Updates

Despite feeling I haven't got time in my life for even just the jobs that keep the house running, I have managed to find a little time (when I should be going to sleep but mr me is away) to update my blog a little. There has been a rather long pause in my posting, so thought I would list the "headlines" that have changed in my life since 2009.

• Baby blue is not really a baby now - he will be 2 next month! Can't believe how big he is and how much he has changed - of course this is quite predictable, but I still can't believe it. For this reason I shall have to change his name on the blog to either mr moo or the noodle. Mr moo possibly expresses him better, but may be easily confused with mr me? Will maybe try both and see how it goes.

• I finally finished my GP training in May, after much tribulation and stress over the winter. I now work 2 and a half days per week at a practice 12 minutes drive from my house which was one of my training practices. Some days I enjoy all of it, most days I enjoy some of it.

• I am busy. Busy, busy, busy. I spend a lot of time trying to streamline my life so I save time for myself. But better not talk too much about this or I'll start whingeing.

• I have developed an addiction to charity and vintage shopping. My favourite recent purchase was a vintage dark blue chiffon evening dress with hand beading around waist and hips. I wore it to our church ball recently and felt fabulous.

• I have discovered how much fun having a toddler can be. Before having mr moo, I worried that I only really wanted a tiny baby and then would want to give it back.

• I have also discovered how draining having a toddler can be. Sometimes I feel like an expert diplomat combined with a disciplinarian. Spend a lot of time not managing to finish a sentence without having to break up a scuffle, wipe a nose, prevent an injury or perform "bumping along on the little red tractor" again.

Well that's all the news I can think of right now. I'd better go to bed, as mr moo is still on British Summer Time.

Pluto?

Interesting conversation occurred at coffee time in the doctors' room today. There were 4 male GP partners and myself in the room, and 2 of them were having a long and involved conversation about the practice nurses, and problems that keep erupting with them and communication issues. Here is how it went:-

Partner 1: "What you've got to remember is that men are from Mars, women are from Venus..."

Partner 2: (pantomiming a secret nod towards me) "Careful, there's one in the room. And she's got pregnancy hormones...watch out!"

Partner 1: "No that doesn't count; she's a doctor."

***************************

So where am I from? I'm confused.

a small post squeezed past the bloggers block

So I passed my exam! In theory, this might mean I never have to take another one! Sooner or later, I'm sure I'll crack and need to do some course or other that gives me more validation of my intelligence. But that might not be for a long time... All I have to do now is complete 9 more months of training and do some online assessments with my trainer. And then I will be an independent GP! which is actually a bit of a scarey thought.

I feel like I should feel more elated than I do. At the moment I feel a bit flat and anti-climactic. But hopefully soon it will sink in what this really means. Apologies for the lack of promised more regular blogging. Hopefully some inspiration will strike me soon.

where i am now

Right now I am sitting at the computer in our small, messy front bedroom that we use as a study. I am partly wishing I had the time and energy to sort through all the notes and paperwork in this room, but just now, I don't. The blinds are still open and I can see the deep blue not-quite-dark-yet sky, and hear the boys who are still playing out on the street. I'm huddled in a hunched position with very poor posture, because I feel cold. I'm wearing a hoodie and jeans and my hair is in a mess. I know there are things that I must do, because I will feel better when they are done, but I feel too physically and mentally tired to do them.

Tomorrow I'm travelling to Croydon, because I'm sitting an exam there on Monday. If I pass it, it means I have all the exams necessary to become a member of the Royal College of GPs, and to complete my training scheme successfully in February 09. It means I can be free to just work and live for a while, see people, garden, sort out the papers in this room, enjoy the summer etc. If I fail it, it means another six months of exam anxiety and work, another £1260 to pay, and I will spend our lovely 2 week holiday in Scotland in September working for the exam. It's a practical-type exam - I have to see 13 actors who are playing patients, communicate effectively, ethically and manage them well in the space of 10 minutes each. Quite stressful. I'm quite stressed. But I know I have worked for it.

Instead of typing this, I should be - checking my train times, and the frequency of the connexion across London, checking the exam details, putting a tendon hammer and tape measure into my doctor's bag, working out how to carry my suit without squashing it, packing my case, having a shower, doing my hair, calming my mind down, going to bed early.

