

“OK, sorry—that sounds stressful. Unfortunately, this is the only way it can be done. It’ll literally take 2 seconds. Just click the link and write which medications you need.”

The pot is boiling.

“I can’t do it. If I don’t get this medication by tonight, I’ll go to hospital and die. And it’ll be YOUR fault. You’re disgraceful.”

I try to stay calm, composed.

“I’m not trying to be difficult, I’m trying to help—we have a simple process. It’s not hard to do. And it’s the only way we do it.”

“You are disgusting. I hate you. I’m speaking to PALS (Patient Advisory Liaison Service). I will sue you for every penny. I hate you. F*cking DIE. F*ck you.”

It’s jarring to be spoken to like this — with little warning, and out of no personal fault. It makes me realise the privilege I generally have.

A few minutes later, she writes on her request form:

“You are disgusting. I need this sorted. I will sue you for every penny. I am going to PALS. I don’t have time to make requests so that I don’t die.”

Then… she requests her medication.

Aftermath and Reflection

Wow. I look through her notes for any justification. Her asthma has been stable for a long time. We’ll give her some slack—she may well have a husband in hospital. The loudest anger often belongs to the loneliest heart.

She’ll receive a formal warning. But any more rudeness won’t be tolerated.

I ask Jemima how often this happens.

“Sometimes once a fortnight, sometimes multiple times a week.”

A real insight. NHS Receptionists are taking a complete battering up and down the UK, in a totally broken system. Back to GP life.

Jane: Seen but Unseen

Jane, 78, comes in with an odour like she’s hiked the length of the UK. She also looks like she’s run it—limping in with a walking stick.

About a month ago, I sent her to A&E with a high index of suspicion for degenerative cervical myelopathy—a medical emergency where a spinal disc bulge in the neck becomes so pronounced it compresses the spinal cord, causing neurological symptoms and pain. She was close to going straight in for an operation but they discharged her and she’s got worse in the meantime.

Her neurosurgery outpatient appointment is on Friday.

She underplays her symptoms. The smell tells its own story—of someone struggling to care for herself; someone struggling to be seen. I advise her to exaggerate her symptoms at the appointment. She who shouts loudest, gets heard—especially in times of crisis.

The Call with Ritu

At lunch, I speak with my clinical supervisor, Ritu—an experienced GP in a leadership role and also a practicing GP at another site.

I’d arranged the call to ask about reducing my hours. But the conversation evolves.

I explain the pressures—both in and out of work. I’ve been working on a passion project that’s making a big impact on people’s wellbeing. But it’s based in London, and I often drive long distances. My friends, family, and business partner are all there.

Juggling work pressures alone is tough because of systematic issues in the NHS, the organisation, and the practice. Throw in the travel and the side project, and I’ve been left on the edge of burnout—racing heart, chest discomfort, irritability. I don’t look forward to coming in.

I tell her I can’t see myself here long-term. The job hasn’t matched what was promised. It’s felt like I’m a junior doctor, swaying at the whim of incommunicative, labile management decisions—people I haven’t even met in a year.

I’ve had no real opportunity to influence or leave my mark. The whole place has felt like chaos.

I tell her that despite this I really respect her. She’s been caught between a rock and a hard place. It’s no reflection on her—but I want to hand in my resignation.

“I know this must come as a surprise to you.”

There’s a silence. Then she speaks.

“Not really. I’ve been around the NHS long enough to know these things happen. Sadly, General Practice is more often than not just a job these days. It wasn’t always like that. But if you have a passion, follow it. And I get it—you’ve done incredibly well there under a lot of pressure. I’ll support your transition however you need. And if there’s any way we can change your mind, let me know, because we’ll miss you terribly. Have a think, get back to me before writing a formal resignation. But do what’s right for you. I get it.”

She validates my experience. I’m touched by her response.

There’s relief—but also a sense of leaving something unfinished. We’ve come a long way. Patient feedback shows a steep rise in satisfaction.

There’s a slight internal conflict.

George and Max

George, an old boy, comes in.

A scan—ordered due to blood in his urine—shows advanced cirrhosis. His liver is failing. That means less protein, more fluid build-up, and a higher risk of bleeding. His legs, thighs, and abdomen are filled with fluid. He’s bleeding into his urine too.

It’s likely a late-stage, palliative situation, though I can’t say for certain. I refer him urgently to hospital for a drain and full work-up.

Max is new to our clinic, having just moved down from London. She’s sweet. Autistic. Arrives with a formal demeanour, keen to update her NHS records—she’s changed her name from Ona to Max, which caused two NHS accounts to be created.

She also wants reassurance that her gender transition from male to female can be supported and managed locally.

Once reassured, a weight is palpably lifted and she lightens. She tells me excitedly she’s planning to join a transgender running club and get super fit. She’s just moved to the area and is buzzing.

A Difficult Decision

After work, I mull things over.

I like the patient demographic. It’s colourful. They need support. We’re doing a good job—far better than before. The practice manager we’ve had for the last six months is excellent. AI is coming in to help alleviate administrative burden. Medical students too—which I’m excited to teach.

But there are too many issues with the organisation and its processes. None of us can fix them without decentralising decision-making from the top—or protected time to lead change.

It’s going to be hard on staff and patients if I leave. Without sounding like I’ve developed a God complex. Well—maybe there’s a bit of a God complex in there.

I mean, if I left and things got better without me, it would slightly crush me. No one wants to leave a key role and see things improve, do they? Ideally, you want to see the place completely crash and burn.

Keeping the Door Ajar

I decide to leave the door ajar slightly.

I text Ritu:

How about a trial period—reduced hours and protected leadership time for three months? Not saying I’ll take it, but it gives me something to weigh up before I resign formally.

She immediately replies:

“Leave it with me, I’ll speak to the bosses.”

Off to the Highlands

Tomorrow, I’m off for nature therapy in Scotland and to hang out with my newly elected Goddaughter.

A chance to breathe, before I decide whether to walk away fully.

The Day in the Life of a GP 17: No Time to Breathe, But Here’s a Breathing Technique

Morning Surgery

Jessie, a young lady – depressed and not sure why. Hard when limited clues. Eventually I assess through the lens of a useful framework for life – Tony Robbins’ 6 human needs- certainty, uncertainty, love/connection, significance, growth, contribution. As I talk about it – it becomes clear that she struggles with uncertainty. A lot of people do but her manner is distinctive. She requires routine and if she loses it she cannot function. She does not have a job for this reason. I screen her for autism before sentencing her to a 5 year wait for diagnosis.

88 year old Beryl. (It’s funny how you can almost guess the age of a patient by their name—Beryl’s never going to be a teenager, is she?) – she’s intermittently shaking, got the jitters. Today she’s fine but it’s occurred 2–3 times in the last few months. Ideally I would bring her in for a quick MOT but there’s no appointments. A big chunk of General Practice is hypothesising confidently or buying time: I hypothesise it’s her blood pressure and explain how adjustments to blood pressure changes when we stand up as we get older are slower and more sensitive to dehydration or low sugars.

 ‘Next time it happens try drinking a pint of water, eating something with a bit of salt/sugar in it and then lie down for 15 mins. If it’s still an ongoing issue or getting worse let us know and we’ll bring you for a check over’

John, 43, under haematology for his dormant multiple myeloma (blood cancer) has developed weight loss and is understandably anxious. I request an extensive blood panel for tomorrow so we see if it’s related to his cancer.

63-year old Bert who has a Crohn’s disease (inflammatory bowel disease) flare-up – his markers of gut inflammation are through the roof despite recent treatment. I write an urgent message to gastroenterology to expedite his next outpatient review as they haven’t plans to see him anytime soon.

