Wednesday, 2 January 2013

Farewell full time General Practice

A mere 30 years ago today I began as a partner at Cobbs Garden Surgery in Olney. Even in 1982 New Year's day was a bank holiday, so I began on January 2nd.  And as of today I have now reduced my commitment to three-quarter time. Perhaps not a major change, but significant for me none the less. What's changed in general practice over those 30 years?

1.  I seemed to have quite a lot of free time in my early years. Particularly in the middle of the day and the early part of the afternoon when leisurely lunches (sometimes paid for by drug companies) and pottering around at home was quite possible. Indeed this is probably where the 'he's probably on the golf course', rumour began of many a GP.

2. Patients received less from us but were somehow more grateful than many seem to be today. I guess this is all part of a culture change in a society which expects banking, shopping and medicine to be on tap at any time of the night or day with an associated decline in 'reverence' for authority figures.

3. We had no mobile phones!  How on earth did we cope?  It certainly meant that you were far more tied to your home or surgery.  Indeed I even remember with some mild excitement hearing of a neighbouring GP who had a 'portable' phone that enabled him to be at the bottom of his garden and still take calls. So 'housebound' were we-or rather was my wife (before the change in demographics of medicine; in my graduation photo the percentage of females was about 10%).

4. Adding to the disadvantage of no mobile phones was the necessity of being on call one evening per week (or more if colleagues were on holiday). In addition I was on call for one in three of the whole weekend having done an open surgery Saturday morning.  With no means of contacting me directly the patient had to ring my home-thus restricting my wife to house-sitting, and then she had to track me down, via a succession of phone numbers of the patients whom I was visiting. Indeed often I would return before she could get hold of me, only for me to need to retrace my steps for another visit in a similar area.

5. I recall many times when reading a bed time story to one of my daughters, that  I was interrupted by the need to go on a house visit. On the other hand the generally undemanding nature of much of the day work meant that I was nearly always available for attendance at school  functions.

6. Getting out of bed at 3am on a cold February morning, defrosting the car (and my hands) and finding   a house with just a name and not a number in a small village, only to find that the distressingly wailing child had now gone to sleep, was challenging. Indeed home visits  and often keeping the patient at home,  after such conditions as myocardial infarction or heart failure or stroke was not at all unusual. How much money, resources and time are currently wasted by the knee jerk call for an ambulance for relatively minor problems. Some of the latter is due to the inexperience of the operator on the other end of the phone who may well simply be using a pro forma tick list. Of course I realise that the threshold for just simply going to A+E is much lower generally-whether it be patient, NHS Direct or even doctor mediated.

Oh blimey, I think I've got about another 20 points. It's just as well I've 'retired'.  More anon.
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