I shall go and do these things now. I need to stay calm, but just now I feel numb and unreal. If you have a second, please pray for me or wish me luck. I'll let you know how it goes, and try to blog a little more regularly when it's over.

glee

On Thursday and Friday last week, I had to visit two different hospitals where I used to work. One trip was to spend time with the substance misuse liason nurse, and the other to try and finish off an audit I was supposed to be doing during my last job. The whole process filled me with glee that I am no longer working in hosipitals.

"Ha ha ha," I thought to myself, as a very loud alarm (possibly the fire alarm - who knows?) went off for five minutes for no observable reason, making conversation almost impossible, but not causing anybody to stop their work. "Hee hee hee," I gleefully mused, as I listened to a stressed looking SHO have a 15 minute row down the phone with another SHO about a rota swap. (although obviously I was sorry for the poor bloke.) "Ho ho ho," I chuckled when I had to eat some form of cardboard in the oppressively decorated canteen. "Ha ha ha ha!" I felt like saying, when a consultant from my previous job tried to give me a rollicking about the fact that there are discharge summaries piling up to be done in the junior doctors' office, without realising that I had actually left and didn't work there any more.
Felt like telling him that now I work in a place where people actually treat me as a fellow professional rather than some kind of naughty lazy student who needs to be told what's what.

And in all the quiet moments on my own, walking down the corridor, or washing my hands in the skin-stripping soap, and especially in the car on the way home with the windows down, I was singing a little song... It was the tune of "Bread of Heaven/ you're not singing/ are you scotland in disguise", and it went, "I don't work here, I don't work here, I DON'T WORK HERE ANY MORE!!! (any more) I don't work here any more!"

GP land forever

I'm back where I want to be. I've finished my last hospital job, and I'm now working part time at a practice, part time for a substance misuse service. No more nights. No more long weekend shifts. Today was my first full day of doing my own surgeries and visits, and I enjoyed it. There are still stresses, of course, and I still seem to be pretty busy with paperwork and learning and assessments. But I love the job really. I love working in a place where people feel comforted and listened to rather than scared and depersonalised. I love seeing people's homes, families, normal clothes and the progress of their lives. I love working in a place where all the staff make an effort to know your name and what you are like and you are treated as a person by your employers instead of some kind of slave shift drone. I love having a room and a doctor's bag and driving out on visits on a frosty bright day and organising my own time. My new trainer seems really encouraging and nice, and the drug/alcohol job is interesting and challenging. It's good to be back

The Pedestal

I have had one of those periods of my life where my insecurities surface more than usual recently, for various reasons, and one of them reared its ugly head the other night when stressing to mr me at about 1am when we were in bed. This insecurity is one of the worst things about being a doctor.

Rightly or wrongly, when you tell people you are a doctor, they have a certain reaction. Normally it involves the word "wow!", and there is instantly a certain mystique about you that wasn't there before. You have seen babies born, you have seen people die, you have (hopefully) stopped a few people dying, and most people place their trust in the integrity and competence of their doctors. So they suddenly look at you in a slightly different way. Being me, I normally say "I'm a doctor," in a slightly apologetic way, as if to say, "please don't look at me differently" (although I notice I have recently started introducing myself as a doctor, instead of a junior doctor. So maybe I am getting slightly less self-deprecating)

I am getting more able to live with the pedestal that people put me on. Perhaps too much so - sometimes I try to imagine how I would feel if I wasn't a doctor any more, and I realise that I am slowly depending more and more on my career for my sense of self. I am well aware that pride lies that way, and I attempt to "consider everything a loss compared to the surpassing greatness of knowing Christ Jesus my Lord." (Phillipians 3:8) I know that I need to work more with God on finding my sense of identity in Him and not in the things I have or am here in this world.What I still find very hard to live with is the nagging fear that one day I am going to fall off the pedestal.

