I also had a good chat with Dr B (Dr I'm shadowing), about the hardest parts about being a GP.
1-Patients expect you to know a lot about everything, compared to a specialist who only has to know a lot about their area.
2-The volume of work to do everyday, the lack of time, and the demands on you from nurses,social services and the hospital, if a patient is discharged from hospital because staff don't know whats wrong with them, they will go straight back to the GP, and a good proportion of people who come in with an appointment don't necessarily need one for medical reasons, they just want reassurance. Which is where the "social worker side of the job" comes in.
3- The stresses on the GP's to take back working 24 hour shifts. Working 24 hour shifts were originally taken away from GP's, and in the Cornwall area given to a private group named SERCO, and now it turns out they are pretty poor and and government want to give the 24 hour shift back to GP's. Dr B said working from the early morning doing appointments, then doing visits and the huge amount of paperwork, then to go onto working nights you become exhausted and its not possible to work both days and nights.
4-The demands from patients wanting resources. As a GP you cannot investigate everything because you cant afford to do so. You can't go ordering head scans and every test under the sun willy nilly, and GP's are also under pressure to save money (the NHS has to save £20billion this year).
For example a 80 year old woman had been on long term drugs as a preventative measure against osteoporosis. The recommended duration of treatment is 5 years, but she has been on these drugs for 10 years and was wondering why she had suddenly been taken off them. Dr B explained the recommended duration but she wanted to go back on them, but she cant, not without good reason. She had already been on them for double the recommended duration, but we simply couldnt given them to her without good reason, and outside of the guidelines, because it is expensive! Imagine if we put every post menopausal woman on preventative treatment for osteoporosis and to prevent fractures, that would cost thousands of pounds for every fracture you would save.
Home Visits
Today was quite a sad day for home visits. We went to visit and elderly lady with schitzophrenia and end stage cancer of the gullet, she was not aware of her cancer diagnosis. Upon arrival she was all alone in the house, bed bound and extremely weak and pale. She said she has nurses come in 4 times a day to get her up and feed her, but apart from that she is basically laying bed bound in a dark room waiting to die. The reason for the visit was because her carer said she had fallen and hurt herself. But the patient had no recollection of the fall and was adamant that she didnt need anything else and was fine. (apart from being so weak she was able to move). And so myself and Dr B (after checking her over) had to leave because there was literally nothing we could do. There seemed to be no plan for her care, having her go into a nursing home would be so much better for her because at least she would get the company and the interaction with staff etc. But she literally spends all day laying in a dark room! :( Very upsetting today!
No comments:
Post a Comment