Locum a lifesaver for GPs

Medical Matters: This is the time of year when you can hear the forlorn sound of a GP calling for a locum. It sounds a little like Mary calling the cattle home across the sands of Dee and the GP is often as unsuccessful as poor Mary was. When the days are long and the schools are closed, a GP feels the need to get away.

That is where the locum doctor comes in.

A locum nowadays is as likely to be from a foreign country as not: South Africans plodding around the wet towns of Ireland dreaming of the sunny veldt, adventurous Australians with hereditary wanderlust, or eastern Europeans treating the soft Irish with their fat tummies and high blood pressure - the rewards of affluence. Most have come to save some money and will eventually return to their homeland. Some will stay, and very welcome they are too, for general practice in Ireland would be unsustainable without them.

Traditionally, a locum was a doctor in training. They would spend two weeks of study leave in a rural parish, working by day and swotting by night to emerge full of knowledge and with the price of their inordinate exam fees.

A GP friend of mine once blithely told one such young doctor, before he took off for a fortnight in the sun, that she would be all right if she remembered to always play it safe.

"I couldn't get a parking space on the Monday morning of my return," he told me, "and when I did, I couldn't get in the door. Half the practice was there. She had told them all to see me as soon as I got back. The other half she'd sent into hospital." At least he could not complain that she had not taken his advice.

Another friend of mine took time off from her work as a dermatology registrar to act as a GP locum. She decided to refer a patient with a skin problem to the dermatology outpatients, as his problem was likely to prove difficult.

Then, as now, the waiting lists were long and when he eventually got his appointment, she had been appointed as the new consultant. She told me that his face was a study when he saw the doctor who had referred him sitting in the consultant's chair.

Not all GPs used to treat the locum well. Some would advise all private patients to keep away until they returned. The replacement would be expected to bunk down on the treatment room couch. The practice nurse would also go on holidays, as well as the receptionist and the doctor in the adjoining practice, and the locum would be expected to do the work of them all.

A locum in this situation would retaliate by running up the phone bill, smoking in the office and changing all the settings on the computer. Most importantly, they would tell the patients that they had all been on the wrong medication for years.

If the locum replaced a bad doctor, word soon got out. Patients would come for miles around for a second opinion and a thorough examination. It was much easier to replace a genius; then nobody would come near you.

Some patients cannot bear to be parted from their beloved doctor. These are the ones who have nothing wrong with them but have a file the size of a telephone directory. They sit and sigh, devastated at having to forgo their twice-weekly chat. Then they ask piteously: "When did you say the doctor will be back?" The only consolation is that these self-same patients will whinge to the GP about the wonderful young doctor who thoroughly understood their problems.

Some doctors put the locum up in their own house. There is something ghostly about living in a deserted family home, with their pictures on the walls and their books on the shelves. You are almost glad when a patient rings. Almost.

Eventually, the car full of luggage and tanned children pulls up. The two doctors have a brief discussion about the major triumphs and disasters. A cheque is discreetly produced and pocketed, and the locum drives away from a place where they had been vitally important for a long fortnight and to which they may never return. The usual incumbent starts reading the mail and life goes on as before.

Soon, the only change is an unfamiliar script in the notes and some memories.

• Pat Harrold is a GP in Tipperary and is Muiris Houston's locum for this week's column.