Medical Matters: A day in the life of a GP – doing 90% of the work for 2% of the budget

A few years ago, one of the medical weeklies ran an unintentionally hilarious column with the title “A Day in the Life”. An eminent doctor would give a chronological account of a typical day.

The column quickly degenerated into a competition to see who could work longest, hardest and with the least regard for their health and sanity. It had to be pulled before someone did themselves an injury.

One GP described a lifestyle in which he left the house at dawn and arrived home at 1am to start his paperwork. A surgeon responded with an article in which he never slept, ate or saw anyone who wasn’t a patient.

That was then and the GP world has become more exciting by dint of volleys of cuts from the Government and the HSE, so I thought I would try to describe a day in my life as a GP in post-apocalypse Ireland.

Beginning with death
The day starts with a death. An old friend and patient passed on just before we opened and I drop in. I have medical student Emma with me.

When I get to the office I crank up the computer. I love the software system dearly; I don’t know how we coped years ago rooting around in charts for bits of paper. The danger is that the patient is left staring jealously at the side of your head while you stare devotedly at the screen.

Then I attack the post, or rather it attacks me, as it mainly consists of a list of demands from outpatient departments that we do a load of blood tests. It would appear that nobody in hospitals knows how to take blood any more.

The first patient in has a toddler with her. I send her off to get a urine sample while he sits contentedly and we watch Peppa Pig on YouTube. Daddy Pig says that he loves his job and I feel that mine can be pretty good too.

As patients, clients or service users (sometimes all three) come and go, I reflect that the consultation is an amazing thing. You have to tune into a different energy every time – interview, listen, pick up cues, watch body language, ask leading questions, identify problems, form plans, arrange follow-up and miss nothing.

Then you take a breath and do it again. It is a bit like tightrope walk- ing. Everything is fair game, from the very old to the very young. You never know what the next problem will be and you are always learning.

There are more than 20 million consultations in general practice in Ireland every year. If the health service is like a farm, the GP service is a sturdy pony. Hospitals are huge gleaming racehorses which gobble up all the best hay while the pony does nearly all the work and lives on scraps of grass. The problem is that if the pony is laden with more and more work, he will eventually break down. I send off a load of referrals, which is like trying to book a Ryanair flight without the internet.

Nenagh is the cafe capital of Ireland and just off the M7. I walk into town for lunch. When I get back, I bleed the radiators before freezing warts and injecting a shoulder. It’s good to be the boss.

Properly assessed
I am down that evening for Shannondoc. The co-ops have transformed general practice. All calls are proper- ly assessed, GPs are given feedback on what went on, the equipment is ready and safety is taken seriously. I finish at midnight – a long day.

Doctors, like musicians, divide their work up into sessions . A session is a morning or afternoon block of work. It is recommended that you do no more than eight sessions a week, for your own good. I sometimes do 10 or 11, as I do a lot of teaching. Most GPs do something extra these days, as the viability has fallen out of practice and several established GPs have shut up shop. What were once regarded as substantial GP jobs now have one applicant, or maybe none at all at interview. Maybe the idea is to run general practice down so we join up to new systems at the cheapest rate?

I now think of the old GP stories about how hard they used to work as the bad old days come round again.

As we drive around the country, we hear on our car radios that we are the most important part of the health service, that we do 90 per cent of the work for 2 per cent of the budget and that we are highly valued. And, like Boxer in Animal Farm we resolve to work harder. Good old Boxer. Whatever happened to him?
Dr Pat Harrold is a GP in Tipperary.