Today I was in a local hospital (back to the hand sanitiser and bare below the elbows), shadowing the GP who was wearing another hat as one of the medical directors. There was more time for chat and finding out about his roles than yesterday, with distinctly fewer patients around. He spent time explaining the ins and outs of the bureaucracy and challenges involved with managing health care services at the trust level. Something that is never out of the headlines is waiting times at local emergency departments or ambulance turnaround times, and getting an insight into the various factors influencing these was useful.
The GP took me down to the Acute Assessment Unit, where GPs can refer patients to and I stayed to see what happens there. As well as taking some of the pressure off the emergency department, it allows the GPs to refer patients they are concerned about to have more tests and investigations done. It was interesting to see what happens there, and I was surprised as I had never heard of it before! I observed as a patient was admitted, a history taken and examination done, before seeing the various investigations take place and results come back, allowing a course of action to be established.
I had a really interesting discussion with the GP about the opportunities and challenges of working in a rural practice. (This is a great website with lots of information about being in rural general practice – http://ruralgp.com/). In his spare time (I know, apparently he has some, even with his extremely busy schedule!), he is a part time farmer, and he feels this gives him an insight and affinity with his patients of the same profession. I think it also gives him more weight when giving them advice, as he clearly has more of an understanding and appreciation of what their lives are like than most doctors. The one key difference is that he does not rely on the farm for his income, and so clearly the many financial stresses that we heard about last week in Rural Support are less applicable to him (https://frombaatoahh.wordpress.com/2016/09/09/day-4-rusty-skills-and-drills/). We then talked about how in the countryside, everyone is related, and he tried to explain to me some of the complicated connections between different families in his practice (some of which were so involved I found them hard to follow!). The fact that he treats a lot of whole families, over their whole lifetimes, means he is aware of a lot more of the contextual and background information and situations that may be influencing their health and this means he can treat them more appropriately, using a biopsychosocial approach. He said something that resonated with me – these people are people, not medical conditions – and in a healthcare sector which some say is becoming increasingly depersonalised, it was good to hear this opinion voiced. By living in the community in which you practice, and investing in your lives, it will inevitably be more difficult to see patients suffer but I believe this is good motivation to do your utmost for them to alleviate suffering and where possible help restore them to full health.
Super cute cow joke because I’m currently finding it hard to be punny:-
What did the Mama Cow say to the Baby Cow?
-It’s pasture bedtime!