I changed jobs last year. One day during the last few weeks at my old surgery, Mary came to see me. Mary is in her mid-sixties; an infrequent attender, our only meetings had been around the time when she had become severely iron deficient and anaemic due to an as-yet undiagnosed gradual benign gastrointestinal bleed, which was dealt with swiftly after she suddenly decompensated and collapsed in our waiting room whilst waiting for an ECG. After a short hospital admission she was back on her feet and apart from a couple of follow-up checks and repeat prescriptions for iron tablets, I hadn’t seen her again. Until this particular day.
“Long time no see”, I greeted her as she walked into my room. She gave me her usual bright smile in return.
She had a cough and was a little breathless. She explained to me that breathlessness had been the only symptom she had experienced prior to her anaemia-related collapse, so she was naturally a bit concerned and was seeking reassurance that it was only her cold that made her feel a bit below par this time.
Whilst I carefully examined her chest and for signs of anaemia she said, “Rumour has it you’re leaving?”
I looked at her in surprise. My resignation had happened quietly and was not advertised anywhere. I had only just started sharing my news with a small number of patients, the ones I felt needed some time to adjust.
“How did you know?”, I replied, “I haven’t seen you for months.”
I put my stethoscope away and my eyes met hers again. “Well, you know. I do Mrs Smith’s hair on a Friday, at the salon. She told me last week. She was most upset. In fact, we all are. To lose you. You are such a lovely doctor. We didn’t talk about much else for the rest of the day”.
It seemed many of her clients that day, and every day, were also my patients. One was a young mum who I had supported through the brutal reality of severe postnatal depression. Another was the wife of an elderly man, together we had cared for him during his final illness. A third an elderly lady with multiple medical conditions whose constantly changing drug therapies were causing side effects and confusion, and we had slowly worked things through together. And so it continues.
They fully understood my reasons for changing my work pattern: the never-ending long days, the constant panic filled runs to get to the childminder on time, the need to feel I could breathe again. But they were upset. Upset to lose me. I had been their doctor and they had appreciated my hard work. I had been a good doctor to them.
Mary did not have recurrent iron deficiency anaemia, she had a heavy cold. But this consultation still stands as one of my most important since I became a GP. It made me think about how important a part a GP may play in another person’s life.
It made me realise that for some patients their GP may be the one stable factor they have in their life at a time when illness makes them vulnerable – a source of trust, direction and support. A significant part of their life.
I feel privileged to be that GP for some of my patients. As general practitioners we have an amazing opportunity to help patients at their time of need and we are ideally placed to be their first port of call when they are ill, and to manage their ongoing medical care. There is almost no limit to the symptoms we may encounter during a working week.
Whilst specialists become experts in a small field, we as GPs need to consider a huge range of diagnoses on a daily basis and become experts in generalism. This requires inquisitiveness and skill. It requires dedication and stamina. It requires the ability to take risks, to manage uncertainty with confidence, and to tolerate not having all the answers.
A good working day in general practice excites me. Not because of the occasional patient who requires an ambulance from the surgery after a collapse in the waiting room, but because it challenges my curiosity and clinical knowledge. Because it almost breaks my dedication and my stamina. Because sometimes I am not prepared to take risks, because I don’t like not having all the answers.
To have good working days in general practice we need GPs who get excited. Who have great clinical skills, are ambitious to provide the best care for their patients and who have empathy. General practice gives you new and different challenges every day and it never stops. If you get it right, the rewards are countless.
But we also need time. We need sufficient resources. We need to set boundaries and prevent our general practice from becoming misused. Curiosity and dedication are easily damaged if negativity prevails, and even the toughest marathon runner eventually tires.
The ladies in the hair salon make me smile. They are proof that general practice is still important and that we make a positive difference in our communities and to people. They are proof that I chose right when I decided to become a GP.