General Practice and my own list

Hi,


Busy week this week finishing off my big project, which is now happily handed in. As long as I have passed it I am good and happy. Medical school sometimes seems like a series of hurdles you just need to jump over to get to the end and graduate. One more hurdle passed (hopefully)... Because of this project, I didn't get up to too much this week either, taking the opportunities to stay at home and try and work (but mostly procrastinate) when possible. I did spend a bit of time in the hospital though, and more importantly, spent my last day with the GP I had been placed with. I got to run my own consultation list, which was pretty scary at first. As I got into it, it became easier though stranger, as I think the GP put some of her craziest patients on the list for me to talk to!


It was very sad to leave the GP I have been working with, its very unlikely that I will be with her during my GP rotation next year as the medical school tries to balance out rotations in large and small practices. This means that, as this GP practice is practically a polyclinic, I will probably be in a single room that doubles as the GP's bedroom next year. This is one of the most exciting parts of general practice, it comes in all flavours!


The GP had decided that for this visit, she would give me my own 'list' of patients to see, meaning  people who had called up for appointments had been given the option to see me. I wasn't going to be the only person seeing them, fortunately (unlike when I was in Tanzania), so this wasn't unsafe. It just helped the GP see more patients, and helped me practice running my own surgery, as it were. I was given log in details to the software used to display the appointments, patient notes, 'QOF alerts', and so on. Made me feel pretty important! I got used to the software, pulled up the notes for the first patient, and went out to the waiting room to call her name...


The first patient didn't go as well as I would have hoped, as she seemed convinced that I was a doctor, despite all my protesting against the idea. She opened with the phrase "Its a good thing that they assured me you were a doctor before I saw you walk through that door, as you do look very young"... I don't know who had been assuring the patient that the medical student was definitely a doctor, but it made her (probably) gout presentation a lot more complex than it needed to be!


This was followed by a couple of very straight forward cases where women wanted to delay their periods for a holiday and an anniversary. Not much I could do as a student here as much of these was prescribing, something that I definitely shouldn't be allowed to do yet! This was where the simple cases ended, though, and the rest of the day seemed to be filled with complex psychiatric patients. If I didn't know better, I would have said that the GP found it hard to deal with these patients who there is very little to do for in general practice, so gave them all to me to see instead... If I didn't know better...


I slogged through consultations with a number of people who had been diagnosed with borderline personality disorder (where I think I was demonised a little more than idealised), and as was beginning to give up hope with general practice, when a 10 year old girl came in who had been suffering from mouth ulcers in her cheeks. A nice simple case, or so I thought, but after a minute or two of talking I began to feel a bit uneasy. The girl had come in with her mum, and their relationship just felt a bit wrong. Not really sure what it was, but there seemed to be some tension and... well, I am not really too sure what it was. On talking with the GP afterwards (before deciding on a course of action, of course) she told me that this 10 year old  had been manipulating her mum and dad for the last few years into getting what she wanted after she had been caught stealing sweets from a local shop. It seems that as a GP you get to be part of everyone's life story, and hear about all those things that go on 'behind closed doors'. A great job if you are a bit nosey like me, but as it seems that everyone is crazy beneath the surface I may not be won over by the GP quite yet!

A borderline patient example with Barney - from the site in the top left...

Before leaving, I was discussing my patients with the GP and other practice partners. One of them, most eloquently, said that borderline personality disorder patients are the hardest to deal with in general practice, whether they love you or hate you, as they are very hard to get rid of. This is because you cannot refer them for counselling as you would with many other minor psychiatric problems "as it is like wanking for these patients, they just cannot get enough"... Not the most politically correct way of putting your point across, but I think I see where he is coming from. Perhaps counselling reinforces their behaviours by giving them too much attention. 

The GP who I have been with all of this year said some very nice things about me before I left, about what an amazing doctor I would make when I qualified and how she had every faith in me. Very glowing praise, and I am sure she says it to all medical students who she teaches, but it made me feel good. She has added me on facebook to keep in touch, so I will have to remove all of those embarrassing photos, but it will be good to keep in touch!