Tuesday, September 22, 2009

A day in the life....

The BMA are keen for us to invite MPs into our surgeries at the moment. must be something to do with the looming election. I'd invite ours, but a nearby practice has beaten us to it, and after my recent run-in with Alan I'm not sure how keen they would be anyhow. So instead I'll open the doors to all of you, my loyal readers for a little snapshot of an average day at the Ambridge Surgery.

8.00-- Surgery opens. Dr Neighbour (an insomniac workaholic) starts consulting-- he will consult until 10.30, break for admin and for coffee at Coffee Time (c) The Ambridge Surgery 2000. He will then consult again from 11.30-12.00. Mean while the Duty Doc from yesterday afternoon (your humble interlocutor) will turn on the Surgery Mobile-- the contact for all urgencies from 8.00 to 8.45 when the surgery switchboard will swing into operation. The ringtone and the wallpaper on said phone he will not immediately recognize as they have been reprogrammed by his offspring. Thus every mornig urgent calls can become a little whimsical voyage of discovery-- it's odds on the poor supplicant caller will be heralded by "The Macarena" or the latest Motorolla Death Metal ringtone. The Duty Doc is powerless to prevent or alter this.

9.00 Dr J begins consulting after an idyllic drive through the Borsetshire lanes, accompanied by the plangent strains of the Macarena, punctuated by updates on "Our Wayne's" vomiting. Our Wayne (aged 22 and still living with Mum) is invited to attend mid-morning for an examination.

Morning Surgery I

In no particular order we see and try to help;

two survivors of severe trauma (one abused by a relative from age 7-- over 40 years ago, but still grappling with the fallout, one still being abused by an ex patrner who is about to receive an injuction in the hopes that this will make him stop),

one wheezy babe in arms who is otherwise quite well, though mum takes some convincing of this,

a patient with a chest so bad they require night time ventilation but remain desperate to be able to get back to work,

a patient made psychotic by amphetamines,

a man in an Aircast Boot (imagine Robocop in pale blue plastic) after ankle surgery who just needs a note for work-- and something for the pain,

an expectant mum six weeks off delivery for a check up and a chat about some mechanical chest pains she's been getting because of the pregnancy -- she's not an Ambridge native and has no family within 300 miles so she's also feeling a little isolated and apprehensive which makes her worry more about her chest pains,

Our Wayne, looking a bit green around the gills and in the grip of a touch of food poisoning after a dodgy curry (and around a gallon of Lager) last night,

a couple of "Flu" victims who felt iller on tamiflu than with "flu"-- so probably not then,

a man in need of gluten free bread who's in a rush to get home again before his demented wife (not our patient-- she has kept to her old surgery for the past 40 years and he sees no reason to change her registration) takes it into her mind to wander or to try to set the house on fire.

11.00 Coffee Time (c) The Ambridge Surgery 2000. Half an hour set aside for all the docs and the management team to meet and chat. Sometimes we actually get around to chatting about the punters-- more often movies, kids and knockabout comedy one liners...

11.30-12.20 Morning surgery II

6 more punters with a random assortment of ailments. One requiring urgent hospital admission for a possible embolism which puts the rest around 15 min's behind.

12.20 (but really 12.35) Driving License Renewal Medical.
HGV and PCV (that's lorries and busses to you and me) drivers need a five yearly license medical. 20 minute exam and form filling exercise. Passes without incident.

13.00 Home visits. Two today that will take us to 14.00 and lunch. On the way one lady with nasty pain after shingles last month. We had hoped Zovirax would have headed this off, but no such luck, so now we will need top notch pain relief, probably for a few months-- drat. T'other had come over "all unnecessary" this morning and in the end turns out to have cystitis-- a powerful confuser of little old ladies (and indeed little old men, though less often for reasons too boring for here and now). At least she should be better after 3 days on antibiotics.

14.00 Lunch. Life being too short to make sandwiches, Mr Sainsbury is called upon to provide and does so admirably, which takes us to 14.15 and...

14.15 Phone calls (5) of which three count as "worried well" and two relate to consultations a few days back and effects of the pills therefrom. Then repeat prescriptions 25 to sign and 10 or so to be updated and reprinted for signature.

Now, when I was a lad repeat prescriptions usually ran to a blood pressure pill or two and the odd painkiller. Nowadays most repeats are for 4 or 5 items, which for the over 50s will more than likely include a statin, aspirin, at least 2 blood pressure lowering agents, something for heartburn, and one or two items to overcome the side effects of the other meds, so they warrant a bit of scrutiny, even when they look routine.

15.00 Afternoon Surgery
3 straight hours consulting. We don't break for Tea, so the machine on the desk supplies a steady stream of Java straight to the Jesterly mug-- well from the jug on the hotplate at least...
The surgery will be pretty much a reprise of the morning, or will, once a week, be an all comers "Duty Surgery" for really urgent sore throats and ingrowing toenails-- o.k. I may be exaggerating, but the definition of urgent is mutable depending on which side of the desk you're sitting. To be fair last duty surgery saw me admit three patients urgently to hospital where often I can go months without admitting anybody-- in the words of the song "it goes to show you never can tell".

18.00 Notional end of afternoon surgery, often overtaken by events so average end of surgery closer to 18.20 (worst this year so far closer to 19.05).

18.20-? catch up on calls, write up home visits, stare blankly at the walls waiting for the caffeine buzz to wear off enough to be safe to drive home.

Scattered through the day will be emails (professional and personal) and on any given day, laughter, tears, births, marriages and deaths, blood, sweat and tears. In short about as much fun as you can have with your clothes on and staying within the law.

Not quite the two surgeries and an afternoon on the golf course in between of yester-year that everybody still assumes to be the norm.

Still I wouldn't want it any other way now would I.


alhi said...

That was fascinating! Just strengthens my belief I did the wrong degree:(

Doctor Jest said...

alhi-- oops. Sorry :-(

alhi said...

Ah, don't worry about it Dr J. I've known for quite a while I did the wrong course at uni. Just too old to do anything about it now, and believe me I have looked into it!