The Good GP Training Guide, Introduction

A Day in the Life of... 

Morning, branch surgery, then a house call. Patient number 14. I'd put that one in our house call book. A sixty-something retired business lady, attitude of a thirty-something. In April she'd perforated her bowel at 40000 feet en route to Miami and a dream cruise. Imminent cruising alters pain perception, and after a torrid night in a Miami hotel room she felt a little better and joined the ship. First night at sea, high fever, collapse at dinner and so to sickbay. Airlifted to somewhere in Mexico and 38000 dollars' worth of emergency surgery for perforated colon secondary to large malignant tumour. Back home for general evisceration then heroic chemo. A hospice discharge letter earlier in the week suggested she might be at home, so I scribbled a note offering to say Hello. My visit the result. I was expecting a harrowing encounter. I rang the doorbell. Through the frosted glass I spotted my patient jinking sideways to hip-charge a black labrador into the kitchen. I didn't know she had a dog, such a good prognostic indicator. Door open, into front room, do have a seat doctor, so nice of you to visit. Hospice? Marvellous! Sorted the pain relief. And the incontinence. Partner appears, Labrador owner. Labrador appears and sits down to be patted, sniffing my trousers, I have Pointers. Can I help you with anything? How are things going? You are halfway through chemo, how is that? All fine. She radiates vivacity. Thank you so much for coming. I'll come again. I clasp hands. The bravest and most scintillating woman I've ever met.

Back at the Health Centre, soon to be razed, meeting with architects next week. We have a new one a'comin’. An inverted ziggurat, all glass and flying bridges, five storeys high.

Review results. One stands out. New patient registered a fortnight previously. Patient 16. Hypertension and microalbuminuria to an extent that would make a spoon stand upright. Quick phonecall, come and see me, just back off a rig. Receptionists, please chase blood results fast. Quick talk with younger partner who knows more about renal biochemistry than I do.

On call doctor early afternoon, two late calls, second, Patient 17. Elderly lady with breakthrough cancer pain. Her daughter-in-law used to play tennis with me when I was 10. Another Labrador! Adjust the dose of long-acting opiate. More clasping of hands, always an ordeal for Scots. Thankfully no kissing. Yet.

Afternoon surgery. Start with Proteinuria Man, Patient 16 Redux. He's doing a lot of training and body-building. On a high protein diet. The Byelorussian version with stacks of anabolic steroids. And he's jaundiced. Nope, I haven't sorted him yet. 

I finish almost on time. Patient 35. He is the perfect last patient on this particular Friday. Thirty-ish, with a tiny skin tag left upper eyelid and mild folliculitis. Hip Hop! Soon to go home.

"So, am I your last patient of the week?"

"Yes." I say, still marvelling at the simplicity of his lovely skin tag, the joyous absence of psychomorbidity.

We chat about football.

"You'll be glad to finish the week," he says. "You guys must be sick and tired of dealing with the same things all of the time."

Er... No!

Alec Logan

aleclogan@dial.pipex.com

GP, Wishaw, Scotland