Now that I’m a GP, I get to see all sorts of people

As a GP registrar, I’ve come to see many different things. Some things are straightforward, some are a little more complex. The challenge is being able to manage both fairly well.

For those straightforward cases, they are time savers, and give me that little bit of confidence that I’m doing something right. But those more complicated ones, I end up spending time looking up databases and management guidelines to figure out what to do. And even then, I may still have to speak to my supervisor.

Working today, I got the opportunity to essentially to tell a drug seeker to get lost. Well, not so bluntly, but essentially, I told him “I’m not allowed to prescribe you that”. He ended up saying he’d go to ED (after possibly having a fractured hand because he punched someone yesterday – all in the name of ‘self defence’). Trying to tell this man up straight that I wouldn’t prescribe it was pretty tough I must say. The patient persisted and persisted, but I had to hold my ground and just say no.

My next patient was a woman who came in for review of her test results. Of course, being the curious one and trying to do a thorough job, I had to enquire why the tests were ordered in the first place. It was largely due to hair loss. A quick inquiry into her social background revealed more about her possible hair loss than any blood test could tell. She was having a strained relationship with her daughter, she was essentially cut off from family due to her current partner, and her father was quite ill. My hypothesis is that her hair loss could be from stress. The patient also revealed, that her partner just told her that he was leaving her right before dropping her off at the practice. She broke into tears right in front of me. I offered her some tissues, and tried to advise her about constructive ways of dealing with this difficult event ie don’t drink alcohol, get some exercise, get social etc.

We’re I’m currently working at, I see all sorts of interesting people. Probably because of the low socioeconomic status group that come through. Really, I see a lot of blue collared workers. I could have potentially seen more well off people by working across the road at the mall. But I don’t think I would learn as much, and wouldn’t be made ‘tough’ from the relatively well off people there.

Having come across a variety of people in the last few weeks, I realized that there’s going to be lots of stuff I don’t know. And also lots of people who may not be the most reasonable of people to talk to.

And this is perhaps where I think it’s important for me to stick to my principles. I believe in being respected as a doctor, rather than liked as a doctor. I think I’ll go further if I’m respected, rather than if I’m only liked.

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Looking at the World

Since having a medical education, it has made me look at people in ways that I never used to look at them. I’m more observant of people around me.

In medical school, the crucial thing we were taught, was to use our eyes. In our clinical examination classes, we were taught that a general order of examination of the patient was: observation, palpation, percussion, auscultation. Note how observation comes first and foremost before you touch them, and before you use your stethoscope.

And so we’re told that you can glimpse a lot of information about your patient just from watching them. A person who limps into your practice may indicate something like pain from the knee or hip (maybe from osteoarthritis), and an infant who is brought in in the mother’s arms with reduced responsiveness and alertness is probably quite sick.

When you’re observing people all the time, it only becomes natural that you apply it in public. In general, the major thing I glean from seeing people are whether they are well or sick. Then little other subtle things I may observe – things like gait, scars present (may indicate things like past knee replacements), and just other things in general like if they’re pale, have rashes or so.

In turn, I guess being able to apply it in public means that I’m constantly using the skill of observation, and hopefully it will aid in my further career development.

Changes In Place

How time has flown. It has been a month since working at the big metropolitan city. Work seems to be hectic at times, sometimes even stressful. I have become more senior, but I some how still don’t feel ready. It’s that anxiety all over again. Am I good enough in the eyes of others around me?

What has been reassuring I suppose, was the revelation that I was still  expected to discuss every single paediatric case with either the registrar or consultant. This was revealed to me just a week ago when I had to meet my supervisor. What a relief in knowing that I wasn’t expected to be managing cases all on my own.

What still makes me extremely anxious, is in venepuncture. With 8 year olds+, I’m reasonably ok, but it’s the little babies that still worries me. If I miss, I’ll have to call a senior doctor given that it is incredibly distressing for the babies and the parents. I would like to, no in fact, I need the practice,  but every time the mother says something like “oh yea, he’s really difficult and it would be best if an experienced doctor could do it”, so I always end up asking the registrar.

