Today it was back to the rural GP for the morning and another busy surgery ensued. I was struck by the variety of the patients seen, and the fact that before they walk through the door the GP doesn’t know what they are coming to talk to him about, and he could have one patient, happy to be pregnant, immediately followed by a discussion about end of life care.
One patient, a farmer, came in, and following a discussion about rollators revealed two weeks ago he had fallen while trying to put a cover on a silo, put his arm out to break his fall and has been left with stiffness and pain in his shoulder. It was only now, as it hadn’t got better and was restricting his activities on the farm, that he decided to seek help. After he left, the GP told me that he doesn’t have anyone to take over the farm, so now at 70 he is doing the same tasks he was at 30. I think this must be an increasing problem for farmers in Northern Ireland, many of whom do not have succession plans in place. Spending time with the GP and observing his interactions with his patients has given me a lot to ponder as I contemplate starting placement in a hospital in a couple of weeks time, good communication skills are clearly essential.
At lunch time it was time to swap with Ruth and I headed out to a veterinary practice in the countryside, first being unsure whether I classed as a large or small animal for which door I should enter the practice through!
It was small animals this afternoon, so I saw a little kitten that had got caught up in a car engine get stitched back together, followed by a dog getting a polyp in its ear cauterized. It struck me as somewhat ironic that while studying medicine the first surgery I have observed has been on animals! Many of the techniques used are similar, although there is the added challenge in establishing a diagnosis in that a) your patient cannot talk; b) your patient may have sharp teeth and c) there is a high probability they may use said teeth on any nearby limb or digit.
The cacophony of plaintive whines coming from the room where they are housed, coupled with an array of distinctive smells was certainly a feast a lot for the senses! One cat in particular certainly had cat-titude. During the afternoon many farmers came in looking for various medications and treatments for their livestock and it was clear they had a very good relationship with the local vets. I’m not so sure that many of them are as frequent visitors to their GP surgery. I’m looking forward to hopefully getting out to farms tomorrow and dealing with the big animals!
After finishing at the vets, the GP very kindly had Ruth and I out to his house for dinner, where we saw some of his livestock and machinery. We then saw the kind of support networks that exist in these rural communities in action. A neighbouring elderly farmer and his wife have both recently taken ill and are in respite care, and the GP along with other neighbours are looking after his animals while he is away. We went up to see the cattle being fed and watch a beautiful sunset over the rolling hills. Although the circumstances are unfuortunate, it was heart warming to see the genuine regard and care with which these farmers view their neighbours.
Once the cattle were fed, we headed into the town nearby to see around the Doctor on Call centre, which our GP says has revolutionised rural provision of health care, by taking pressure off local GPs being obligated to work on calls multiple nights in the week while still preventing unnecessary attendances to the emergency departments. It was interesting to see how it works and see the triage nurses in action. Visiting early in the night on a weekday in September is a very different scenario to if we had visited on a Winter Bank Holiday, I imagine!