A poster-snatcher and a happy child: Momentous occasions in the clinic

My first two weeks as a GP have gone by in a blur.

General practice is such a mixed bag. I love how each appoint­ment is something completely different

Many things have happened in a condensed amount of time and it feels like I have seen many more patients than I did when working in a hospital. In the mêlée, a few people stand out.

One lovely gentleman tried to steal my poster. We had just finished our consultation about his medications and how good his blood test results looked. We stood up to say goodbye when he spied a bright green poster behind me.

Emblazoned with “Understanding type 2 diabetes”, it features a diagram of blocked arteries and failing kidneys. He looked at it for a minute then pulled it off the wall, the push pins disappearing under my examination bed. (I must remember to look for those!)

He asked, “Can I have this?” I was a bit shocked and replied, “Why do you want it?” It wasn’t my idea of household decor.

Apparently, he had no idea that diabetes affected all the areas of the body shown on the poster and wanted to show it to his wife at home.

This was quite an eye-opener for me. I had assumed that, because he had had type 2 diabetes for the past 10 years, he understood it. Boy, was I wrong!

ANOTHER PATIENT who stood out for me was a cute primary-schooler who came in with leg cellulitis. She’d had a course of antibiotics from another GP without any improvement. She had stable vital signs and was otherwise feeling okay.

I had a look through her results and saw a previous MRSA-positive swab. I changed her to a new antibiotic and reviewed her twice more over the next week.

Her leg got much better, and she was raring to go back to school.

Her older brother was coming home with exciting stories and she was quite cross about missing out on school just because of her “silly leg”.

It was really nice to see the continuity in general practice.

I felt we developed an easy-going rapport by the second and third visit, and it was good to see my interventions in action (and working).

The last thing that stood out was the screening. We do a lot of screen­ing! For nearly every patient, I was looking back through test results for cervical smears, or for mammogram or retinal screening letters; checking when the last blood tests were; or asking about bowels, and bleeding, and how many times they needed the bathroom at night.

KNOWING I HAD limited time with each patient, I often had to choose which area to champion that day.

The amount of “did not attends” was staggering. One patient had not attended his retinal screening for diabetes four times over the past two years. We had a chat about why it was important and he agreed to a re-referral. I was left wondering whether he would actually go. Could I have emphasised this part more or explained it in a different way to get through to him?

In reality, it is his decision and the onus is on him. But I know I will feel like I have failed him if he doesn’t turn up this time either.

General practice is such a mixed bag. I love how each appoint­ment is something completely different, although I did have a surfeit of “repeat script” visits.

At the end of my first two weeks, I can now (vaguely) use the computer system. I have learned the names of most of the staff. I can find the tea room and toilet without getting lost. I know where to park and how long the drive will take. And I’m starting to feel like maybe I can do this. n

Dr Cat is a trainee GP working in a New Zealand general practice