Medicine is a lot about the way you present your knowledge. E.g. you have a young female patient with a chest pain which sometimes occurs at rest, on breathing in, then goes away again after a few minutes. You ask a few questions and it sounds like a chest pain related to anxiety. That is your diagnosis. You know that there is probably a tiny percentage chance that it is something else. But the risk calculator instilled into your brain by practice is telling you that this tiny risk is not worth investigating for. Do you tell the patient all this? No. She is already anxious, you don't want to make her more anxious. So you tell her in your best reassuring manner to try a few simple measures to reduce her stress and that the pain is nothing serious. To safety net you maybe ask her to come back if things don't improve. For the patient to go away happy and to get better, you need to come accross confident. This "bedside manner" that doctors have to have can sometimes feel like an act. You are taking on the anxiety, so that the patient can stop thinking she is ill. But the general public often seem not to understand that the art of diagnosis is, by it's very nature, a sophisticated type of educated guessing. In many cases there will be some uncertainty. But if your educated guess later proves to be wrong, the patient may forever think you are a bad doctor, even if 9 out of 10 colleagues would have done the same thing.

Then there is the question of knowledge. The volume of medical knowledge is vast. It covers all diseases from prematurity to senility, and from every system of the human body. It is almost impossible for one person to know it all. Especially with some of the questions I get asked in my day to day life, eg "why does my tongue hurt when I drink pineapple juice?" or "is it usual for one twin to be left handed and one twin to be right handed?" But if a patient, or worse, an aquaintance who is asking you medical questions, suddenly finds that you don't know the answer, sometimes they look at you like their world is tumbling around their ears. Because doctors know everything.

Maybe some doctors know everything. Gregory House, for example - he knows everything, and that is very lucky, because he has the most statistically improbable caseload of conditions I've ever seen. I have met a few who seem to remember every footnote from medical school. But the vast majority of doctors know about the conditions we see every day in our chosen field, and for the rest we depend on remembering some of the information, knowing where to find the rest of it, and recognising when to refer to somebody else.

I find it very hard to be under the constant pressure of being expected to be some higher form of human being, who never gets things wrong or doesn't know the answer. It doesn't help that I am naturally rather ditsy, and tend to bump into things a lot. Sometimes I can see people looking at me thinking "well, at least she's not a surgeon!" after I have done something particularly dyspraxic. I am getting better at coming across confident and all-knowing at work, but in my day-to-day life, it's just not me. I'm too honest to pretend I know all the answers all the time. Sometimes I love to be somewhere where nobody knows what I do, and I'm just a girl, just another person on the street. I also regularly fantasise about being a housewife, and not bearing this responsibility that sometimes seems so heavy.

I am well aware that I tend to live my life far too much through other people's eyes, and worry constantly about what others think of me. I think for this reason I feel these pressures more than many of my colleagues. I am also aware that a lot of what I'm describing may well be me projecting my own insecurities onto others, and imagining they are mentally criticising me when in fact they are doing nothing of the kind. I don't think it helped that in my first few years of medical school, my housemates were constantly commenting "I can't believe you are going to be a doctor, you're so dozy/clumsy/I can't believe you're going to skip a lecture!" etc. I know that I am a bit scatty, always have been, and this is something I have to fight daily in order to make sure I practice safely by staying organised. I never go beyond the reach of my competence, and I am honest with patients about this. Maybe if I can deal with my inner critic, I can start to let the rest of the world think what it likes about me.

Nothingishness

I am struggling at the moment with this blog. I seem to only blog when I am doing nights. I also seem to spend a lot of time feeling melancholy when I'm on nights. Somehow I see the negative side of everything. Eg going to New York with a girlfriend is no longer an exciting adventure, but scarey and selfish, because I haven't been away without mr me abroad since we got married. When I finish nights tomorrow morning I will probably become suddenly euphoric - that is what normally happens.

I think I've also not been blogging much because I've had a bout of sciatica, and sitting on hard chairs at computers seemed to be particularly bad for it. It's feeling much better now, but I am starting to feel a little old with all the aches and pains I've had recently.

Life seems very busy at the moment. There seem to be a million things on my jobs list, which I am constantly revisiting in an attempt to feel in control of it. A lot of things are admin to do with my training scheme, and my MRCGP exams are starting to loom large on the horizons of my thought. I haven't had to seriously revise for anything since my finals, and it is a bit of a psychological barrier.

So this is a grumbly post! I apologise, and shall stop now, and go take a little rest before baby checks at 6.30am. Tonight is the night the clocks go back, so my 12 1/2 hour shift is 13 1/2 hours instead. I think this may be affecting my outlook a little.