Susan, 60, on Ozempic – one of the weight loss injection medications many elite got wind of and it’s become so popular there’s a shortage. The crampy tummy pain, the nausea, the side effects are getting too much for. She’s barely eating. Certain foods e.g. fatty make side effects worse so we go through diet. Her heart rate is 105 signifying she’s not really doing that well. We trial anti-sickness medication, pain relief and a strict Ozempic-conducive diet for a couple of weeks. 

Harry, 40-something, has sinus congestion. His left ear is also painful and hearing is reduced. It became worse after swimming. His left ear drum is retracted and swollen. His right ear has 2 unusual cystic shaped lesions blocking part of his ear drum. I’ve not seen them before but they look benign. I issue decongestants, antibiotics and advise rinsing his sinuses out with saline water. I also write to ENT for guidance on whether these cystic lesions warrant an urgent or routine input.

Benny, 71 – feeling anxious. A bit of a worrier. Coping ok with it. He is quite active, but he lives alone. He has no mobile phone or computer which reminds me of how different the lens each person views the World through can be. I notice an abnormal prostate blood test from 2 years ago which was investigated but worth repeating to make sure it’s normal now, even though he has no new symptoms. Then I teach him a balancing breathing technique called Nadi Shodhana – one of the most foundational breathing techniques in yoga to help his anxiety.

Tony, a paramedic, has been out to see a patient Gerry for a suspected stroke. It turns out his blood sugars are low and he had a hypoglycaemic episode causing slurred speech and reduced consciousness. They treated him and reversed it. He is a bit clueless about how to use his insulin. His wife is at home with him which makes things less risky. I advise them to record his blood sugars before and after meals for 3 days and we’ll get him seen in clinic with our advanced nurse practitioner who can tweak his insulin doses and ensure he understands how to use it.

Tracey has a million things wrong with her at a young age. Diabetes, possible Crohn’s disease. Loads of pain. She’s got a painful foot which she says she tried everything for. She’s stretched it, she’s changed her footwear, she’s on painkillers. She’s trying to improve her diabetes. She throws all of her problems at me in one go and I feel irritated as she complains about everything and everyone as she often does. I get it and I get she’s not happy. We have a good relationship so today when I’ve got limited capacity, I don’t feel bad as I signpost her to see the physio and bring the consultation to a close quickly.

I have a patient in the waiting room but need a break from people and start whipping through 85 scripts and 20 blood results, taking action where needed.

76 year-old Henry – he has had a couple of falls and is having giddy spells. He’s known to have prostate cancer which is well controlled. I notice his bloods on the hospital system show a big drop in his kidney function and a possible infection but no one seems to have done anything about it. I check his numbers and his BP is quite high and will need tight control if his kidney function is as bad as it was in February. His blood pressure when he goes from sitting to standing is fine. We’ll re-check his bloods then review everything. After he leaves, I ponder if I should have just treated his blood pressure there and then as it’s probably contributing to his symptoms. No time to give it much thought.

Lunchtime MDT

At lunch – there’s a meeting to discuss patients needing multidisciplinary team input to ensure shared care and collaborative work which is necessary. Pop out for 15 mins to get some food. I call a friend to vent. We have a weekly ‘chat-shit call.’ We vent with no judgement about work and life. Doesn’t matter whether we’re right or not. We just get it all out. Today I vent about how reception keep dumping patients on top my clinic as if I have some sort of endless bank of energy. How I send emails to people to ask for things or to raise issues and don’t get a response – it’s a joke. It really is. And I’m close to quitting. The truth is, it’s not any individual’s fault that we are not a team but it is the organisation’s responsibility to listen to me and give our team autonomy and space to improve things. Rant over.

A 70 year old patient has been discharged from hospital with some drastic changes in his medication because his blood pressure was dropping too low. It’s really tricky because his heart isn’t functioning well and is causing fluid build-up in his legs and chest. The problem is that the medications which offload fluid away from his legs and chest, also lower his blood pressure. So when you stop those medications, the blood pressure picks up but the fluid collects again. He’s walking a tightrope – step off on one side and you drown in fluid, step off the other and you collapse from low blood pressure. It’s quite an investment of time, energy and expenses to facilitate this delicate dance as he’ll need home visits – does he even want to walk this tightrope? Our system always presume yes. A conversation for another time.

Afternoon Clinic

Jayden, 6 months, constipated with hard stools and hasn’t opened bowels in a week apart from one hard pellet. He’s straining and crying. He’s on formula milk and about to start weaning on solids. We go with mashed fruits/prunes/peas on top of the usual measures such as hydration, massages and warm baths and we’ll review if he needs laxatives next week.

Naomi, 40, a suggestive lady with chest pain. She comes in, smiling and touches me on the arm. ‘Oh hi Doctor.’ She has a well-endowed chest with a garment celebrating rather than obscuring this attribute. She repeatedly points down at her lower sternum, pushing her chest where it’s painful. I maintain eye contact. She’s had a cough which has probably caused a small muscle strain, nothing to worry about. Breast to move on quickly.

60 year old with tummy pain and intermittent constipation and diarrhoea. Sometimes the constipation can cause overflow diarrhoea as the blockage causes the fluid to push its way around the hard stool and come out as liquidy stool. Sumptuous stuff. Treat him with a trial of high dose laxatives and advise him to stay close to the toilet.

91 year old with elephant-sized legs since 2 weeks ago. It’s from fluid collection. Sometimes it can indicate fluid on the chest too but his chest is clear and his numbers are ok. Rather than over-investigate a 91-year old with multiple trips, I go with a practical solution and give him water tablets to relieve the fluid and hopefully reduce the swelling and pain in his legs. We’ll review him with some bloods again in 2 weeks.

Marie, 66, has severe back pain and is struggling to walk. She is incontinent – ongoing for a while. She was seen in the bladder clinic 2 weeks ago who reportedly started 2 medications. The letter communicating outcomes from the clinic has not come through though. She wants the medications but I can’t issue something I don’t know about. She also has chronic pain all over. She also thinks her back pain has progressed to compressing the spinal cord (emergency) as she’s lost sensation around her rectal area. She wants strong painkillers but says everything I’ve suggested won’t work. Hence why someone referred her to the pain clinic but that was 9 months ago and she’s not heard anything. She wants solutions. I can’t help her much but will review her for a face-to-face appointment to assess her back pain to ensure it isn’t an emergency. I’m running 40 minutes late. I’m in a numb, tired state of autopilot now.

Gerti, 35, has a sore throat for 2 days and really doesn’t warrant medical input so I offer him a curt performance.

Asked by the advanced nurse practitioner to pop next door to help her with an 18 year old female with itchy, discharging nipples. Sometimes blood. She’s seen the breast team before as someone referred and had cancer ruled out. Possible breast infection, a bit of a punt as I’ve not seen this presentation before. Antibiotics and moisturisers.

Jose, 2, has started walking with his toes facing slightly inwards. I check his leg length, his standing alignment of his hips, knees and ankles before making sure range of motion in each of those joints are normal. I ask ChatGPT a question on in-toeing (game-changer) and reassure mum and dad 10% of children develop this and it’s usually outgrown by 8-10 years old.

An email comes in from the nursing home asking for antibiotics and medications for haemorrhoids. I pause and contemplate if I have the emotional equivalent of haemorrhoids. That’s how I feel at the moment. Low-grade stress all the time that I do sometimes forget about completely but can get a lot worse in short bursts. I conclude I have emotional piles.Time to surgically remove the problem?

