A day in the life of……….…….…a Doctor at Church Street Practice
Patients seen on day: 34
Male: 12
Female: 22
Age <18 : 3
Age 18 - 59 : 20
Age - 60+ : 11
I arrived at work at 7.30 and was the first one in so had to turn off the alarm, put the lights
on and open the consulting room door. I turned on my computer to start the main
programmes which are used to detail patients’ notes, appointments, e-mail, outside mail
and dictation software. Whilst the computer is booting up, I start the day by signing 10
prescriptions left over from previous day. When I get a prescription, it is not just signing it
but involves looking up and checking medications, renewing repeats in some cases and
dealing with queries that the dispensary staff can’t answer (i.e. medications a patient hasn't
had for a while, or repeats asked for too early or too late). Some patients I know, some I
don't, a few queries to be dealt with later in the day regarding an insulin script.
By 7.45, I start dictating letters for patients I saw yesterday. One is to a local chiropractor
and the other may require some investigation regarding an allergic reaction, I am not sure
who would be most appropriate to refer to. I will ask the secretaries to look into this.
Interrupted at 7:55 by another GP to discuss a few of the day’s issues and also a couple of
patients he had seen. In particular, we are at issue with the treatment of tennis elbow and
the use of steroid injections!
At 8:00 I finish dictating then load up the blood test results which have been sent from the
JR. These are sent electronically to reception at 8am and are distributed according to who
asked for the tests. All have to be verified and commented on. It is a tedious process.
Some patients I will remember but some of the routine checks, I may not and it often
requires reviewing the notes of each patient. I have about 40 results this morning, which is
about average. They are a mixture of things from regular screen for diabetes and
hypertension to more urgent tests. The comments will range from saying they are normal
to asking patients to talk to me. One particular result which indicates low potassium will
require me to ring the patient later to make a plan for thinking about dietary increases and
then repeating the test. I will do this at the mid-morning break.
Its now 20 past eight and I wander down to talk to the GP who has an interest in eye
problems about a girl I saw yesterday. I am not sure what's wrong and have asked her to
come and see him today. At the same time I look at some photos of a rash that he has been
sent which seems non-descript. We discuss the photo with another GP who has an interest
in dermatology.
08:25 Just enough time before the referral meeting to check emails. (I am presently
arranging the 2nd meeting of a young GPs group. We meet monthly to discuss the latest
clinical, political and personal issues!) I also look up any updates to the management of
nocturnal leg cramps, which I saw someone with yesterday (making sure my knowledge is
up to date!).
At 8.30 each day we have a referral meeting where the GPs discuss all referrals we are
thinking of making. The reason behind this is to make sure that they are appropriate.
There are often other ways of dealing with a problem than just getting a specialist opinion
and the practice uses each GPs own specialised knowledge i.e. eyes, skin, women's health,
paediatrics etc to help decide this. There are often solutions we haven't heard of or a more
specific clinic to send patients to. It’s a dynamic group that most practices won't have. I
think we benefit enormously in discussing things with each other and as a result so do the
patients! The patients are getting 5-7 amounts of brain power rather than one! 2
At 9 am, the appointments start. My first is a lady who needs a chaperone and luckily, I
find one of the nurses free before surgery. The use of a chaperone for some examinations
is a must but often disrupts the rest of the day, mainly because finding someone to help
may mean an extra five minutes or more for the patient. The patient I am seeing requires
care jointly between us and the hospital and is reviewed every 6 months. Before the next
patient, I need to call the information manager as I can’t find right heading for the
computer entry. As always she finds the solution quickly!
9:10: See a man of 42 with chronic low back pain and prescribe pain killers. I will review
the medication effectiveness by phone. GPs see an awful lot of back pain, and along with
other chronic joint problems it is often difficult to manage.
9:20: A girl aged 8 with mouth ulcers. It is nice to talk directly to children rather than
parents as they are often good historians!
9:30: See a male, 49, for diarrhoea and vomiting advice. The D+V season started about a
week ago. Most of the time the cause viral and is treated with time and fluids. Often with
self-limiting viral illnesses the main difficulty is putting across to our patients that they will
get better without treatment.
9:40: See a female, 39, with a chest infection which is not improving. Explain giving the
antibiotics time to work and discuss worrying symptoms.
9:50: See a female, 27, with ear an infection which is not improving. Again, explain things
will take time.
10:00: Male, 50, for review of shoulder pain and movement problems. The patient
requires a steroid injection, which is a practical procedure I enjoy doing – and hopefully
the patient will benefit from it too!
10:10: Female, 73, who is suffering continued problem with breathlessness. Exercise and
healthy lifestyle were discussed. I referred her for a chest X-ray and will review in a
month after x-ray, if it is normal. We also discuss her recent blood results. I’m now
running 5 minutes late.
10:20: Male, 78, came for review with his wife, after having an echo of his heart. He has
heart failure and will require changes in his medication and a review by the community
heart failure nurse. Apart from this I also reviewed a skin lesion, and gave him the `flu jab.
I want to make sure his wife is coping as his main carer and we explore this. I discussed
the South and Vale Carers organisation and the case management team who may be of
some help in the future. Now 10 mins late
10:50: Mid morning break. Fill it with more script signing, a couple of phone calls caused
by blood tests this morning and prescription requests. Issue prescriptions and arrange for
district nurses to do bloods on the patient with low potassium. At coffee had an interesting
discussion with another GP about the moments where as doctors we know the diagnosis is
going to be bad and how we discuss this with patients and explore their worries.
Now I have 4 telephone slots. These are each 5 minutes long.
11:10: Continued diarrhoea, in female, 41.