Nights

I haven't done proper night shifts for a whole year before this week. I did on calls in psychiatry, but they were 24 hour proper on calls that I did from home. There is a current shift from the previous pattern of doing 7 nights in a row of 12 hour shifts to splitting the week into a block of 4 and of 3 nights, which I think is much better, but the many things I hate, and few things I like about doing nights are coming back to me vividly.

I hate

• the constant nausea. especially when dealing with vomit, or the gunk on newborn babies, which was making me feel nauseous last night
• the loneliness. as a junior doctor at night, you are pretty much a lone ranger, you have a registrar, but often they go to bed, or in the case of this job, are busy on the neonatal unit. then there are the nurses, but often they are busy talking about things I don't understand, like off-duty. tonight they are having a bit of a rant about ward meetings and time owing. i don't blame them, but i cant' really join in. then i get home alone in the morning, and only see mr me when i wake up.
• the way my brain stops working. always disconcerting when mistakes are potentially serious. last night i mislabelled a blood bottle and mishandled my jobs list. tonight i feel a bit better because i slept during the day.
• the headaches, bowel disturbances, puffy eyes and general confusion about what day it is.
• the way i eat carbs constantly and put on lots of weight.
• the way i fall completely out of social circulation.
• the emotional lability. difficult patients, making mistakes, getting shouted at, death, extreme busyness can all become overwhelming. last night i cried just because i saw a baby born.
• waking up to find all the daylight hours have gone, i still feel rubbish, i have no awareness that any time has passed since i fell asleep, and i have to go to work in 2 hours. i know i shouldn't complain about this because a lot of people struggle to sleep during the day, but it is a bit depressing to find that the day has just vanished.

I quite like

• the random bits of time that i get to myself, for example the daytime before i start nights. i can't do anything too energetic, normally end up sleeping in and then pottering around sorting a few things out, but it is a kind of peaceful day.
• feeling useful. things you get called to on nights are more likely to be essential e.g. sick patients or deliveries. (doesn't always apply!)
• being able to say "that's a routine job, it can be sorted out in the daytime"
• learning. it's always a good time for learning because you are more likely to have to manage sick patients on your own, or do procedures. unfortunately the tiredness means i am quite likely to forget it again.
• feeling a bit special. always good for a bit of sympathy. you get excused from most daily tasks.
• having spare time to blog at work!

There seem to be quite a few things i like here, but this is misleading. The day in 6 months' time when I don't have to do nights any more will be a very happy day.

Sweetpea

I started paediatrics last Wednesday, and today was my first day working on the neonatal ward. The SHO mostly works doing baby checks for the one day old babies - making sure there are no abnormalities. I also have to attend delivery suite for all caesarian sections and deliveries where there is risk to the baby or foetal distress. Fortunately at the moment, a registrar is coming with me to the deliveries and teaching me how to resuscitate babies. But the babies are so beautiful!!! When you check for a cleft palate you put your little finger in the mouth. I felt very moved when one little baby started sucking on my finger. I am going to have to watch myself in this job, or I won't make it to the end of my training scheme! The registrar who is teaching me keeps calling all the babies and children "sweetpea", which I also think is very cute. That was it really. Extreme cuteness. Just wanted to share.

Disconnected things

I have a sore throat. I hope I am not getting ill.
My in-laws have been over today and we had a nice time. My mother-in-law was unable to stay out of the garden, so between us we got it tidied up quite a lot.
I am a bit worried about starting paediatrics on Wed. Haven't done any acute hospital medicine since this time last year.
I am currently on call, but haven't been called all day.
I was grumpy with mr me today for no particular reason.
My colleague who has become my friend is leaving Yorkshire tomorrow to take up a new post in the South. I will miss her lots.
The blind at the window is making my eyes go funny with its stripes.
Seeing pictures of myself on facebook keeps making me realise how much weight I have gained over the last couple of years.
Last weekend the friend that I secretly slightly idolise because of her willowy blonde-haired classic beauty got married to a soldier in uniform. It was a picture perfect wedding.
I have really enjoyed the friendships I have made in psychiatry. Felt that the people there were less driven, competitive, materialistic than a lot of doctors are.
I miss my mum a bit.
I am looking forward to the autumn. I hope it is a proper autumn and doesn't just continue to be wet.
I really have to go to bed.

if i can

It's been another one of those days. Those days when I go through the whole of my time at work without once remembering my true motivations for actually being there. (I'm being very honest with myself here). I seem to spend so much of my time working for my pay-cheque, for my career, for the goal of going part-time, to get the nurses or the managers or the patient's family off my back, for the prestige of being a doctor, to impress my consultant or help my colleagues, to learn, or on my worst days, just to get to the end of the day.

