Following a recent "Day in the Life of..." article for The Guardian, their editors asked for other GPs to write to them about a typical day. I'm not aware that they have used mine, but as I wrote it, I thought I would share.
For context, I work in a medium to large sized GP practice in the North West of England, in a fairly deprived area. However, the set up of my practice is pretty good, and compared to local colleagues, I think we have it pretty good!
GP Life
One of the things I find hardest is that you have to remind yourself so often that you are in fact doing a good job.
The very nature of patients is that they come to see me when they aren't well, or at least if they "consider themselves to be unwell" which is the description given to my potential client-base in the GMS contract; the contract that defines what GPs should do.
This means they aren't their usual selves and often take their frustrations with the NHS, Social Care, or just life in general out on you. Even though I have nothing to do with these things, I have to try and and empathise with say, how poorly they perceive the communication about their care by my hospital colleagues; their dislike of the below-minimum wage home care assistant to do everything they want; or that their employer won't give them time off for their child's funeral.
I find people of my own generation (I'm 33) tough to deal with because their expectations are wildly unrealistic. They perceive any illness as abnormal, and often a failure of me as a doctor to somehow prevent. The notion that any treatment I can provide might take more than one dose to fix is unacceptable to some. The human body ages and things don't work as well as it gets older. Unfortunately, it's not like a lease car that you can replace with a new model every 3 years - you're stuck with it and that sometimes means living with a condition.
Then again, the older generation are some of the most entitled. The number of times I am asked to visit someone at home, purely for their convenience, rather than an inability to come to the clinic, where all my kit and their usually extensive notes are. It's not uncommon for us to be asked to schedule our visits around, "when they are out"... it's a stark reminder of how unvalued I am as a professional that the hairdresser appointment warrants a taxi but I don't. I'm frequently told that GPs used to visit their parents all the time when they were sixty years old, to stop and have a chat or whatever. They forget that the average life expectancy is way higher now, and there simply isn't the time to socialise anymore.
It's sad, because I enjoy that, but whilst the patient only has to think of themselves, I am potentially thinking about 10000 other registered patients at our practice, any of whom might be needing me more urgently. Sme of the older generation seem oblivious to the fact that their visit takes at least 3 times as long as a standard appointment, and is usually done instead of my midday meal.
Children are another difficulty. I despair at "awareness" campaigns on TV and on Facebook, because I know they will lead to increasing numbers of requests for emergency appointments to review children for rare conditions they don't have. Whereas grandmothers and groups of mum friends would previously mutually reassure each other, now they spread panic. I disagree with the old adage "You can't be too careful"... I think we are now at a stage of such learned helplessness that the future of publicly funded healthcare is no longer viable in its current form. The NHS simply wasn't geared up for and is certainly not funded to see children every other week "in case their cold becomes meningitis". What happened to the family structure and trusting ones own instincts?
It's rare I see a parent who hasn't been terrified by one campaign or another into doubting themselves and wanting a second opinion from me.
As a GP I can't predict the future, and unfortunately some people will get serious illness whatever anyone does to try and prevent it. Society appears to think differently, and has zero tolerance for any drop below 100% functioning.
I sometimes watch TV programmes like BBC1s Doctors or Ch5 Behind Closed Doors. The latter is quite good, but I still feel comes nowhere near portraying what it is like to be making potentially life changing decisions at 10 minute intervals or less.
It's hard for patients to grasp that I can't "just have a quick look" because what they actually want is for me to reassure them that they don't have something serious. GPs don't possess magic powers, and being thorough enough to reasonably exclude scary diagnoses takes a few minutes. No one thanks a GP for missing something, and in reality, you are taught as a trainee that that you will in fact miss things - medicine is an art as much as it a science. However, GPs are expected to be instantaneous and yet flawless. It's impossible.
On a typical day I will see up to 30 patients in 10 minute appointments. I built extra time into my clinic as I just can't manage 10 minutes anymore... this time is my own and isn't paid any extra, but it allows me to breathe, and more importantly, to sometimes spend 2 or 3 valuable minutes extra with someone.
That's 5 hours of direct contact a day.
I'll then speak to at least 6 patients in telephone appointments, which are usually follow up appointments of people I have already seen, typically taking about 45 minutes.
I'll usually visit 2 patients, taking about an hour. If someone is dying, the administration required to ensure good quality care is in place can easily take 2 hours to arrange. If someone needs admission to hospital, I can spend 45 minutes on the phone trying to organise the hospital and transport there.
