General Practice and Emergency Med: A Bad Combination

Since the beginning of the year, I’ve been working semi-permanently for a private family practice. More recently, I’ve also started doing shifts in the emergency centres of both private and public hospitals.

While doing each of these separately comes with their own challenges, doing them together has proven to be a demoralising combination, because they highlight the failures of each field, and our inability to fix them.

Being a good general practitioner is damn hard. The pressure to see patients quickly is high, and spending 15 minutes per patient is the norm. This means that a lot of health promotion cannot happen. It takes a while to counsel about smoking cessation, when the patient’s reason for visiting is a stomach bug. Perhaps you tell the patient to come back for a Pap smear (because her consultation time is up), but she never does, because she can’t afford another consultation.

And if you want to do health promotion in the waiting room, all the pamphlets are sponsored by some or other pharmaceutical company, so that becomes an ethical grey area.

Emergent patients come to their family practitioner because they don’t want to sit in a queue at the local hospital. The GP sends them to hospital anyway, and the patient has lost R350 (at least).

In the world of Emergency Medicine, we are often faced by the failures of primary care (in state or private). We see the effects of uncontrolled hypertension and diabetes. We get flooded by inappropriate “green” referrals or walk-ins, because patients are tired of not getting results from their GPs. And seeing these “greens” takes valuable time from the very sick patients. (There’s that “distribute justice” they spoke about in medical school.)

The Emergency Centre isn’t there to fix the myriad problems our patients encounter. So we take their bloods and send them to their primary care physician to follow up – on their cholesterol, their high blood pressure, their smoking, their lack of recent Pap smear, their obesity…

To add insult to injury, their is a strong mutual dislike between general practitioners and emergency physicians. Working these two jobs results in a huge cognitive dissonance for me, despite the insight it offers.

I am increasingly desperate to get a more permanent job in a state hospital, in a department I like. Please cross fingers with me.

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The “Good” Intern

The October issue of the South African Medical Journal (SAMJ) published an article, ‘Going the extra mile: Supervisors’ perspective on what makes a ‘good’ intern (De Villiers, Van Heerden, Van Schalkwyk). The paper assesses the opinions of supervisors on interns’ practice readiness, which differs from most research on the subject, which has predominantly researched the interns’ own perception of their preparation.

The study reported on the results of interviewing 27 intern supervisors – a small, but diverse group of consultants, registrars, and medical officers.

What stood out for me was that the interviewees displayed a keen awareness of the challenges faced by interns. They recognise three areas of particular difficulty: transition from student to doctor, adjusting to a new environment, and long/hard working hours. Continue reading “The “Good” Intern”

Global Day for Safe and Legal Abortions

4e1359d8e206b850346e738d142216cdThe young woman left my consulting room after protracted counselling, with a completed J88 (a medical report of assault), a prescription for anxiolytics and pain medication, and a referral to a therapist. She was six weeks pregnant, but would not be for long. Her husband had inserted misoprostol tablets in her vagina, without her knowledge or consent. She was already in the throes of uterine cramps. Continue reading “Global Day for Safe and Legal Abortions”

Stop telling your depressed friend to go for a run

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Gratuitous selfie at the top of Chapman’s Peak. This was a good day, and I DID feel pretty high.

“Go for a run, you’ll feel better.”

If you’ve ever been sad, you’ll have heard this. If you’ve been depressed, you’ll have heard it ad nauseum.

What depressed person has the energy, let alone the motivation, to go for a run? Realise that “going for a run” is a multiplex of tasks. First, you must get out of bed. Then, you must get dressed. You must put on shoes. You must (preferably) eat something. You must unlock the door. You must step into the sun. You may have to greet the neighbour. You must put one foot in front of the other. Then you must do it faster, and remember to breathe.

Continue reading “Stop telling your depressed friend to go for a run”

Anatomy: my big mistake

I had a little giggle to myself while charting the notes of a patient with shoulder pain the other day. Specifically, I was thinking of this post of yore, and my belief that I could get by just knowing what anatomy looked like, and not necessarily its various descriptions and qualifiers.

Boy, was I wrong. (And young. And obstinate.)

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Image via dentalbuzz.shop

Continue reading “Anatomy: my big mistake”

Finally had my “magical paeds moment”

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Not the same child, photo with permission.

The little girl had come in hurt and bleeding. No too bad, a small gash that was easily approximated and taped (gosh, I love steri strips).

Next: the Tet tox.

She doesn’t know about it yet. For a moment I consider not telling her at all, but she is old enough to feel betrayed. So she sits on her dad’s lap, and we tell her about the special injection that will prevent her from getting sick. We may have used some imagination and invoked superheroes, too.

I braced myself for the struggle the moment the needle pierced her skin.

Nothing. Nada. She sat chewing her candy while I taped the injection site.

You know all those cute videos of doctors giving kids their shots without them noticing? I finally got mine, and that felt kind of special. Sometimes, you need just one small success to give you a bounce in your step.

Read This Book: An Unquiet Mind

11552857I love that more healthcare workers are talking about depression these days. It’s something I did not see while I was studying, and that meant that I felt very alone. You might even have seen (or participated in) #crazysocks4docs, which was meant to highlight the high rates of depression in the medical profession. (Some took exception to the term “crazy” – but I’m not going to discuss that right now.)

Anyway, more and more HCWs are doing their part to delegitimise stigma by sharing stories of their own depression. But some mental illnesses are still “off limits” – bipolar mood disorder and schizophrenia, for example; and it’s not hard to know why. For a doctor to get sad and burnt out? Most people can wrap their heads around that. But few are comfortable with the idea of an “unstable” doctor. Society hasn’t become comfortable talking about those disorders that may lead to losing touch with reality. Continue reading “Read This Book: An Unquiet Mind”

The Best GP Advice I’ve Received: Part 1

 

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(c) Simon Prades

The night before my first shift in general practice, I frantically messaged one of my doctor-heroes on Twitter (@sindivanzyl). I think I was hoping for a cheat sheet, something about hypertension and diabetes, but the one thing she emphasised was, “Please, please, always examine your patients.”

For medical students that would probably sound absurd. Duh, how can one not examine the patient? 

But I learned quickly that, in an environment where there are always more patients to see, it is sometimes easier to make a quick observation from across the desk than to do as we have been taught. Continue reading “The Best GP Advice I’ve Received: Part 1”

Doctor. Counsellor. Freedom Fighter.

She was a healthy young woman who came to see me for a “complete check-up” before a holiday overseas. Although I tend to think “complete” check-ups are somewhat overkill, they do present a good opportunity for health promotion and disease prevention. As one does, I asked about sexual history and family planning. She hesitated just a split second before answering, “Well, my only partner is a woman, so I don’t have to worry about pregnancy scares.” And then, we moved on.  Continue reading “Doctor. Counsellor. Freedom Fighter.”