A GP, who has recently left medicine, reflects on the stresses of primary care during the Christmas period.
Approaching my first Christmas since taking the decision to leave General Practice, I have been surprised by an unfamiliar sense of anticipation. A pleasant child-like sensation replacing the dread I normally associate with this time of year.
Twenty years of NHS shifts had wired me to be anxious and a ‘Bah Humbug’ coping strategy had emerged.
The festive challenges I encountered perhaps reflect a microcosm of those facing the wider NHS. By sharing these memories I hope to highlight what staff in the NHS have to cope with on a daily basis, but especially at this time of year.
1. ‘Something must be done’
The Christmas Eve call, that involves a family who decide that they can no longer cope with Granny’s incontinence or dementia. The agenda is to orchestrate a convenient 3-day admission over Christmas. The hidden agenda – carers at breaking point.
Christmas Eve surgery. A miserable child and parents facing the prospect of an Otitis / URTI afflicted Christmas period. The advice to bring them back if it gets worse is pretty hollow given the pending 4-day practice shut down and lack of faith by all parties in NHS Direct. At the back of every clinicians mind is “This the case that’s going to plague my mind all Boxing Day.”
3. ‘The Lonely’
In the middle of a busy surgery a patient who is facing Christmas alone presents. Once the prospect of physical illness or serious mental health issues have been eliminated, the diagnosis of ‘sad loneliness’ has few acute remedies open to clinicians. The combination of impotent frustration, mixed with the ominous time pressure of a heaving waiting room and mounting visiting list.
4. ‘Last minute cancer diagnosis’
The scenario: somebody waiting for the result of a scan/pathology, who finally calls the hospital just before the NHS holiday. The helpful secretary at the other end, points out that the consultant is not available, but that the GP can access the report. Armed with little or no information about planned follow-up, the pressure to ‘break the bad news’ in circumstances counter to every rule of best practice on the subject, is enormous.
5. ‘No beds’
The local hospital is full and the nearest available bed two hours away. On learning this information the patient requiring admission flatly refuses. You have no confidence that this individual will seek help in the case of deterioration. No amount of ‘safety netting’ or documentation will give you peace of mind.
6. ‘Late abnormal results’
18:30 Christmas / New Years Eve, a result lands on the desk that needs actioned. Helpfully the patient has now gone away for the holidays leaving no way of contacting them.
Disrupting the waiting room, demanding diazepam, threatening staff, refusing to go to A&E with significant injuries. With regards to the latter, sometime 12-18 months down the line you will be forced to cancel a holiday due to a court citation as a witness.
These are some of the scenarios I won’t be missing this year!
But like most NHS staff I had good and bad experiences over the festive period. The positives included the generosity of patients, the camaraderie of colleagues and the solidarity of being part of the wider emergency team.
I might not be working in the NHS this year but I will be thinking of NHS colleagues and their families with gratitude and admiration.