I also find that 10 hour shifts seems a bit long, in that when I finish work, I find I have no time to relax. Well, it’s the pace that it works at, and I suppose I’ll have to adapt.

Another 2 and a bit hours and I’ll be heading to work. Not feeling entirely 100% since I have been recovering from a cold (I had to take yesterday off due to illness), but I still have to go.

I wonder what else I can do to break the routine of work and just home? Perhaps some volunteer work? Perhaps join some local clubs (where I can possibly meet the love of my life?) I think I need to find a girlfriend this year.

Panic in the Restaurant

I’ve heard it said before, that chefs don’t like to come home to cook dinner. I see the truth in some of that, as the last thing that I’d really feel like doing on returning home from work, is to focus on more medical things.

But sometimes, there is no other choice, and you just have to. Medical problems that my parents or grandma wants advice about are directed towards me when I come home. When things like “I’ve been getting cramps these last 2 days, what is the reason?” are asked, it’s an incredibly difficult position to comment about. So I try and take a history to glean more information, essentially to determine if it is something serious in nature, or something relatively minor that doesn’t require urgent treatment.

When it comes to things such as these, I don’t want to end up completely treating my family members. I’m happy to provide some advice, but when it comes to some medical problems, I don’t have access to diagnostic tests to confirm suspicions, and that’s why I think that if the issue really warrants serious investigations and treatment, it is best managed by their regular GP. I realized that a doctor without any medical equipment, diagnostic tests or medications is the equivalent of a medical student – just full of knowledge and differential diagnoses, but essentially unable to do anything much else.

This concept of being unable to do anything much was best demonstrated just a couple of days ago. My grandma had only been discharged from hospital for less than a day, but she was extremely keen for some lunch at a restaurant. So out we went to eat some greasy unhealthy Hong Kong food (which gave my Dad and I diarrhoea later that night by the way). Part way through lunch, my grandma turned a sickening pale, then blue colour in the face. She became limp, head starting to slouch. Her consciousness seemed to slip away as seconds passed by. I thought she was having a stroke. Fear seized me momentarily, with pure negative thoughts of gradual decline to a terrible quality of life, and what may be a painful slow death after what followed.

“She’s not responding” my father fearfully exclaimed in cantonese. I must have snapped out of my fearful state following that, and pounced into “doctor mode” after out. Bolting to my grandma’s side, I immediately thought of ABCD, checking for responses (COWS – Can you hear me, Open your eyes, What’s your name, Squeeze my fingers). By now, I mentally thought of hitting the MET call button, which translated to calling the ambulance. Enlisting help from the restaurant staff, I calmly told them that my grandma was in trouble and I was calling the ambulance. The manager took over my phone, continuing the call as I couldn’t give the exact address.

Throughout all this, I didn’t feel like I did a good job. I didn’t know aside from thinking about differentials and continuously assessing her conscious state, what else I could have done in that situation. I felt completely powerless removed from the hospital environment. One of the nearby nurses from a GP practice was called over, and helped to take a BSL and blood pressure.

As my grandma become more alert gradually, her only concern was that I attend my job interview with one of the hospitals that I was applying for next year. She urged me numerous times to attend. After what seemed to be about 5 minutes, she was more alert in herself, and the paramedics had arrived. My mum would accompany her to the hospital, and from my grandma’s urging, I ended up attending the job interview.

Perhaps what added to a particularly anxiety provoking day, was when the interviewer gave me a clinical scenario about a MET call patient. What a coincidence – I’ve just been through one already.

Suffice to say, I probably wasn’t performing at my peak after what happened. The interviewer felt I was too nervous, and felt I couldn’t control my nerves (I found it odd for some reason for an interviewer to specifically mention that). I thought the better of mentioning what happened to my grandma – I don’t want to be seen as someone who wants sympathy points.

I went home by bus, and went straight to the hospital afterwards. My grandma had perked up much more, and looked much better. But what a day that was. What a day!