Diary of a GP: Some days are diamonds, some days are stones

Tomorrow is another day and the one thing you can depend upon is that no two days are ever the same in general practice. But for now, I need a scotch.

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Some days are just tougher than others in general practice.

We all have common frustrations – the printer jams, the authority prescribing line is on go-slow, the batteries in the auroscope have gone flat. These can certainly put a dent in one’s mood, especially when they all happen at once, but generally these are par-for-the-course days.

But then there are days that really hit you for six. Days that really make you question your career choice. Days that make you want to go home, drink scotch and go to bed. Days that – in my case – cause an acute flare-up of my ever-present imposter syndrome. Am I really helping anyone?

Last week I had one of those days.

And I should’ve known. All the signs were there that the day was going to be a shocker, but I’m not sure how I could have avoided it.

First up, I had to tell one of my favourite patients the results of his abdominal CT scan. A 3cm solid mass in the head of the pancreas!

He’s had worsening GORD-like symptoms all year but an abdo ultrasound in January was all clear, and a gastroscopy in February showed some oesophagitis and a hiatus hernia but he hadn’t improved with PPIs, and over the last month he had started to lose weight.

And so – the CT scan. Bugger. Bugger. Bugger. Why do bad things happen to good people?

I got him an urgent appointment with a wonderful surgeon. And there are no signs it’s spread. But it’s pancreatic! And this lovely man knows it. I’m usually Pollyanna in most crises but it was hard to play the glad game here. He cried. I cried.

And that was the first appointment.

The problem is I have never learned the art of somehow compartmentalising that sort of experience, at least not compartmentalising it quickly. I know I’m carrying that sense of sadness and injustice through with me to the following consultations. Maybe they teach med students how to not do this these days?

When one of my benign frequent flyers walked into my room a few consults later I was not in the right frame of mind. She’s in her late 50s with a few medical conditions, none of which are particularly severe and all under control, but she is on a pension, so is bulk billed.

She has somehow got into the habit of routinely making a double appointment every few weeks – that way she is assured she can get in – but then coming in regardless of whether there’s a problem or not.

Today wasn’t the day for me to see her. I was asked my opinion on how to wash a stencilled sweatshirt (yes, you read that right). Asked for a simple definition of how menopause causes tiredness. And asked whether the surgery would be interested in investing in a new POC test that was still in research stage in the US (but she had printed off the internet page where she had read about it).

Enough. I wasn’t rude and I didn’t upset her but that is not happening again. There are too many sick people who can’t get a timely appointment. I simply explained this consult was a waste of time, hers as well as mine.

So that was another great medical win for the day – not.

And then there was the phone call from the psychologist of my 33-year-old chronic alcoholic patient. She’d cancelled her last couple of appointments at the last minute and was not answering her phone. A sure-fire sign that things were bad again.

This is despite an extended inpatient rehab stay last year, regular psychological sessions and strong family support – she had been going so well. I did manage to get in touch with her and, as suspected, she was drinking again and not in a good place mentally. Bugger. She’s such a lovely girl but has this truly terrible addiction.

She’s coming in to see me and she does realise that relapses happen, but I feel her despair. Have I ever helped this poor girl?

And that was my trifecta. Of course there was also my perennially miserable 78-year-old lady, who always “feels lousy” but can’t be dismissed because occasionally it is serious, my 84-year-old with herpetic neuralgia which is only marginally helped with medication and my 34-year-old teacher who is being bullied at work.

And then … the printer jammed.

I know, I know. Tomorrow is another day and the one thing you can depend upon is that no two days are ever the same in general practice.

For every “stone” day there will always be a “diamond” day, where I feel I really do make a difference.

But for now, I’m signing off and going to pour a scotch.