13-year-old with suspected attention deficit disorder. I signpost them to the screening questionnaire and explain they’ll need to find a private provider and we can refer them under the NHS as the NHS waiting list is many years here. He also has a sore throat, so I check him over and advise it doesn’t need antibiotics. Mum isn’t happy. I’m ambivalent, irritable and disinterested.

An email from pharmacy mentioning a medication brand prescribed being out of stock and requesting me to re-prescribe it in generic form.

Then I debrief with Helen, our advanced nurse practitioner, who needs advice with some patients and tests ordered..

Then there’s another 40 pathology results to deal with. Then a few workflow letters from referrals or other agencies to act on. Then 30 prescription requests that need reviewing and signing. I rarely leave work for the next day but today I’m out of juice.

I finally check my emails before I log out:

There’s one that’s come in – a link to a Protected Learning Time session on:

Suicide Prevention. 
How timely.

Diary of a GP 16: Breaking Convention. Psychedelics, synchronicities and the soul of community

Over the weekend, I attended Europe’s largest psychedelic consciousness conference — Breaking Convention. With over 200 presenters from Mexico to New Zealand, the energy itself felt like an altered state. I found myself moving between rooms filled with indigenous wisdom keepers, neuroscientists, therapists, artists, veteran plant medicine facilitators, and curious first-timers, all mingling without hierarchy. As Floris Wolswijk poetically put it, “flower crowns brushed alongside tweed blazers.”

It felt like separate worlds — science and spirit, tradition and technology — were being bridged through open, humble dialogue. There was no pecking order, only presence.

A Fusion of Worlds

The opening ceremony set a tone that merged invention with ancestral wisdom, academic rigour with embodied knowing. It was crowned by a ceremonial address from Mac Macartney, whose presence infused the space with reverence.

Even the foyer was its own kind of medicinal space — filled with fungi-themed fashion, non-psychedelic plant medicines, supplement samples, deep conversations, and books on exploration and awakening. The whole experience blurred the lines between conference, ritual, and art installation. Dissolved boundaries resemblant of a psychedelic experience.

Insights That Landed Deeply

Across three days, I gathered a constellation of insights. Here are a few that stayed with me:

🌿 The Dark Side of Vision

One speaker warned of the dangers of psychedelics; when psychedelic visions or experiences are misinterpreted. If an experience is not properly integrated, it becomes just a hallucination — or worse, a source of delusion. When authority is placed outside ourselves — trusting spirits or insights blindly without discernment — we risk collapse. This, they said, is the line between spiritual emergence and spiritual emergency.

We were reminded as to why elders and guides have always held the space for these experiences in traditional communities. Now, with psychedelic retreats popping up like startups, that wisdom-holding is often missing. “Kids without elders in the village will burn it down to feel its warmth.” A stark warning for the future influence psychedelic plant medicines will inevitably have globally.

A great quote from Julie Holland, psychopharmacologist and psychiatrist and author:💡 “A revelation is a merging of unresolved parts of the psyche.”

This line struck a deep chord because of my learning from yoga. It reframes insight as integration — not adding new knowledge, but reuniting what has been split off, hidden or avoided within us. Like an analogy my yoga teacher used- we work to remove layers of dust from the mirror and then begin to see things that have always been in front of us more clearly. It’s all already inside of us. 

One of the many nature-oriented talks:🌾 Sustainable Cultures, Ancient Technology

A beautiful talk highlighted sustainable living systems like:

  • the Khasi tribe’s remarkable living root bridges in Meghalaya (India) which withstand powerful floods every year (I was lucky to see these in person a few years ago)
  • Bali’s ancient Subak irrigation system, which turns large scale rice farming into a harmonious relationship with nature. A complex, pulsed artificial ecosystem which functions to manage water co-operatively with the environment.

These aren’t just clever designs — they’re embodied philosophies about interconnection and sustainability.

Some exposure to riveting old ancestral philosophy:🔥 Self-Actualisation: Whose Lens Are We Using?

Self-actualisation is the process of bringing out the unique gifts each of us possess inside of us. If we do not realise this potential, we can often feel a sadness. One speaker contrasted Maslow’s hierarchy — with self-actualisation as a goal for personal dominance (e.g. self-oriented)— against the Blackfoot Indigenous perspective, where self-actualisation is seen as an inherent state of being, rather than a goal. In Blackfoot perspective, the goal is not personal achievement, but rather the self-actualisation fuels community actualisation that in turn supports cultural continuity — a life-sustaining ecosystem.

There’s a revolution in this idea. Growth is not separate from community. It is for the community.

🪶 Prosocial Plants

Applying the above perspectives to the use of plant medicines: in the West, we often ask psychedelics or indeed any psychoactive plant: “What can this plant do for me?” But in many Indigenous cultures, the question is: “How can this plant help serve the community?” That shift in framing changes everything. Another yogic learning: intention is a way of bringing a mindful, purposeful experience. The intention behind the plant medicine experience completely changes its effects.

The coca leaf, for instance — source of cocaine — is used in Andean communities during long ceremonies to help people focus and listen. Similarly, tobacco leaf, far from its modern commercial form, has long been used in indigenous councils and talking circles to bring clarity, presence, and respect. These plants were not tools for escape, but for connection and community.

Synchronicities & the Space Between

One of my personal highlights was a totally chance meeting with Darren Le Baron, a speaker I’ve admired for ages. He’s a mycologist, psychedelic educator, horticulturist, and permaculture tutor at Somerset House — doing incredible work with underrepresented communities all over the world, in particular London and Africa. He’s run interesting projects where he has taken juvenile offenders out into the forest and taught them how to cultivate plants and helping them use some of their skills from the streets in the natural world and legitimate business.

His speech flows with a natural musical rhythm — his words are like educational spiritual poetry. I was looking down at my phone whilst walking and smiling at a joke someone had just sent me. As I popped my phone away and looked up grinning, there he was — standing right in front of me, matching my smile and locking eyes like he was expecting me. ‘Darren Le Baron, YES!’ We chatted, and now there’s talk of a potential collaboration. So excited at the thought of it.

These kinds of synchronicities weren’t isolated moments. They were everywhere throughout the conference— like breadcrumbs on a trail I didn’t know I was following. And many of the attendees talk about it. A few years ago, I might’ve dismissed the whole concept as hocus-pocus or fluffy nonsense. But I fully subscribe to it, based on personal experiences. I’ve even developed a bit of a rational explanation.

When we’re constantly in thinking mode, planning mode, or certainty-driven behaviour, our world becomes boxed in with limitations and controlled outcomes. When we try to control outcomes, label everything, and make sense of the unknown by putting it into neat mental categories, we narrow what’s perceivable and possible. The more we label, the less we actually experience.

What happens when we let go of the boxes? When we loosen our grip on the plan, reduce the mental noise, and allow ourselves to be present?

That’s when the magic begins.

Take something simple — like tasting ice cream. You can describe it as sweet, tangy, mango-flavoured. Those words might help, but they don’t truly convey the experience. Someone who hears them doesn’t actually know what that ice cream tastes like — not until they’ve tasted it themselves. Because flavour is experiential, not conceptual. It’s indescribable. Alan Watts’ once paraphrased the Tao To Ching:

‘The five colours will blind a man’s sight. The five sounds will deaden a mans hearing. The five tastes will spoil a man’s palate.‘ Highlighted in the teaching is that fixed notions, like limited colour palettes or soundscapes, can hinder perception

Words can point towards experience, but they can never fully capture it. This is the difference between the finite realm of language and rationalisation, and the infinite realm of experience. The moment we intellectualise something, we reduce it. But when we’re present — truly present — we enter a space beyond words. This is where originality, creativity, and synchronicity live. It’s the space where life surprises us. 

