What registrar years are for. Published @BMA News 16th Aug 2014

You know that a duty surgery is not going well when two or three GPs pop their head in and ask you if you are OK. I was a registrar in a large urban practice that was surrounded by pockets of supported and social housing.

The screen said, “New patient, needs to register, needs medication.”

He didn’t sit down, but paced around the room, shouting at me how he’d been sectioned and then been seeing the Home Treatment Team. But now he’d moved house and needed some more medication, now.

Flustered, I tried to talk to him, and also register him on the computer system so I could generate a script for him. The delay just aggravated him even further.

“Why didn’t you just write a script on the pad you take for home visits?” asked my trainer later that day.

“Because I’m stupid!” I answered, “I hadn’t even thought of that.”

“When the alarm bells are going off, and you have a potentially difficult patient like that, you just do what you need to do to get them out – whether that’s a script, the alarm or whatever,” he advised.

I nodded. Had I become so reliant on computer-based prescribing that I thought I needed it to write his prescription properly? I didn’t think so, I simply hadn’t thought of an exit strategy.

“Just give me my meds or I’m going to kill myself!” he shouted, “If you don’t believe I need them, then call the Mental Health Team.” He didn’t hit me, but pushed up against me, as if we were packed in tightly on a commuter train. He shouted the telephone number, which I recognised.

I dialled, and for once I managed to get through to the duty worker. They knew the angry young man and spoke with him whilst I carried on with the superfluous task of registering him. To this day I don’t know if I did it correctly.

I took the phone back off him, “We’ll see him later this morning, just ask him to make his way over here.”

“Great, thanks” as I hung up the patient stormed out the room, swearing at the top of his head.

He never did get his script off me. A series of concerned faces appeared at my door. The consultation had been somewhat surreal; I remember being convinced at the time that everything was going to turn out fine – perhaps a coping mechanism, or just wishful thinking. I wonder now if by fixating on the script-computer issue I had become blind to the potential danger I was in and to other ways of solving the situation. I guess mistakes like that are what registrar years are for.

Attempting to engage with the DoH. The final chapter?

Our ref: DE00000875513 
 
Dear Dr Dawlatly,
 
Thank you for your further correspondence of 21 July about the Secretary of State’s recent announcement that data about GPs who fail to diagnose cancer in their patients will be published online.  I have been asked to reply.

I was sorry to read that you were unhappy with my colleague’s previous reply (our ref: DE00000872042). 
 
However, there is little that I can add to that reply.  I can only reiterate that the proposals for the scheme have not yet been finalised.
 
However, with regard to your concerns about the release of information to the media, I should clarify that the Secretary of State announced the plans in person.
 
I am sorry that I cannot be more helpful.

Yours sincerely,
 
Tom Andrews
Ministerial Correspondence and Public Enquiries
Department of Health
 

‘Learning to Love’ book is now out!

Seven of my poems are in this new book…

this fragile tent

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The book is now out!

You can get your copy (download or paper) here.

This from the blurb put out by Proost;

“We think this book typifies the reasons why Proost exists.  It’s promoting people’s art and creativity.  It’s giving people a voice and it’s sharing those voices with a wider audience.  It’s almost an incredible good and very moving collection of poems. For those reasons we think it’s a fantastic resource and hope you’ll visit the site and pick up a copy.”

Here’s a poem to give you a flavour by Sheena Bradley

Being true 

Before, I was not
And now, I am
In this place and at this time.
Rain, hail or shine I will hold up my head And bloom…

And not just so that I might be seen, That I might be admired
No, I do not need your praise.

Celebrated or unnoticed Until I’m…

View original post 10 more words

Killing me softly with this job. Published in BMA News 1 Aug 2014

Strains of Roberta Flack drifted in under the door and through the paper thin walls that separated me and my patients from the waiting room.

“Strumming my desk with my fingers…” I started to hum the tune and play with the words in my mind as the patient sat down. I resist the urge to strum my desk as I know this will be perceived as a sign that I am impatient and want the patient to get on with it.

He launches into a story about how work has been difficult for the last 12 months, how he’s had a disagreement with management at work, how his line manager at work is not taking his grievances properly, how work is making him unhappy. He’s just become a dad and work is affecting his sleep. Work, work, work.

Roberta sings, “Filling my mind with his pain…” my imagination drifts back to the melody again as he starts to repeat himself, as though that will make me understand him even more. I stop writing a song to myself and snap back into doctor mode.

“So, why have you come to see me?” I ask, kindly and as sweetly as I can manage.

He didn’t expect that question, so starts to repeat the story all over again, going into the detail of a disagreement with one particular supervisor that has had it in for him ever since he joined the company and that things got so bad on Thursday he walked out, because he couldn’t stand being in the place any more.

Two can play at repetition, “So why have you come to see me?”

He still doesn’t know.

In the brief silence Roberta sings the next line, “Killing me softly with this job, with this job…”

At that point I needed to make the decision between fully immersing myself into a social problem that I can never solve, medicalising his job situation or drawing the line under my ability to make a difference in some people’s lives. Perhaps the job was killing me softly with every disappointment I felt from patients I couldn’t help or being dragged into situations that broke my heart by their awfulness and the lack of solutions.

“Sounds like the problem is your job and I’m afraid I can’t prescribe you a new job. You may want to call this depression, but you’re clearly not suicidal and anything I do won’t stop your job being awful, will it?”

As he left, a little bewildered, clutching a stress management self-referral leaflet, Roberta finished the chorus, “Wearing my heart out, with this job, with this job.”
Not today Roberta, not today.