Busy
An unusually busy day, like those I had frequently before I cut down my hours. There are full surgeries, a bulging tray of paperwork, four visit requests (three visited, one asked to come in), telephone calls and referrals at the end of surgery. Fortunately no further work arose from being on-call. Also fortunately none of the patients were particularly demanding. The one saving grace was that I finished by 7.30pm. Feel weary all evening.I am pleased that despite the pressure of work, I remained calm and explained things in a matter-of-fact way. My main problem seems to be assembling all the facts and holding them in...
Source: A fortunate man - April 11, 2013 Category: Family Physicians Authors: Dr Andrew Brown Source Type: blogs
Mercy
We are few in number at this evening's Maundy Thursday service, held in the chancel which gives an air of intimacy in an otherwise cold church. The foot washing emphasizes Jesus' command to love and serve one another."Lord Jesus Christ, you have taught us that what we do for the least of our brothers and sisters we do also for you: give us the will to be the servant of others as you were the servant of all..."This is sometimes easier said than done. Patients can be demanding and difficult to like, perhaps through fear or for some other reason. It is hard to see Christ in all of them. God's mercy must be wider than we think...
Source: A fortunate man - March 28, 2013 Category: Family Physicians Authors: Dr Andrew Brown Source Type: blogs
Guidance
Recently while lying in bed half-awake coughing up a lot of green sputum, I reflected on the fact that GMC guidance now prevents us prescribing for ourselves or our family. Of course I understand the rationale behind the change: we are not as objective when considering ourselves and our families as when considering others, and there have been problems with doctors abusing self-prescribed drugs. But emotionally it feels different. I have been allowed to prescribe for myself and family since I qualified over thirty years ago. Now I am no longer trusted to do so sensibly. It is the lack of trust which hurts, rather than the m...
Source: A fortunate man - March 26, 2013 Category: Family Physicians Authors: Dr Andrew Brown Source Type: blogs
Reminders
For some reason the last patient of my morning surgery, a "salt of the earth" type in a wheelchair, reminds me of patients on the ward when I was a medical houseman. Goodness me, that was a long time ago! During the day I also see three babies who remind me of my new grand-daughter. I am particularly careful and solicitous with their mothers.I have to visit my patient in the remote part of town again. She still has bad agitated depression and I change her from sertraline to mirtazapine which should help her poor sleep and difficulty passing urine. (Source: A fortunate man)
Source: A fortunate man - March 25, 2013 Category: Family Physicians Authors: Dr Andrew Brown Source Type: blogs
Psychopathy
It occurs to me that some of the stress I feel at work arises because I want to be liked. I start feeling uncomfortable if the patient seems indifferent or, worse, unhappy. I think I would do better if I aimed for cordial but efficient consultations, and wasn't scared of saying “no”. So I have a go at this today.When I get home I am amused to find an article in The Times suggesting that psychopathic personality traits (“ruthlessness, fearlessness, coolness, charisma, charm and, of course, a lack of empathy”) may help you in life if you are intelligent and not violent. “In everyday life psychopaths tend to be asse...
Source: A fortunate man - March 20, 2013 Category: Family Physicians Authors: Dr Andrew Brown Source Type: blogs
Ups and downs
Drive to a visit in a part of town where we now have very few patients. I have been this patient's doctor for over twenty years but this is the first time I have visited her at home. I take this as further evidence that her current malaise is due to depression, as I'm sure she would have come to the surgery otherwise.Back at the surgery I am infuriated by a man who answers his mobile phone as he walks into my consulting room, and has a conversation for over a minute before paying any attention to me. He seems to pick up that I am angry, and apologises. I later learn he is a psychotherapist. On a more positive note, a coupl...
Source: A fortunate man - March 19, 2013 Category: Family Physicians Authors: Dr Andrew Brown Source Type: blogs
An uncertain future
Today I enjoy a talk by a local consultant at the Postgraduate Medical Education Centre. The talks available here vary in quality, but the good ones reassure me that I am doing reasonably well in that area and give me insights to enable me to improve. Afterwards I talk to the speaker and suggest that GPs could probably do well over half of any particular specialist's work, but we can't do this for the burgeoning number of specialities because we would have to be up to date with the latest thinking in them all.She agrees and tells me that she used to be a GP before she became a specialist. She made the change largely becaus...
Source: A fortunate man - March 15, 2013 Category: Family Physicians Authors: Dr Andrew Brown Source Type: blogs
Relief
My heart sinks when I see that my next patient is a young woman whom I have seen quite frequently over the past few months with symptoms of irritable bowel syndrome. She has been reluctant to believe this could be the diagnosis because she is not under stress. Over several consultations I have examined, reassured, tried medication, done all the relevant blood tests and arranged an abdominal ultrasound (which was normal). I have also investigated her concerns about pelvic inflammation by examination and swabs. I really didn't see what else I could do today, and called her into my room with a heavy heart.To my surprise and d...
Source: A fortunate man - March 13, 2013 Category: Family Physicians Authors: Dr Andrew Brown Source Type: blogs
Hello again
I had not intended the title of my last posting (“Goodbye”) to indicate that I was going to stop blogging. But I found it more and more difficult to think of what I might write next, and in the end I decided that it should be my swansong after all. I am most grateful to those readers who kindly wrote to enquire whether I was alright.Of course, I wasn't. Not really. Burned out, I suppose. I felt as though I had been dragging along the bottom for some time, although when I look back at diary entries from decades ago I can see that I have felt inadequate and unhappy as a doctor for much of my career. Not a brilliant caree...
Source: A fortunate man - March 12, 2013 Category: Family Physicians Authors: Dr Andrew Brown Source Type: blogs