To access that space, we need to quiet the thinking mind and turn inward — toward our sensations, feelings, and breath. And we need to stop trying to control things — to let go of fears, step into uncertainty, and lean into trust. Practices like meditation, breath work, goalless play, creative expression, and yes, psychedelics, can help open those famous doors of perception.

Final Thought

Breaking Convention was not just a conference. It was a reminder that the future of healing, consciousness, and culture does not come from any one discipline — but from integration. Of science and spirit. Innovation and tradition. Self and society. Inner and outer.

And maybe my real revelation is just that: a merging of what has been divided. A calling to merge science and spirit. 

Diary of a GP 15: No Soap, No Hope

I come in to work and as Carrie the healthcare assistant pops into my room to borrow a thermometer in the morning, I ask for my hand soap to be replaced as I can’t find any in the store cupboard. I receive a blank look.

‘The soap. It needs replacing.’ She rustles away.

‘We can only find moisturiser.’ She looks at me quizzically.

‘Well I can’t wash my hands with moisturiser!’

She points at the soap dispenser — ‘Why can’t you use the soap from the dispenser?’

‘Because someone has put alcohol gel in the soap dispenser.’

‘Oh. That’s not good.’

‘Listen, Carrie, I wouldn’t be asking for soap if I had access to soap.’

‘I see what you mean.’ She stands there still gazing at the soap dispenser.

‘I cannot work a clinic without soap! SOAP!‘ She scurries off again.

She’s back: ‘There’s no soap in the building.’

‘Right, well someone needs to go and get some, please.’

Someone from reception comes back with a 1/4 bottle of hand soap. ‘Will this do?’

‘For today, yes. Tomorrow maybe. Next week, no.’
Yes. Maybe. No. Help me.

Mr Marine

Mr Marine, 70, hobbles in like a heavily overpregnant woman who’s had a hip replacement. He had a spinal fusion a few years ago, and is actually waiting for his second hip to be replaced — it was cancelled a month ago. He’s in excruciating pain in his back and both legs. He’s struggling. Struggling to walk. Struggling to sleep. Struggling to sit on the toilet.

He doesn’t want to complain but he’s broken. He feels ignored, devalued and let down by the system.

Sometimes, you hear a patient’s words or see a patient’s face and it snaps you out of autopilot. In Mr Marine’s case it was both. I turn and give him full attention. Spinal fusions are rarely a success story, and can even be worse in the long run.

He tells me with a voice on edge about how after the operation was cancelled, no one contacted him. He had to make phone call after phone call, waiting on hold for ages, only to be told by a curt voice that the previous secretary who knew him and his story had left. He had to tell his whole painful story all over again. And then at the end of it, all he received from the new receptionist was a clinical ‘well… you’ll have to wait till you hear from us’ without any time frame.

Unfortunately, his painkillers have stopped working and he worries how dependent he’s becoming on them. He thinks his Multiple Sclerosis (MS), which has been well controlled for a while, might be getting worse too. He’s losing hope.

We discuss CBD oil as an option and medical cannabis from his MS team. De Rastafarian protocol. I optimise his pain meds as best as possible and tell him about nervous system regulation and the potential power of meditation which really can help. I explain tools like cold water showers, breathwork and meditation help down-regulate the pain receptors in the body — this is proven. If you learn to sit still with pain, you can (not saying it’s easy or that I could do it!) break through it in deep meditative states. He’s desperate and downloads an app. I’ll see him in a month. Not because I can help him medically but because he needs to feel like someone is on his side supporting him.

Jemima, one of the front desk girls, pops in to ask for a prescription to be signed. I tell her I’ve quit refined sugar and she tells me she’ll bring me some dates back from Egypt. ‘You just need to make sure you’re still here in July.’ A stern look at me.

It’s like she can see into my soul.

The Usual Suspects: Eczema, Headlice and Haemorrhoids

Then Tiara, a 7-year-old with facial eczema and recurrent headlice. She keeps getting it because of breakouts in school so grandma is fed up. I give some light steroid cream for the face, lots of moisturiser and some medical head lice treatment.

Then I see Joao, a Portuguese burly builder in his 40s who has back pain and some fresh red bleeding from his back passage from time to time. His bleeding is most likely from haemorrhoids. There are blood vessels in the rectum that can bulge abnormally if there’s lots of pressure in the tummy. Then when one is opening one’s bowels, those bulging blood vessels can rip and bleed as the stool passes through. (Delightful sentence — feel free to read it again.) They are more likely to occur when overweight, heavy lifting or constipated.

When I mention ‘overweight’, a big smile peels across his face and he says in a husky, powerful Portuguese accent:

‘I like my food man.’ Followed by an infective loud bout of laughter. I join in.

‘In the last 4 years, I don’t know what happened. I used to be razor thin, like you. Now look at me!’

I examine his back and check for nerve impingement. There’s a small lump there unrelated, he’s worried about — called an episacral lipoma* — common benign cysts that are nothing to be concerned about. He declines a rectal exam to confirm the diagnosis of haemorrhoids but I trial the treatment anyway.

I draw a diagram of the spine and its intervertebral discs to explain the process of back pain, disc bulges and nerve compression. I explain the importance of taking pressure off the spine by regularly stretching the back muscles and strengthening the core and back in the long-term so he’ll see the physio and swim more regularly. I issue a short script for pain relief.

Two more identical back pains. One with an episacral lipoma* on the same side. Weird.

(*Full disclosure: I only discovered the name of this cyst because I am writing about it.)

One of them is about 18 stone and shuffles in. After drawing the same picture and repeating the same advice like a robot, we discuss weight loss — he tells me about how he runs a Scouts and Beavers school for children and takes them on expeditions. He also has a bee colony to look after. He might be large, but he’s pretty bloody active. We go through his diet, and whether he eats snacks, or drinks problematically. He’s pretty switched on about his health. Some people really do have slow metabolisms and get a lot of grief from the world for it.

Drawers, DIY Abortions,

I rush lunch as I ran late. Cut myself some fruits but decided to get clinic started so pop my fruit plate and fork in the top drawer. If you ever get a chance to ask your doctor to show you what’s in their drawers, take it. (Desk drawers.)

Beggars belief. Echel, a 32-year-old who had a medical termination (induced abortion) of her pregnancy last year comes to see me. Medical terminations comprise ingesting one or two tablets of Mifepristone and it causes the expulsion of the contents of conception, ending the pregnancy. It’s a significant intervention that should only be initiated by healthcare professionals.

Today Echel has come in with lower abdominal pain. For some reason, she had 2 Mifepristone tablets left over from her termination last year so last week when she realised she had missed her period by 10 days, she took the remainder of the medication. Without even doing a pregnancy test. Today, 20 days later, she has developed significant lower abdominal pain indicating a possible complication, although her remaining examination is reassuring. Her pregnancy test is indeed positive. I’m not quite sure what’s going on but she’ll need to go in for scans.

I call the gynaecology on-call and tell her the situation and she can’t believe it. She chuckles and says:

‘Wow. This is a new one, not had this one before. She’s tried to terminate her own pregnancy without a healthcare professional. Wow. Wow.’

Her exasperation persists for an entertainingly long time whilst the patient is sat right next to me — I do a bad job of trying to disguise my entertainment.