In fact, none of these reasons are enough to do the job I do. My primary reasons for working are - corny as it sounds - to help people who are ill, and to work to the best of my ability to give glory to God. The moments that I love my job are the ones when I suddenly feel that I am really connecting with a patient, whether that's because somehow the advice or medication or treatment that I am giving is helping, or, more often, because they feel someone is listening and understanding their pain.

On days when I am in danger of forgetting all about the real reason I am there because I am bogged down with all the other rubbish that comes with working in the NHS, sometimes this poem helps me.

If I can stop one heart from breaking,
I shall not live in vain;
If I can ease one life the aching,
Or cool one pain,
Or help one fainting robin
Unto his nest again,
I shall not live in vain.

Emily Dickinson

Ok, so maybe the end is more appropriate for an RSPB worker, but the rest of it fits for me. I hope maybe it helps you too.

Drained

I am sitting in my clinic room, having just finished seeing my last patient of the day, and feeling emotionally exhausted and unable to focus on anything at all, so thought I would have a little moan on here before attempting to do my dictation. In fact maybe I will do my dictation tomorrow, as I don't feel up to it really. This is really just a self indulgent grumble, so if that is annoying to you, stop reading now. I've just had a day of difficult patients. I saw my most difficult patient on the ward today, and she just fills me with such anger and guilt by a mystical process psychotherapists like to call "countertransference". By coincidence, I was presenting her case as my presentation to all the other doctors at the lunchtime meeting. I was doing this without the support of my team, who are all away this week, and I felt a bit insecure doing the presentation, as I was the person with least experience in psychiatry. Got some useful input from the other doctors though. Clinic this afternoon over-ran, I had several very distressed patients, one patient turned up stoned, and halfway through I seemed to lose my power of decision making and my ability to listen. Most of the time psychiatry seems like a bit of a holiday because we really don't spend as much time seeing patients as any other speciality, but I think that's necessary, because when you do, it's just so tiring... Think I need to go spend some time gardening. That always straightens me out.

Mangling Medical Careers

Just wanted to put a link in for anyone who would like to understand what is going on but is not a medic. This post explains it very clearly.

IMGs

It is a very bad time to be an IMG in Britain. For those who don't know what this means, an IMG is an international medical graduate - someone who took their medical degree outside the EU area. Life is chaotic enough for all junior doctors at the moment with the new system called MMC, where everybody is given their jobs through a centralised computer system and there is an entirely new system of training, as I briefly ranted about before here. I am one of the few to be immune from this intensely stressful process, as the people already on a GP training scheme are able to complete it without having to apply for anything else. Click on this link to see how it's affecting someone else in the system. So there is an immense amount of uncertainty around for most people, but it is much much worse if you graduated outside the UK and Europe. In March of last year, with scarcely any warning, the Department of Health announced that it was abolishing permit-free training for doctors from overseas. In effect this means that if an applicant for a post is from the UK or EEA, and is competent for that post, the post cannot be given to a doctor from overseas.


There are many reasons for this. Historically, 30% of UK doctors have been IMGs, they could train in this country without a work permit due to our need for their skills and the shortage of UK trained doctors. In recent years the number of UK graduates has risen and the number of doctors coming in from abroad has also risen due to the popularity of the UK for training and the access to the assessment exams to work in this country. This in addition to the reorganisation of jobs for MMC has led to a lot of competition for posts. While most people agree that it is important for all UK trained doctors to be able to get a job in this country, and that the GMC should stop encouraging IMGs to come to this country by continuing to conduct the PLAB (Professional and Linguistic Assessment Board) exams, it is the effect on those doctors already here that seems deeply unfair.


Doctors from other nations who come here first have to pass the PLAB exams (which are expensive), then frequently have to work in non-training approved posts to get experience to get to the final goal - jobs approved for training which can then lead on to registrar and even consultant posts if they are very successful. Many doctors have been here for several years, moving around different SHO (senior house officer) jobs, working away from their families (especially if they are married to another doctor), moving around, living in hospital accommodation, uprooting their families and working difficult shift systems. Suddenly many of them feel that it has all been for nothing, they will not be able to get onto training posts, and many will probably have to leave the country and try to start post-graduate training again elsewhere.


