generalpractice

Visit cap proposed in Alberta

There are some proposed changes coming in Alberta, which those of you working or thinking of come to work here should know about.

The Section of General Practice of the Alberta Medical Association is proposing a cap on the number of visits that can be billed in a day. This may have a significant impact on walk-in centres in particular, which often rely on large numbers of relatively short visits to drive income. For the average family physician with a mixture of long and short appointments it may not have much of an effect.

My most recent resident recounted how in BC (where a similar cap exists apparently), at walk in centres the physicians all see patients until they have reached their daily limit, at which point the walk in centre is closed, whether that is 11am or 9pm. 

It seems curious from a health policy point of view in Alberta, where one of the stated objectives is to increase access to primary care, that this is thought to be achievable by limiting how much work doctors can do. Initially these changes were suggested because they would promote quality over quantity, but latterly it has been reported that these changes are designed to reduce the inequity in income between family physicians. 

Perhaps it would be better to reduce the inequity between primary care and secondary care providers instead, to make primary care a more attractive career option for Canadian medical graduates.

"Thank you"

Today was my last day on GP and I was surprised to find myself feeling a mix of emotions. I’ve been looking forward to this day for a good few weeks now, mainly to escape the mind numbing boredom and whinging which I have withstood daily for the past four months. But unexpectedly the past couple of days have really changed my thoughts on general practice.

Yesterday I went on a home visit to see an old couple who I have visited many times over the last few months, I didn’t do anything extraordinary for them, just brought Mr W some antibiotics from
the pharmacy and picked up some milk for them on the way over. Anyone would think id just given them a winning lotto ticket, they were SO grateful. Mrs W hugged me and had tears in her eyes telling me how wonderful Id been and how much I’d helped them over the last few months, Mrs W even quoting that I had saved her husbands life (a massive exaggeration!). They made me a cup of tea and were genuinely so appreciative and thankful. I felt like id actually made a difference, if only very small, to this lovely couples lives, and it felt good. A similar thing happened in clinic today, one of my “regulars”, a lady who I have seen every two weeks with extreme anxiety/depression, came to say goodbye and brought me a card. Again, she cried while telling me how much of a difference I have made to her life and how much she would miss me. You don’t form these kind of bonds in the hospital. Continuity is something I really value, I like getting to know people and forming bonds that allow them to tell you things that they wouldn’t tell anyone else. I like that I have gone into people’s homes and had a cuppa with them while discussing their medical problems. And I like being appreciated. Something which doesn’t happen very often in the NHS. Sometimes it only takes the words “thank you” to lift your spirit and turn a day from bad to good. It has taken me leaving the job to see how much some of these people have valued me and my time. And it’s times like this that I am proud to be a doctor working for the NHS.

So here's the plan...

I used to journal when I was little, then turned to blogging when that became a thing, but I’ve been out of it for a while. I had recently planned to restart my blog, and then decided I was going to have to get tumblr thanks to Taylor, so let’s see how I go blogging on this platform.

I hope I have something to write you might find interesting: about life and work and my opinions, with the odd bit of poetry. I do like feedback on my writing, but please don’t be too harsh!!

Why did I decide to go back to blogging? Partly that I’m feeling that overwhelming urge to write things. And partly that I start a new job on Monday so this kinda feels like a new chapter.

taylorswift

General practice..

Sorry it’s been a while since I posted, I’ve been struggling a bit recently and had lots of the usual bullshit “hoop jumping” stuff to work on. So I’m currently working in GP land.. I’d been looking forward to this job for it’s rumoured short hours, endless cups of tea, never having to walk miles across a hospital, and I assumed people would be nice.. Why is it that any positive hope I ever have for this job is ALWAYS dashed within a few working days??

So, each week I have two “half” days, which sounds lovely, but by half day what they actually mean is we will pay you for half of the day, yet expect you to stay until late. Want to book annual leave on this “half” day? it will cost you a full days leave… The full days are anything but short too, I arrive at 8.15 and leave around 6.30… For all this I am paid an ‘unbanded wage’ which equates to about £1500 a month… (About £600 less than I was getting on my previous job). Before anyone thinks “that’s actually quite a good wage…” I’ve calculated that I get around £11 an hour.. I was watching a benefits programme on channel 5 recently, and a genuine scroat with no qualifications walks into a shop and gets an £8/hr job dressed like a homeless man… £3 less then I make having spent 6 years at uni, which cost me around £40,000 followed by two years doing what I believe to be the most stressful job imaginable!