And finally at the end of the day, a phone call from the paramedic home visiting crew — an elderly lady needing antibiotics. The daughter is also worried about a specky red rash at the base of her mum’s ankles. She’s been started on blood thinners recently and I advise it’s likely related to that and is nothing of concern but to contact us back if worse, new symptoms or concerns.

If I had a pound for every time I’ve written down ‘contact us back if worse, new symptoms or concerns’ I’d order a tonne of soap to deliver to Carrie’s home with a note saying ‘THIS IS WHAT I MEAN WHEN I ASK FOR SOAP.’

Time to wash my hands of another dirty day down under in primary care.

Diary of a GP 14- Get Your Popcorn Out: Primary Care Unfiltered

Mr Bundle

Mr Bundle, a 78-year-old gentleman — another casualty of a system designed to reduce the need for doctors. A local service has been developed where pharmacists are trained to manage simple conditions like coughs and colds. One of those conditions is shingles.

Unfortunately, without strict criteria or GP-led oversight, these services can often fall short of acceptable standards. In response to unprecedented demand — much of it arguably unnecessary and fear-driven — there’s been a shift to offload doctors’ workloads onto non-doctor professionals. These include physiotherapists, nurses, physician associates, and pharmacists. In theory, a good idea. In practice, not infrequently a big problem.

Mr Bundle is a victim of this. He’s had shingles for five weeks. He was correctly given Aciclovir — but his shingles was around his eye: ophthalmic shingles. Not to be neglected. Especially when the rash extends down the nose, as it does in his case. That’s a red flag. You don’t mess about.

This form of shingles can inflame the eye, affect vision, and even cause blindness. His vision has already deteriorated. I urgently refer him to the eye hospital.

Today he calls me. They didn’t give him any pain relief, though they’ve started treating the eye. There’s confirmed damage — whether temporary or permanent is unclear. I prescribe pregabalin for nerve pain. It works for shingles. Codeine and paracetamol don’t.

Poor Processes

A receptionist thinks it’s acceptable to book a patient into an appointment slot that expired 20 minutes ago — meaning I’m now 30 minutes behind. I send her a curt message: these decisions require my consent.

I desperately need protected management time to deal with these issues. Despite being Clinical Lead, I’ve been asking for this for five months with no progress. There’s simply no time during the clinical day — and still, no sign-off from the people who own the practice.

I gave up trying four months ago. It was making me stressed.

Meanwhile, the so-called leadership session remains with Helen — our Advanced Nurse Practitioner from before I arrived. She’s been doing fathomless work beyond all measurable metrics. As in, no one actually knows what she does. But she’s not held accountable.

We, the doctors, on the other hand, are micro-managed — perhaps because we’re paid more.

Stop Complaining.

On the topic of complaints: Helen’s bullish approach has now landed us a serious patient complaint. It’s escalating. The plot is treacle. Get your popcorn out.

Lunchtime Lockdown

Just as I finish morning clinic and am heading for lunch, a message from the Reception Manager:

“Lock your doors. On the phone to the police.”

A patient who previously threatened staff — and was de-registered — has come back. He’s high, drunk, and refusing to leave. We’ve been asked to stay indoors. There’s a hoo-ha outside with the police. Eventually, they escort him off the premises and warn him not to return. If he does, he’ll be arrested.

Afternoon Horror Show

My most noteworthy patient of the afternoon is Errol, a 93-year-old with a fistula — a hole connecting her colon to her skin, caused by a previous abscess. She was discharged by the surgeons, but the fistula has worsened. The dressing no longer contains the faeces. She walks in and my nostrils recoil and my eyes flicker.

MUST. KEEP. POKER. FACE.

It’s not pretty. The skin around the wound is inflamed. I urgently re-refer her to the consultant who discharged her two weeks ago — without checking the wound.

Redressing it takes forever. Her daughter has a lot of questions. I’ve never been good with bad smells, no matter how many I’ve faced. I answer patiently, but with each new question, I feel more and more infused with this dense faecal aroma and contemplate the long-term effects of this trauma.

She eventually leaves. I throw open the windows and drench myself in Californian white sage smudge spray. It burns my eyes. Worth it.

The next patient walks in, pauses, and looks at me judgementally.

“It wasn’t me, it was the dog.”

And tomorrow, we do it all again — dog or no dog.

Diary of a GP 13: 37 years of Grace and Grumbles

Today is my birthday.

I woke up early and lay in bed, relaxed and feeling quite a deep sense of connection — a change from the busy mind I often wake up with.

As I lay in a relaxed morning stupor, I contemplated that I came into existence on this very day 38 years ago — limp, incapable, and dependent but filled with potential. Suddenly I was thrust into a World with a unique human capability of consciously perceiving the environment around me. The thought of the moment I first met my parents is quite remarkable and brings a smile to my face.

I promise I didn’t smoke anything this morning.

After some time contemplating existence and life through a different lens, I jumped out of bed and headed out for a run at 6am.

A cloudless, crisp morning sky. I jog gently, breathing in slowly and deeply the fresh morning air, and as I look up at an expansive sky, the body and mind sharpen. I’m treated to a Capri-Sun styled sunrise with a most drinkable tangy orange, purple and blue-coloured concoction.

I come home and meditate. The silence gives me an idea — instead of fuelling the practice with more sugary treats for my birthday, I’ll buy a round of scratch cards (I’ll fuel a different addiction). During my meditation, I enter a deep sense of peace and calm, and when I stop, I feel a deep gratitude and appreciation for my life.

As with many medics, there’s always a striving for more — not being enough, needing to learn more, do more, be more. A few moments spent recognising how much good in my life has happened purely by grace is both important and powerful.

At least 50 percent — probably more — of the good things in my life have been borne of luck. I didn’t choose my location, parents, my family, my school, my teachers, or any of that. Even friends come into your life by chance, even if you choose to keep them. These are the foundational influences for the development of who I am — someone relatively stable and comfortable, living in a safe environment who gets the privilege of freedom to grow and experience much of life on my terms.

I really have had every chance to allow me to succeed in life. Sometimes, we can over-congratulate ourselves for successes, or be too hard on ourselves for our failures — when so much of it is down to chance or grace.

I enter work and make myself a nice, well-brewed cup of tea.

Three hours later, the appreciation starts to wear off.
A series of chaotic patients, excessive requests, and interruptions from other staff.

My first patient needs their anticoagulation switched, as their clotting profile is too erratic — sometimes the blood is being thinned too much, sometimes too little. It needs quite a thorough assessment using scoring systems. It puts me behind my 15 minutes.

“Hi, there’s a patient who needs their medications for tomorrow as they’re going on holiday, please can you issue them as soon as possible?”
Right now? Yes, of course — I’ll drop everything and make sure you’re sorted to go on holiday.

I do it because they have medications they can’t afford to miss. Probably need to put more barriers up, but really feel like there should be processes in place for it. One of many things needing to be worked on here.

“Hi, psychiatry have rejected your referral as they need more details.”

The patient is suicidal and unable to pick up medications because they’re too anxious to leave the house. What more would you like to know? Their dietary preferences? Their favourite colour?

A task from our remote GP:

“Hi, I can’t download the audiology form, please can someone on the ground print it off and complete it for me?”
Yes, I’ll do your jobs for you. Chuck them my way.

She’s nice and good, but I’m getting pissed.

“Your 11.15am appointment is running 10–15 minutes late just FYI.”
Perfect, I have lots of space built into my day to accommodate this.

Then I receive an email informing me that the study leave I’d been granted in two weeks’ time — which I’ve already paid for and booked flights for — can no longer be granted as there are no other GPs available to cover shifts.