I am pretty aware of these issues at the moment, as I am the only UK graduate working as an SHO in this psychiatry department at my current hospital. The other SHOs are all IMGs and they all have a very high level of stress at the moment. Some have been shortlisted for interviews, some have not. Most have spent at least some time on the internet in recent weeks looking at jobs in Australia. One is currently in Australia checking things out there. Others are chasing round gathering information for their interviews, trying to second-guess what the interview process will be like. Several have been ill. A young Pakistani doctor who was working in the UK, and involved in the legal challenge from BAPIO to the DoH's decision has recently commited suicide. It all makes me feel very guilty, both that my job is so safe because I am British and to be part of a country that would do this to people who have been helping to provide a service to our NHS for many years.

talking for a living

Psychiatry so far is a little bit like falling into thick treacle. Have had to slow my brain right down so it doesn't particularly expect me to be doing something all the time. As I had been warned it is a completely different pace of life. But maybe it needs to be so you have time to process and deal with the volume of heartbreak or craziness that can come out of just one patient when you ask them everything about their life, which is pretty much what you have to do to take a psychiatric history. I know craziness is not a very politically correct word to use and I'm sure that sometime soon I will be saying "this person is suffering from paranoid delusions with a formal thought disorder due to drug-induced psychosis" with the best of them, but just now my immediate gut reaction seems to be "wow, this person is really mad". Think I will enjoy it, certain I will enjoy having more time for my life outside of work. I can even do my on-calls from home! Hoorah for being able to sleep in my own bed with mr me and just going in if I'm needed!

Has been wintry weather this week - snowed yesterday and there's a severe weather warning out again tonight, which has meant that me and my sister have cancelled plans to drive down and see my grandad in Hertfordshire this weekend. Maybe not strictly necessary, but I think he would have worried a lot about our journey. Much more so than if one of our husbands was driving us, I suspect. But then Grandpa is 89, so I suppose I may overlook his old-fashioned attitudes and not mind. Especially as mr me tends to be a much more confident driver than me, so I suppose he is right in a way. Anyway, we will rearrange to go down and see him soon. Will be nice to have a weekend with no active plans. Mr me had got used to the idea of having a weekend on his own, so perhaps I will go round to my sisters' and watch TV and drink wine...

Moving on...

One of the things I find difficult about being a junior doctor is the changing jobs. Just to explain my current training scheme... I started it in Feb 2006 and it lasts for 3 years, involving six 6 month posts. 3 are in hospitals, 2 in general practice and one half and half. So far I have done a job in A+E and am just coming to the end of my first general practice job. Next Wednesday (it's always a Wednesday - I'm not sure why) I shall start my new post in Psychiatry in a nearby hospital.

There are some good things about this system, but quite a few bad ones as well.

Good things:

• you don't feel stuck in a rut, and you keep learning new things.
• it makes you adaptable and better at getting on with people
• no problem seems quite as bad - eg you find a colleague difficult to deal with, you can say "oh well, I'll never have to see him/her again in a few months"

Bad things

• All the forms!!! Every 6 months I fill out a CRB form, a wages form, an occupational health form, a car parking form, a name badge form, and I have to show up with the same collection of important documents. This time I can't find my passport - not a good sign
• it is unsettling. my wages, my rota, my journey time all change every 6 months, not to mention what I do all day at work. this time my wages are going down. boo.
• because you know from the start, and so does everybody else, that you are only there for 6 months, you just don't invest emotionally in the job and the place as much as you would if it was permanent. and likewise people don't see you as a long term colleague or potential friend in quite the same way that they might if you were staying around. In hospital maybe the consultant never quite learns your name properly, or you don't fight quite so hard against the stupidity of the rota because as above, you know you only have to put up with it a bit longer by the time you've realised how rubbish it is. Or as in my current job in general practice, you're working with a team of people who know they'll probably be together the rest of their working lives. They know each others' families, habits, they remember weddings and births, mishaps, illnesses etc. And although they've all been kind and friendly to me, it's not the same and you can feel the slight (very slight) distance. It makes me sad and means maybe I don't expect to find lifelong friends at work. I think some people are better than me at this, maybe they live more in the moment, invest emotionally even though they know it's only for a short time, and are more likely to see colleagues outside of work and stay in touch afterwards. Maybe it is partly to do with the fact that I find initiating a friendship a little bit difficult. It's that step between "I like you and we chat about stuff and get on well" and "you are my friend and not just a colleague", that I find difficult to get over. Whether this is because of all the job changing, or whether I'm just using that as an excuse for my own hesitancy and insecurity I'm not sure.