So anyway, what does a day in GP consist of you ask? To illustrate this I will detail a typical day.

08:15 - arrive 45 minutes before paid hours start in order to tackle the mountain of “tasks” that are inevitably waiting for me. Phone calls to worried parents of children with a cold, calls to the elderly who may or may not be extremely sick, calls to anxious young women who are bleeding from their vagina and hadn’t stopped to self diagnose their menstrual period (true story..).. I find the mix of bullshit and potential serious stuff quite stressful, as I have to decide over the phone who can self medicate at home, who needs to come in for one of the very limited emergency appointments, who warrants a home visit and who should go straight to A+E.. Not always that easy and for any mistake you make, people will come down on you like a tonne of bricks.

Then begins clinic. I will see between 6-8 patients in a morning session. I work in an area where the average IQ is around 5. This means that amoebas will saunter in telling you that they need antibiotics for their common cold on a daily basis. Despite living on the local council estate all of their lives, most still seem to struggle with the English language. I don’t know if you’ve ever been unlucky enough to meet this type of person but they usually have no teeth (or limited teeth) and constantly shower you with little droplets of spit as they struggle to articulate their already limited vocabulary. And they are ALWAYS right, there is NO reasoning with these people. After possibly 20 minutes trying to explain the indication for antibiotics and their irrelevance in viral infections, it will always end with them saying “you’re all fucking useless you doctors” or my personal favourite from recently: “knew I shunt O wasted ma time wiv ya, al jus av’ sum o’ ma mams [antibiotics] anyway if ya gunna be tight, you wunt be sayin ‘no’ if I wa’ foreign nah would ya?!”. I must imaginary ‘face palm’ around 100 times a day. Only today I had someone demanding furosemide for their swollen knees. I was a bit confused and asked where she had gotten this idea from. It turns out because she had furosemide in the past for swollen ankles, she wanted some for her knees.. I explained how it isn’t the same problem and that furosemide wouldn’t help with her knees, this obviously got me a whole run of abuse as people are literally incapable of being educated here… Tackling stupidity, racism and abuse are daily struggles in my life at the moment.

The morning clinic will go by so slowly that by around mid day I feel like I’ve already been at work for 12 hours.

Lunch time brings a whole new barrel of fun… Home visits. I was told I wouldn’t be expected to do these as a junior… WRONG. I’m expected to do 2-3 every day. Some are heart breaking, like when you visit cute old couples struggling to cope with independent life at home. Some are frustrating, like the many patients who claim they are too sick to come to the surgery, but yet when I arrive they will be arriving back from the shops carrying 20 bags of food. But most are just extremely stressful. It’s the first real time that I’ve been “alone” as a doctor. I go to the house and have to make an assessment, diagnosis and plan for the patient, without anyone else being around to double check my findings. If I decide they can stay at home with antibiotics, but then they die in the night, that it PURELY my fault. If I send them to hospital and it turns out to be one of the many inappropriate referrals A+E receive daily, that is purely my fault. I feel far too inexperienced to be making these decisions alone, but that’s just part of this job. Constantly in the deep end, never ever just paddling comfortably.

Afternoon clinic brings another 6-8 patients. Nearly half will be depressed and want me to solve their life problems with the wave of my wand. There will be at least one more abusive antibiotic demanding amoeba. There’s nearly always a child with a cold. Then always one patient where you think “what the actual fuck”. For example, the patient who came to tell me she suspected her partner was gay as he would only have anal sex with her, she literally just told me this then stopped for my opinion. What do these people actually expect me to do?! I had a recent patient come and tell me he had a scab on his head where he had recently scratched it, the scab had fallen off a few days prior to the appointment and had now healed well…he just wanted me to check it was all ok… WTF do you actually want me to do about your nicely healed wound?!

Most days go by without me having treated an actual problem, yet I go home wondering if any of the ridiculous shit was actually an unusual presentation of something serious. What if the crazy anal sex lady actually has a frontal lobe tumour making her declare these private things to me… What if scab man actually had a serious skin disorder…. What if the woman who I thought had come on her period was actually having a miscarriage… It’s ridiculous, but could happen.

By the end of the day I feel like I’ve been there all week. And it’s only Monday, another 4 days of this shit before the weekend. And yes, I get every weekend off, and although I never thought I would say this, I would HAPPILY trade my weekends off for a week full of interesting patients, arrest calls and the occasional day where there aren’t too many patients and everyone sits on the ward eating cake. One thing you know for certain about GP, there is NEVER going to be a quiet day, and RARELY an interesting one!

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