Yesterday, I was also told that I might need to take annual leave to attend a doctor’s appointment that the hospital have arranged (not me)— I can’t quite believe that my annual leave allowance is even being considered.

I’m trying to comprehend the river of peace and gratitude I felt this morning, and its rapid erosion by a sense of frustration and injustice. Confusing.

At lunch, I nip out and walk off the nonsense in the sunshine. Then I get everyone scratch cards and a (small) cake — it’s important to make effort for these seemingly unimportant things. A bit of fun and celebration in life is vital. No time to chat though — I just leave a note for the staff and hand them all a scratch card.

The rest of the day whizzes by:

  • Duncan, the 23-year-old with everyone dying around him. His grandfather has had a stroke and is now on a syringe driver with a cocktail of end-of-life medications. Of course. Duncan is obviously struggling but is spending a lot of time reading and meditating more. A supportive chat.
  • A diagnosis of perioral dermatitis in a 38-year-old who had been misdiagnosed with eczema. It’s always a rewarding diagnosis because so often perioral dermatitis — a rash around the mouth with inevitable cosmetic concerns — is misdiagnosed and treated with moisturisers or steroid creams, which actually make it worse. Patients are a bit fed up but light up when an alternate diagnosis with a different management plan is made. An antibiotic cream for 8 weeks, avoidance of triggers like makeup or alcohol-containing creams, and she should be fine.
  • Marie, a 24-year-old medical student, is overwhelmed by it all. She struggles with the uncertainty of life. We talk about how this comes back to wanting to control things. To control outcomes. An impossible desire. I ask her questions to challenge her framing of uncertainty. Actually, the biggest growth, learning, and adventure come from embracing uncertainty. In medicine, this is such a vital tool for growth as a doctor. It requires egos being shattered at times — because as a medical student, I was embarrassed often. Not knowing what to do or what to say. Awkwardness. Mistakes. A lot of picking yourself up and dusting yourself down. Now I see it as a privilege. As long as you’re adequately supported — which is not always the case.
  • A 22-year-old with premature ejaculation, resistant to improvement despite masturbating daily. Understandably, it affects his confidence. He does not have a partner. I refer him for counselling, advise on a start-stop technique (also known as edging) — where one gets to the point of ejaculating and stops — which can help retrain the process. Strengthening the pelvic floor is really helpful too, so I send him Kegel exercises. I also advise him it’s very common and he shouldn’t feel embarrassed. He’s keen for a quicker fix, so I start a tablet for depression that has a side effect of delaying ejaculation.

In the evening, I finish late and head to the pub for a birthday dinner. It’s a joyful affair of good conversations and playful insults — mainly aimed at me, as is often the case when mixed friendship groups come together and have me as a common target. I enjoy it — a form of therapeutic abuse.

So, a full-spectrum birthday — true to life. It certainly could be worse: I could be grappling with grief, sporting a rash around my mouth, struggling to last longer than a minute in the bedroom… and still clinging to the illusion that I can control any of it.

Diary of a GP 12: Touch Down

Back to ma clinic.

Vienna was a joy. Elegant. Magnificent. Organised. Culturally sophisticated.
I walked the city snapping photos like it was a museum — and then stepped into museums within the museum. The Kunsthistorisches — unfortunately named, but deeply inspiring. I wandered palaces, absorbed the atmosphere. Travelling is invigorating.

Saskia was so humble, kind, and radiant. She invited me to another of her events before whisking me out for breakfast. People stop her constantly. Life in the limelight.

Then — back to clinic.
My first patient, Kelly, 45. A social worker referred her, concerned about her history: alcohol abuse, mental health struggles, and her weight — 48kg.

But she’s actually four months sober. Living with her sister and her sister’s four kids — crowded, but her sister cooks healthy meals and gets her out walking. She’s put on 12kg in the last three months. I congratulate her.
Still smoking a lot of weed, though.

We chat.

She tells me how she was burned across her left breast at age two. Older siblings made her show it off to their friends. Later, when her parents split, she began wetting herself — till age 15. More bullying. Then came the drugs. Then prison.

She explains gate fever — how prisoners start panicking as they near release. Six months out, they know what’s coming. Having to be self -sufficient – organise their own life and cook their own meals; impossible task. Falling in with the wrong crowd. Relapsing. Reigniting old feuds.

She tells me getting out and trying to rebuild was one of the hardest things she’s ever done.
The alcohol. The weight loss. No energy to cook. Food is expensive.

She cracks a joke about MasterChef and we giggle.

This is one of my favourite parts of the job — connecting, meaningfully, with people from all walks of life.

A stark return from Vienna’s red carpet to the grit of real life.
The full spectrum.

Diary of a GP 11: The Plus-One Plot Twist

8 days before I arrive in Vienna, I receive a message from Saskia.

“How are you? All ok? Are you bringing a plus one?”

“No, I was planning on riding solo.”

“OK. Maybe it’s better if you bring a plus one, but no pressure.”

Cogs turning. How am I going to magic up a plus one in a matter of days for a Wednesday night in Vienna?

In 2025, got a wish? Technology can make it happen. I change my location on a dating app to Vienna.

I match with a few people. Front-runners (i.e. those who actually reply) are Anaelle, Charlotte, and Maia.

Charlotte can’t make it. Anaelle might. Maia also seems keen. Maia’s photos are arty — hard to tell if she’s my type. Anaelle seems cool. She’s a doctor in Vienna and sounds fun. I confirm with Anaelle.

The night before the show, Anaelle cancels — she’s ill. Crap.

Maia’s in.

I arrive in Vienna and hop on a train to the city centre. Saskia texts asking if I want her driver to pick me up from my hotel. She asks where I’m staying. I hesitate. She recommended a hotel that costs £450 a night. I am not staying there…

I arrive at my supposed hotel. But no booking. Chaotic life. I thought I booked it but apparently didn’t. I scramble to book another hotel around the corner — desperate for a nap after waking up at 4am.

It’s one of those historically grand-looking hotels with staff dressed to the nines… but the whole place is dated and worn. A bit like watching Paul McCartney sing these days. I nap in a single bed with slightly smelly sheets. I’ll find a new place tomorrow. For now, it’ll do.

That evening, I meet Maia for dinner at a Mexican restaurant. She’s tall, slender, glamorous. Sweet too — but delicate. I get the sense I could sneeze and blow her out of my life. An incredibly sensitive soul.

She slowly opens up. German, from the Black Forest. Her father’s a philosopher. Seven younger brothers who terrorised her growing up. She was the black sheep. At 28, she’s already lived in New York, Paris, Vienna, Prague, Barcelona, and Munich. An artist in the wellbeing space. She’s sweet.

I eat her weight in Mexican food. She’s full after a whisper of cumin and a sigh of lime.

We head to the first district. A huge poster of Saskia glows outside the venue. We queue on the red carpet, waiting for our zodiac-coded bracelets.

As we wait, Maia reveals more: two years ago, she was modelling for one of Paris’s biggest agencies. She loved it — but it didn’t make her soul happy. She was surrounded by badass models — cool, kind, gorgeous. She was offered marriage by some of the richest men in the world.

Let’s just pause.

Yesterday, I was changing the bins at a rough GP surgery in one of the most deprived areas of a UK city, stepping over used needles outside the front door… and now I’m on the red carpet at a Viennese fashion show with an ex-Parisian model as my date.

Hell yeah. I’m going to enjoy this evening.

We flit about, check out the bags, the shoes, snap some photos. We sit front row. The show begins. Saskia appears on screen — fierce, stylish. Then the models walk out in elemental-themed dresses.

