Monday, 25 February 2013



A good week, though busyness has lead to a slightly late posting again. Cannot win them all! I pick up on some 'hints' during one consultation with a woman, organising a follow up consultation to talk about her concerns, which is very rewarding (giving me a taste of being someone's GP), and I pass on some of the Viagra tips I had learnt a few weeks ago. The latter patient is really impressed with my knowledge of how to 'play the game' and tells me I will make a brilliant GP. I have talked about this before; it is funny how just regurgitating information to a patient which you learnt a few days ago can make you seem so smart. I guess that most of medicine is just remembering and regurgitating information (such as how to treat a heart attack / best blood pressure pills to prescribe in a 50 year old diabetic), until you turn onto research, which is far more science than medicine anyway. Still, its nice to be complimented and have someone think you are good and respect you, even if it is not earned!

The stark reality of me medical knowledge. Fortunately 6 years at medical school has taught me to pretend I know what I am talking about.

As for this lady who I called back, she first presented on Tuesday with what she thought was a hernia coming through an old C-section scar. She has had a number of hernias in the past in similar locations, which have required surgery, but on examination I couldn't see anything hernia-like at all. I thought this was a little strange, given the fact that she has had hernias before, so should know what they will be like. I chatted a little more with her while I waited for the duty-GP to finish with his patient and come and check mine, (the duty GP always checks the patient I see to make sure that they are not dying or something horrific before I discharge them). She mentioned this being close to the anniversary of her daughter's death, and on further talking to her about it, she seemed very down about this. Wondering whether this might be the 'actual' reason for her coming to the doctor, I asked her if she wanted to come back on Thursday and talk to me a little more about this, and she happily accepted, though seemed guilty that she would be wasting my time. 

Come Thursday, I was hoping that she would book in for the appointment, and she did! I ended up talking with her for an hour; she was severely depressed, scoring 21/27 on the PHQ-9 (a GP style depression screen). She was worried about so much, her home situation, her daughter's anniversary, someone who had abused one of her other children but had now developed MS, meaning she didn't feel able to go to the police about the situation, there was so much bottled up. Giving her a chance to talk about it all openly, and have a cry, really seemed to help. We talked about her coping mechanisms, and how helpful she found the Samaritains, and ended up increasing the dose of her citalopram (an anti-depressant). At the end, she was so grateful and thankful, saying what a difference I had made. It felt really good, the fact that I had spotted that this lady was unhappy, called her back for a chat, and helped ehr out, though perhaps only a minor amount. This must be the appeal of being someone's GP. You know them well, you are there for them when they are upset, and you can bring them back to help them with any other problems they have, rather than just treating the organ you specialise in in hospital medicine. This really is holistic medicine, something my medical school harped on about all the time in lower years, but I actually like it! If being a GP is like this all the time, I really wouldn't mind it at all. Before this rotation, GP was pretty much considered as a no-no for career, but now I thinkl its well worth considering. I wouldn't say that it has captured my heart, but it would be silly to rule it out when I love aspects like this. Perhaps I will try and get a GP rotation in my F2, and give it a real go.

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