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Diary of an FY2 – A Compartmentalised Life

June 29, 2016

It was Socrates who said that the unexamined life is not worth living. I have nothing to fear. Life in GP-Land is filled with examinations, between the history and the green prescription forms and usually a self-referral leaflet for physiotherapy. But between the middle ear infections and arthritic knees and suspicious lumps and tired-all-the-times and coughs and cold and all sorts of pain, there is still room left to examine myself.

I find my clinics are getting more emotionally and intellectually draining as the weeks creep by. This is due in part to the frequent mental gear-changes I have to make, with shark-like turning precision. As different actors shuffle in and out, playing the role of Patient, I remain the Doctor. But that role changes so frequently:

  • Avuncular, explaining that it is just a sore throat and will get better with fluids and paracetamol. And antibiotics won’t help.
  • Concerned that those vague symptoms – feeling a bit more tired, losing a little bit of weight, a niggling tummy pain – might be the stars in a sinister constellation. Please don’t be alarmed but I’m faxing a referral letter now and thinking of a word beginning with C.
  • Reassuring. The ultrasound, the chest X-ray, the blood tests are back. It’s good news, everything is clear! Or, well, you’re kidney and liver function is good but I’m a bit worried about your cholesterol and HbA1C so here are the things we can do about that…
  • Consoling the woman who has escaped an abusive relationship but gently weeps in my clinic room. Offering a tissue and the silence she needs to speak. Offering what help I can, signposting where she can go next.
  • And then back to someone who has burning, stinging sensation when they pee.

At least, I hope that what patients get when they come to me, not just the the prescriptions and information leaflets and X-ray forms and blood tests. I hope that I am more than just a vending machine for co-codamol and amoxicillin, a Chinese Room in chinos. Cogito ergo sum – I think, therefore I am more than just that?

The Doctor exhibited 1891 by Sir Luke Fildes 1843-1927

The Doctor by Sir Luke Fildes. Dispassionate exam? Compassionate witness?

Often patients will apologise for bothering me, or wasting my time, with their complaints. I am hasty to correct them. Appointments that have given rise to blood tests, X-Rays, specialist referrals are the exact opposite of a waste of time. And even those who illnesses are self-limiting often have quite valid reasons for seeing someone with a stethoscope.

But that is only half of it. As Socrates said, the unexamined life ain’t worth living. I can see hundreds of ears and throat, listen to lungs and hearts abundent, and feel knees unending, but there is still one system left to examine. Doctor, know thyself! Life in GP-Land is not just a mental rollercoaster, but an emotional one too.

I enjoy treating the minor, self-limiting illnesses, comfortable in the knowledge that 99.9% will improve no matter what I do, but my “laying on of hands” has validated its benign course. (But all-the-while paying heed to the small voice at the back of my head that this could be epiglottitis, could be a tumour, could be Crohn’s or an ulcer).

Musculoskeletal problems frustate me because I can’t guarantee if and when they will improve – But be it bone, muscle or tendon, I know most things are helped by ibuprofen and physiotherapy.

Investigating the squishy bits (Internal medicine, if you will – horribly vague US phrase) is so very different to the Medicine practiced in St Elsewhere and Worthwhile General. My most powerful tool and treatment is Time, as I’ve mentioned before. Time to titrate, experiment and investigate. I get a real pleasure out of this kind of Medicine.

It is said that psychiatry accounts for 40% of general practice appointments. I don’t know where that number came from, or even if it is accurate, but it has a strong feel of “truthiness.” There was a time when I thought, yes, this is what I want to do! Nowadays I feel, not hopeless, but helpless. Patients come to me with their anxieties and their depressions, feelings that they’re no good, that everyone would be better off without them, occasionally the feelings that they should kill themselves. I see women coming out of abusive relationships carrying their mental scars with them. I see so much struggle and strife and suffering and, armed with a prescription pad and a leaflet about talking therapies, I feel wholly inadequate.

Who doesn’t feel like this? But I do what I can, and I try to do it with compassion. And I’ve seen people get better and I might have played a small part in that. A friend of mind has a tattoo that reads, This too shall pass. It’s a reminder worth writing in indelible ink.

There are times when I feel out of my depth, when I feel like “just a medical student” pretending to do Medicine. Then there are times when the diagnostic cogs click, I make the diagnosis and start the treatment and, damn, I feel like a doctor. Not just any doctor, maybe even a good doctor.

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The space between these times is usually around ten minutes.

 

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2 Comments leave one →
  1. Bex permalink
    June 29, 2016 7:51 pm

    Luv it! Best blog yet!!!

  2. July 4, 2016 7:33 pm

    Really enjoyed this, Rhys! Thank you.

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