This is my first fashion show since I worked as a waiter for an events company when I was 18. So when I say that these dresses blow me away, it’s kind of a big deal. But seriously — the elegance, the fit, the shimmering gemstones, the presence. The aura of it all. Wow.

The show ends. Applause. Saskia walks the stage with her models. Cameras flash.

Maia and I chat away, comfy in each other’s company. She tells me how much she’s enjoyed it. How she feels nostalgic.

We grab a drink, then head toward Saskia. I tap her on the shoulder. She beams, hugs me, pulls me onto the stage. She calls someone to take photos of us. We hug again and chat warmly, standing under the lights. She’s lovely. So is Maia.

We meet boxing champions, musicians, artists. It’s all so much fun.

Life is sweet. Am I in heaven? Someone turns to us and asks,

“How long have you been together?”

“We’re not together.”

“Oh… you’re just friends. Do you both live in London?”

“No, she lives in Vienna.”

“Wait, so how are you friends?”

“We just met on a dating app… we’re on a date.”

“Wait — you brought a first date to Saskia’s fashion show? This is amazing. Did you know she was a model?”

“Nope.”

“Well that was lucky then.”

“Don’t get me started, mate. I hit the bloody jackpot.”

Everyone bursts out laughing.

Maia, bless her sensitive soul, soon gets overwhelmed and tired. We leave. There’s a moment of intimacy. A kiss. A softness.

And in a camera flash, it’s over. I’m back on my smelly single bed. Chuckling away to myself.

I wouldn’t have this ANY other way. That feels good.

Diary of a GP 10: From Bali to Viennese red carpets- Diving with Mermaids, Flirting with Fashion and Managing emergencies at 35,000 Feet

The Escape to Bali

In January, I took a trip to Bali. Much needed from the isolating chaos of my GP job. I started off by heading to an island off the coast of Bali called Gili Air and learnt to scuba dive with an open water PADI diving course. The skillset and training is incredible. It strengthens awareness, non-verbal communication and harnesses the art of observation. I wish I’d done it sooner.

It was incredible — seeing fluorescent shoals of fish, friendly giant sea turtles and magical, bizarre sea life reflecting a range of emotions and moods. Shades of Alice in Wonderland except underwater. And real. I had to pinch myself.

To dive is an incredibly peaceful and mindful activity; you move slowly to conserve oxygen, breathe deeply and calmly, and the environment is utterly captivating.

The Mermaid

When you go out on the boat for dives, the crew members include instructors, trainees like myself and then a couple of people doing ‘fun’ dives, who come and go during the course. On the 3rd day, one afternoon, a gorgeous blonde lady walks on to the boat. Jaw-droppingly stunning. My eyes widened and I thought to myself: ‘I must talk to her.’ She kept herself to herself. So subtly, at some point during the afternoon, I positioned myself appropriately, thought of a low-pressure opening question and plucked up the courage to go for it:
‘How was your dive?’

‘Nice’ — and a look in the opposite direction.

After the trip, we were taking gear off and she was next to me and so I asked another question. Another disinterested response.

Well that’s that then. Worth a shot.

Tactic: Switch

The following day — I walk on to the boat and take a seat. A few minutes later and The Superbabe strolls on, back for another dive.

OK, let’s go. Change of tactic. A tactical tweak.

This time, I talk to everybody else on the boat except her. I’d built up a great relationship with my 2 instructors over the last 3 days. I’m the life and soul of the party. One of them says in earshot of her: ‘I think you might be the best student I’ve had since I started working here.’ (That was a gift from the Gods).

It works. She talks to me.

And that, ladies and gentlemen, is an essential lesson in human psychology.

We talk and there’s a connection.

This time, as we’re packing up, I ask for her number and see if she wants to hang out later. She does. And she types in her full name. Saskia Steiner.

That evening, we meet and go for dinner. I can’t quite believe my luck. I am sat opposite a 10/10.

The Catch

But there’s a catch. There’s always a catch.

She has a long-term boyfriend. She’s taking her first holiday in years. They are both workaholics. She’s a celebrity in Austria and has an unbelievable array of dazzling skills and achievements to complement her dazzling looks. Cordon-bleu chef, actress, presenter — you bloody name it.

We spend a lot of time together as friends during the week. We go on a dive together. When I come back on land, I’m jotting down all the fish and sea life I saw. An instructor leans over and tells me:
‘A Mermaid. Write down mermaid. You were diving with a mermaid today. Really.’
I chuckle.

I buy her a pearl necklace and we say goodbye. During the trip she was working on a clothing line for a fashion show whilst we’re there. We make an agreement that I will come to Vienna and see the fruits of her tropical island labour. I promise.

Three weeks ago she messaged me. I have some annual leave I need to take.
If there’s one thing I am down for, it’s a solo adventure into uncharted territory. And this time it’s the Viennese red carpet.

Mysticism & Medicine

On the way back from Bali, I’m an hour from Heathrow reflecting on my trip which also included:

  • A silent retreat where I had a revelation that I would come home and quit my GP job because there’s more to life than this abuse.
  • A water ceremony at a temple at the crack of sunrise with a priest who repeatedly dunked my head under several waterfalls. At times, I’m gulping water but it’s in the name of spirituality and consensual so all good.
  • A visit to an ex–veterinary surgeon–turned shaman psychic. She does a reading on me telling me I am an old soul with diamonds ready to release to the World. She also tells me: ‘Even though you feel you are doubted and underappreciated by those around you, keep going. Don’t change anything.’ So I decided not to quit my job.

The above was all facilitated by a friend who lives in Bali. A few years ago he left medicine to set up a start-up. He invited me to join the start-up but I declined. He recently sold the company and now finance isn’t something he’ll need to really worry about again. Hmmm. The mind wonders.

However, now that we have a shared experience of a silent retreat, being waterboarded by a Hindu priest and psychically assessed by an oracle, we have a friendship of significant spiritual wealth. Much better.

In-Flight Redemption

During my reflections, a call on the PA for a doctor.

A decade back, on a plane trip to India, when I was semi-asleep, an announcement like this occurred. My brother tried to wake me up for it and I didn’t really respond. And then when he jolted me again I murmured: ‘We’re on a plane to India, someone else will be up there in a flash.’ Medics are always keen beans. Eventually an air hostess walked past and I raised my hand and she said: ‘Don’t worry, there are 10 doctors at the front of the plane now.’ I looked at my brother to say ‘Told you so.’

This story has been exaggerated enormously amongst friends. It’s a smear campaign with lasting reputational damage.

I raise my hand.

There’s a man in his 60s, overweight. Smoker. Family history of cardiac disease. He’s clutching his chest.

Come on mate, at least bring a bit of originality to the table. Straight from the textbook heart attack.

Before I see him, the air hostess asks to see my medical certificate.

‘Really? I have just been on a scuba-diving spiritual pilgrimage to Bali.’

‘You can’t see the gentleman unless we have proof you’re a doctor.’

‘Right I guess I’ll sit back down then. Good luck with the court case.’

I turn around, pause, and then just decide to speak to the gentleman without their permission. I firmly ask them to get me the equipment to assess him. His blood pressure is high but all his other numbers are fine. The only medications of use they have on the plane is Aspirin — so he has 300mg aspirin. And some oxygen.

Heart attacks can be really serious so they deserve careful attention, but in reality it’s a minority — albeit a significant one — which escalate to life-threatening illnesses. We’re landing in 30 minutes so the paramedics will take him straight from the landing strip to the hospital.