On a typical day I also review about 40 blood, laboratory or x-ray results. On a good day, I might just need to file them, but potentially all 40 might require me to create an electronic task to an administrator, perhaps to arrange an urgent or routine appointment, a repeat test or a prescription. This takes about 30 minutes, but I can often do these 1 or 2 at a time as patients I'm seeing walk down the corridor.
In addition to blood tests, patients requesting their repeat medication need these arranging. I will look at around 50 prescriptions a day. This takes time, as I need to check that the medications are safe, that any necessary monitoring or reviews have been arranged, and there are often notes from patients asking for additional medications, each of which needs individually checking and prescribing. As a prescriber, I'm legally responsible if something bad happens and no one will take into account that I was busy or the patient was demanding a medication that I thought unsafe.
After tests and medications, I then read around 50 letters a day. These range from outpatient appointment letters, letters to request medication, letters detailing a patients hospital inpatient stay or anything really. I have to be good at scan-reading to find details... often there is vital information buried in a letter that I need to act on, such as a medication dose change or a referral request.
Some days I will also be "on call" or the "duty doctor". This means that in addition to the above, I need to deal with all queries patients make. This means every phone call where someone wants to discuss something, patients turning up asking for emergency appointments or prescriptions or other health professionals asking us to do something. People are often surprised that we can't "have a quick chat" or "do a quick prescription" at the drop of a hat, because they don't see what's happening behind the clinic room door.
Once the daily tasks are complete, I need to do the referral letters. This can take a surprising amount of time as many departments insist on us completing their own particular forms.
It's worth noting that this work takes between 10-12 hours per day, which is why many GPs appear to be "part-time" - in 3 days a GP can have worked a standard working week.
And lastly is the administration of a practice. The Department of Health, the Care Quality Commission and other agencies require practices to produce reports and data to ensure we are doing our job well. A large chunk of GP pay comes from managing long term conditions to targets, which is why GPs want patients to have blood tests "again" or to see them and review their conditions.
There are often local initiatives too, such as trying to see older vulnerable people to put anticipatory care plans in place. These need time to arrange.
GP practices are usually private businesses, whom the NHS contacts out to do certain tasks. In the past GPs would often do extra, unfunded work simply because they enjoyed it. We don't have time for those luxuries anymore. As the funding for general practice stays static but the needs increase, it can be hard to keep the business afloat. I've heard it said that GPs could simply be paid less, but this seems unfair, especially when more and more work is being moved from hospitals to GPs with no change in the funding proportions. And frankly, if I'm going to give up large parts of my life to be a GP, it has to be worth it. No other profession is expected to work for free, and given the hours and responsibility we take, I don't think it's unreasonable to earn the same as a say a plumber or a solicitor.
The responsibility we shoulder is undescribable. Everyone, from other doctors, nurses and clinics, to parents, social workers and the media thinks GPs should do more, be more available, make fewer errors and detect more cancers whilst simultaneously not over prescribing, wasting resources or keeping people waiting.
At the end of a day, I am usually burnt out with decision fatigue and a desire to take no responsibility for anyone or anything. Choosing what to have for my tea can sometimes be a bridge too far!
Today, a Friday, my 3 colleagues and I saw multiple additional and complicated patients all afternoon, in numbers and complexity way above normal. We left work several hours after the last scheduled appointment, because seeing patients who say that they are emergencies comes first. I haven't done my correspondence reading or all the prescription requests for today because I was asked to visit two patients late in the afternoon. We don't really have capacity for these, so I have to do after I've finished work.
Both were older people, and one the result of the local hospital deciding to send someone home without adequate arrangements in place, meaning I had to sort it. I spent just under 2 hours in total on the telephone or visiting to manage this patient, but ultimately, by doing my job well, I managed to cover up the failings of others. I won't get, nor do I expect praise for simply doing what the public expects. Holding the lady's hand and reassuring her as she closed her eyes in bed after a long day is a privilege I'm afforded and don't take lightly. I am allowed into the hardest bits of peoples lives and I'm grateful to those who put their trust in me. I think most people want to feel needed and useful, and I'm lucky to have the opportunity to be in the position to help.
I keep a thank you card with me that a young patient made for me because I took time to explain her eczema to her. This took longer than 10 minutes, and in the grand scheme of things I'm pleased, because I hope to empower that little girl to be a teenager and then a woman who looks after herself. It would have been far quicker for me to just prescribe something and send her on her way to figure out herself. But I didn't. That small token is why I do the job, for a sense that I can make a difference. And so, whilst on a performance management level, it made the next patient late and irritated, I tell myself that it's worth it.
Without these fleeting moments of gratitude, I don't know that I could go on.
