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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Tips and Tricks: Planning Your Elective [Part 1]

Screen Shot 2018-11-20 at 14.17.59Since I’ve kind of started paying more attention to the blog again, my friend Caroline asked me to share some tips on electives. (Hi, Caroline!) You may remember the elective series I ran a few years ago. I haven’t exactly stopped the series, I just am not really in the position to seek out medical students for interviews anymore. (Guest posts welcome, hint-hint, nudge-nudge.)

I’ll give as much advice as I could gather from myself and friends, over a few days. Today, I’ll start off with the process of choosing your elective.

Disclaimer: This will be written with South African medical students in mind. For international students, note that some things might not apply to your program.

First: Start. Early.

If you think you’ve got plenty time, you’re wrong! I have a colleague who went to Oxford for her elective, and she booked her space for the program more than a year in advance. If you have a holiday between exams and rotations, use that time. Do not rely on the hope that things will just fall into place. (I speak from experience.) Continue reading “Tips and Tricks: Planning Your Elective [Part 1]”

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”

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”

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.”

General Practice is not exciting, but it is fulfilling

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By Lauren Squires, with permission. Click image for her Instagram.

As I enter into my third month of General Practitioner work, I find myself reflecting. I started with private GP locums to fill the gap til I got the job I wanted. But now I’m signing a contract and I’m here to stay – for at least another five months.

One evening, my housemate asked, “So, did anything interesting happen at work today?” When I responded in the negative, we laughed about how my work had become almost mundane compared to working in hospital and coming home with fascinating stories of grotesque injuries and life-saving surgeries practically every day. Continue reading “General Practice is not exciting, but it is fulfilling”

GP Work is Hard

One week of some GP locums and I am exhausted.

7b609ee5184afeee3a442d25e5549028I can spend 10 minutes per consultation if people have straight-forward tonsillitis or gastroenteritis.

But what about the parents who are hesitant about vaccinating? I need more than ten minutes to make an impact.

What about the woman whose pregnancy test was unexpectedly positive, and needs to discuss options? She might not have anyone else to discuss options with.

What about the myriad people with psychiatric illness? I need more than ten minutes to figure out if it’s depression, or if there is a history of hypomanic spells. Is it substance induced? Is there another general medical condition? Who can start someone on antidepressants after a ten minute consult? Continue reading “GP Work is Hard”

Tips for New Interns: First Week at Work

Last night I worked my last shift for Community Service. 1 January 2018 will mark three years since I walked into my first day of work. And on that day, more than 1,000 new interns will enter our workforce.

I remember the nerves the night before: being unable to sleep. Feeling like a fraud, like I had been allowed to graduate by accident. Worried that I would be labelled Worst Intern Ever; worried that I’d have awful colleagues. But I survived the first week, and eventually the first year, too.

And so will our new interns. I have some tips for those who need ’em.

64062aa6fd8336df8d9536c250fadde7 Continue reading “Tips for New Interns: First Week at Work”