Finally, I can reclaim my brand as a kind, benevolent soul.

Next Stop: Vienna

So here I am on the plane, en route to a Viennese fashion show, spiritually waterboarded, emotionally dazzled, and medically alert.
Let’s see what happens next.

Diary of a GP 9: Standing Tall in the Smoke (31/3)

Back from a close friend’s stag in Amsterdam.
Hungover in body, spirit, and soul.

Monday’s already rough — and the other GP’s phoned in sick. Glorious.

Jake

Jake is doing well. It was really heartening to get on a call with the multi-disciplinary team (MDT) for him last week.

A week after his binge-induced, axe-wielding, explosive-threatening shit show, we had a meeting with his alcohol support worker, a mental health nurse, a social prescriber, a care coordinator, a psychotherapist, myself, and another GP. Some really great professionals who spoke with compassion and insight.

I left the call feeling like Jake will finally be getting the support he needs.
All he needed to do was threaten to let off a bomb. Twice.

His support is helping. Off his own accord, he’s given his bank card to his mum to prevent him from drinking booze.

We had a chat about what he would achieve by blowing up a bank and how he might try and express his anti-capitalist views through more peaceful ways. It’s clear he has some form of neurodiversity, and psychiatry are helping manage this. He’s doing reasonably well now that things have been put in place.

Mona

Mona, applying for universal credit, needs a note.
She has excruciating pain from her migraines and endometriosis — painful bleeding, frequent, and headaches that leave her bedridden. Endometriosis is a terrible diagnosis for some. Has an impact on the whole body. Her migraines are quite possibly related.

She is cycling through a range of medications. After a while, one will work.
But the question is — is it the medication, or is her body just managing to heal itself?

Sometimes I’m not sure. Most studies compare a drug vs a placebo. But the missing arm is the “do nothing” group — which often reveals the body’s quiet ability to heal on its own.

There was a psychiatrist who once told a student:

“1/3 of our patients will get worse with our medication, 1/3 will be the same, 1/3 will get better irrespective of it.”

A damning indictment of the pharmaceutical industry. And although I think some medications are beneficial, I think there’s enough truth in this statement to demonstrate we have a systemically unwell, unjust medical culture of prescribing, prescribing, prescribing — which knows no end and helps the man at the top and not those lower down.

Miranda

Interruption from reception.

Miranda, age 28, with two previous miscarriages, is now 11 weeks pregnant and has had some spotting and cramping.
There are no appointments, so I write an urgent referral to the early pregnancy unit. She cannot be made to wait 10 hours in A&E.

Janey

Janey, age 3, with a suspected urinary tract infection.
She has intermittent pain “down below,” grimaces sometimes, is potty training, and occasionally has discomfort when passing urine. Ongoing for a week.

No issues with bowels. No discharge from down below.
Her examination is fine. Urine is clear. Tummy soft, not tender. Medical observations are normal. She can jump up and down — a useful test to see if pain or being unwell is significantly affecting function in children. If they’re able to, it’s reassuring.

I tell Mum it’s not an infection and I’m reassured there’s nothing to worry about — so let’s keep an eye.

She’s anxious though. She wants to know what it is.

I explain that sometimes I don’t know the cause. What I do is look for concerning features — of which her daughter has none. I explain my process — I’ve assessed for problems on the skin, the vaginal area, urinary tract, and bowels — and I can’t find a problem.

If there is something concerning going on, it will get worse and become apparent with time.
Most of the time, with these cases, things get better and there’s nothing to worry about.

She is reassured. At the cost of my finite energy.

Laurie

Laurie, age 16 months, with constipation.
She hasn’t opened her bowels for over a week and passes hard stool which sometimes causes bleeding.

We trial a new medication — the previous ones aren’t working.

She is otherwise well and growing nicely.
No risk factors for worrying conditions. But it’s unusual to have ongoing constipation with a good diet, while breastfed, and on a good dose of laxatives.

I will trial another medication, and if it’s not better, we can consider further tests and speak to paediatrics for advice.
Suspect we’re heading in that direction.

Wound

The (nice) nurse Nora comes in and asks me to look at a wound. Unusual.

Dmitri, age 31, healthy male, with a 1cm necrotic black ulcer under the little toe extending deep into the foot. It was a small blister 6 weeks ago and it didn’t improve with antibiotics. He has never felt unwell with it but it’s gradually become worse. There’s a white callous around it for 2cm each side. Infection has spread — I can see a callous forming on the other side of the foot.

It’s painless — suggesting the infection is severe, as the nerves aren’t doing their job.
No diabetes, no risk factors — strange.

I’m worried it has spread to the bone. Could have life-altering consequences. I refer him to A&E for imaging. He is a bit shocked.

No time for it though. Write the letter. Back to clinic.

Appraisal

At lunch, I have an appraisal.

A yearly check to make sure I’m meeting the requirements of a GP. A review of the year. It’s rigorous — but they’ve relaxed the demands for evidence of ongoing development. It was too much work when things got so busy.

My appraiser is a GP from London.
We have a nice chat. Makes me realise I probably need more GP friends in my life. It can be a bit hard to explain the quiet emotional haemorrhage of a day in general practice to someone outside it. At times this year, I’ve wanted to give up. I still mull it over. General Practice can be a lonely place. You go into work, see a high turnover of patients, deal with all of the problems that crop up, and just absorb all the problems of the staff and the patients. I don’t really connect with my colleagues here. The other GP here is nice, but we’re not close. And then you go home, and slot into home life with all its modern-day pressures. In my case, I guess I’m lucky. I don’t have the pressures of a young family. But I also live alone. So there’s not really anyone to share with when I get home. Not that I need that often- but sometimes it’s necessary.

But on top of this I’ve been spending much of my time outside of work developing and sharing education tools on something I’m passionate about — wellness. I realised I can’t really continue as a care provider without sharing what I know about how we can calm our minds and prevent ill health. Up to 75% of primary care presentations are contributed to or directly caused by stress or emotional dysregulation.
And yet we learn nothing about this at medical school.

But at times, this work feels like a job on top of a job.

After lunch I nip out to get 5 minutes of sunshine
(but mostly to buy a pack of chocolate cookies).

Afternoon blur

Jamie, age 4, snoring.
Can happen when a child’s tonsils are too big. His are like golf balls and there’s no space at the back of this throat. It’s a surprise he can even eat.
Urgent referral to ENT.

Sean, age 45, felt terrible three weeks ago but couldn’t get an appointment.
Now feels fine. Time captured. Winning.

3 x Did Not Attends.
Wasting NHS time but… there’s always a part of me that’s happy. Can do some admin.

Justin, age 45, joint pain. Elbow X-rays show signs of Paget’s disease of the bone — rare condition. Early diagnosis makes a big difference.

I send an email to rheumatology, ask for their opinion, and request bloods: Alkaline Phosphatase, calcium, phosphate. All rise in bone tissue breakdown.

Viratucih — she needs reassurance.

Anxious. Thinks there’s something abnormal in her throat — feels like a lump.
But she can eat normally. No regurgitation. No vomiting. Weight stable. Had a CT scan in A&E recently — normal.

She has Globus — a sensation of a lump in the throat with no organic disease.
It’s psychological. Associated with stress/anxiety.
She accepts the diagnosis – damn straight. Ain’t nobody got no time for that.

(Unless, of course, you need me to have time for it- in which case I will compassionately reassure you.)

Close

The practice manager sends me a message at the end of the day:

“How has the day been? Are you doing OK?”

“Never been better.”
Smashed it.
Can I have a stag-do every weekend?