11:15: Medication review for a female, 48.
11:20: Medication review and vomiting in a boy aged 4 after he took the medication I had
prescribed yesterday. Symptoms caused by medications we prescribe are often
unavoidable but I still worry whether it was right thing to do.
11:25: Check before a visit to a female, 89.
Back to seeing patients.
11:30: Female, 60, concerned with a chronic headache. Headaches are often a difficult
problem to deal with as patients often think the worst and we have to reassure them that it
is a mostly a benign temporary condition.
11:40: Female, 77, who is tired and has been asked to come in by husband. 3
11:50: A double appointment for antenatal (pregnancy) check on a female, 41.
12:10: A female, 23, who needed health education about the cervical screening program
and symptoms. Public health and patient education - always a worthwhile part of the day!
12:20: A last minute cancellation meant I could catch up with prescriptions. This also
meant I was now running on time again!
12:30: Girl aged 5 with allergy.
12:40: Telephone call to elderly patient with blood in urine but a history of cancer who
feels weak. I will need to visit him later.
12:50: Started eating lunch, while going through 10 more prescription requests and issuing
medications that the dispensary can not issue.
1:10: Interrupted by a GP from Newbury Street practice. He requires a signature on a
cremation certificate for a patient who had died. This necessitates a history and then
talking to someone who was around at the time of death. In this case, I was able to
telephone Wantage Hospital, where patient died, and speak to one of the health care
assistants. However, the staff member who knew patient would not be in until tomorrow
so spoke to Knapps to inform them that certificate would be done then.
1:20: Filling in two insurance forms for patients either claiming insurance or applying for
it. This is a tedious job as you need to sift through a patient’s history even if you know
them well!
2:00: Visits: First to Childrey to visit a patient recently discharged from Wantage hospital
following a hip replacement. Patient very anxious that I may re-admit them but doing well
so needed a lot of reassurance and going over safety. Carers and a son close by but I make
a mental note that may need to be referred to the case management team in the future.
....Then back to Wantage to visit the patient I spoke to earlier with blood in urine. There
are lots of difficult problems which I was able to discuss openly with the patient as they
know they have had cancer for some time. The patient was last seen at the hospital 2 years
ago, and it's probably time to be seen again. It is encouraging that the patient is open about
what may or may not be. Patient choice and frankness are important here. I will be
referring him to Urology. Took blood while there. I also need to contact the district nurses
by e-mail to warn them, as if continues could lead to the patient needing a catheter. Get
back to practice an hour later, run through reception discussing with dispensary about a
Nomad tray for a patient's meds. Solve issue and collect rest of scripts (another 20) to
check, sign etc! Have to then fill in details of visits into patients notes.
3:20: Check mail - usually letters and other information regarding patients which are
scanned in every day. They are generally on the system from 3pm but do get put on
throughout the day. The number of letters varies wildly from a few to having 30! Today I
have an average of 12. In looking at them I have to high-light and comment for things
which need to be summarised into notes or not. There are always extra things to do
sometimes doing a prescription, contacting patients or discussing as a team. Today a letter
from rheumatologist asks for a patient to have digital retinal screening. I discussed this
with a colleague as the investigation is probably not needed, and will discuss it further with
the ophthalmologist when she comes to clinic on Friday morning and then e-mail the
consultant.
3:40: Telephone appointment not taken
3:45: Telephone appointment not taken
3:50: 41 year-old female with multiple problems. We also discussed smoking cessation
and childhood sleep problems in son.
4:00: Female, 24 with issues with pill and its risks. Changed type and gave counselling.
Also discussed weight management and referred to nurse team for weight issues – the
nurses are more up-to-date with knowledge and better equipped to deal with this.4
4:10: Female, aged 60, with dizziness who is worried due to history of cancer, maybe
connected. Now running 5m late
4:20: Shoulder pain in a female, aged 52. Now 7m late
4:30: Female, 41. Double appointment to review low mood which allowed time to discuss
all issues. Double appointments are very useful with psychological complaints. The time
allows us to explore ideas without being rushed! Although I am now10m late
4:50: Male, aged 62, with problems with medication. 12min late
5:00: Coffee but really straight into next appointment as running 12 minutes late!
5:10: Urinary problem in a 21 year-old female.
5:20: Male, 64 with tendonitis.
5:30: On going treatment of a female, 47, with acute exacerbation of asthma.
5:40: Fertility problems in a 27 year-old female.
5:50: Male, 61, with arthritis. Discussed complementary therapy. I quite enthusiastically
support complementary therapy if it does no harm and doesn’t prevent diagnosis. Often
will use in chronic musculoskeletal problems.
6:00: 50 year-old male with difficult chronic problem.
6:10 Female, 22, discussing contraceptive safety whilst having D+V.
6:20: Infected bite in a 59 year-old male.
At the end of surgery I always look to see how other colleagues are doing with their
appointments. I find that the duty doctor has had to go out on several urgent visits and the
other GPs are seeing some of his patients. Another GP is admitting a patient and thus has
two patients still waiting, I see one and another GP sees the other. In some practices each
GP keeps themselves to themselves and will not necessarily help out in these situations. I
am very happy that we all have similar feelings about work and am pleased I work in such
a supportive environment.
6:40: 39 year-old male with a throat infection due to be seen by the GP on the visit.
After seeing the extra patient, I chat to the receptionist - who is on until 7 - about an
admission last week. Then I finish off a few more prescriptions but some will have to wait
for tomorrow morning! Close down the computer and leave at around 7pm.
Another eventful, interesting 11½ hours..... and I am sure the same again tomorrow!