Anyway, that was far too long for the content of a bullet point! I will be sad to leave this job - the people are all nice. Particularly enjoyable to rant along with the other doctors about the state of the nhs, the patients, hospital medicine - everybody except us really - at lunchtimes. Have got to know a few patients - some see me regularly as "their doctor" and I've never had that before. Have got used to finding out what happens to people instead of them vanishing off into the ether and never seeing them again, which is what happens in hospital medicine. Anyway, I could happily work here for longer. However, psychiatry sounds like it will be fairly relaxing, I had some good feedback from my GP trainer today, so there's not too much to grumble about. I can cope with moving on.

An average day in General Practice

Today I felt good. I saw a patient today with a problem which has been present for a couple of weeks and has been referred non-urgently. The problem has been getting worse since then, and is now significantly affecting his functioning. He and his family are very worried and asked if they could get the appointment any quicker. So I rang the (very helpful) phoneline for the speciality involved, and they arranged me an appointment for tomorrow morning. One of the rare occasions when you feel really proud of the NHS. So now the patient thinks I'm wonderful, and more importantly, his problems and his anxiety will soon be resolved.

Today I also felt bad. In my one hour tutorial with one of the GPs at my practice we did an in depth analysis of a case I saw on call just over a weekend and handled pretty badly. Basically I allowed myself to be pressurised into calling an ambulance for a patient when that wasn't the most appropriate thing to do. Going through your mistakes in detail for an hour is a very good learning experience. It doesn't make you feel very good about yourself though.

I saw 17 patients today and they all made me feel different things. Some made me feel sad for them, some made me feel uncomfortable, some made me want to bang my head against a wall, some made me confused, some made me feel like I'd done something good, some like I could have handled things better. Some made me feel I wished I could have got to know them better. Most of these things I now wouldn't remember feeling if I wasn't deliberately trying to remember. The general effect of all this is to send me home feeling a bit drained and with occasional moodswings. The ones I remember most are the ones I was a bit worried about for whatever reason. Sometimes if I try to remember all I've done in a day my head feels like it's in a fog. I expect this will only get worse when I go to 10 minute appointments instead of 15.

Anyway, why am I sitting at work at ten past seven typing this when I've only just finished my paperwork? I am going home to my lovely husband who is making me tea. Then I have to see whether the floor in the back bedroom is ready to be sanded at the weekend. Hey-ho!

First Post

Having been inspired by reading blogs of some of my friends I have decided to write one of my own. Used to keep a diary, but this is much more satisfying to the ego, as if I ever manage to say something clever, someone might possibly read it.

This is not intended to be a medical blog, as a) everything has to be completely anonymised according to certain rules and even so, I’d hate for any patients to recognise themselves, and b) I’d end up talking about the NHS and that would just raise my blood pressure far too much, instead of being therapeutic. Frustration may occasionally overspill into a general rant about patients or healthcare system, but that’s not the main thing I want to write about.

I’ve called the blog doctor/woman, because that seems like the main tension in my life at the moment. Sometimes it seems like when you’re a doctor you don’t feel allowed to actually be a person any more. You have to be a reflective listener, non-judgemental and professional at all times. Sometimes I get home after a day at work and start acting insane for an hour or so, dancing around and saying stupid things because I’ve been so sensible and professional all day. I’m not saying I think doctors shouldn’t be professional or non-judgemental, but it can be a strain. It starts to make you feel maybe you can’t have your own opinion any more and you can’t decide to run down the street shouting “I’m a weapon of mass destruction” and waving an inflatable carrot. And maybe you can’t. Maybe part of the job, particularly the job of a GP, is becoming a respected member of society. Which is why maybe I need an alter ego who is allowed to be a romantic, a bit of a dreamer, someone who gets excited and rants about things, someone who writes poetry, over-reacts, cries, loves surprises and occasionally binges on chocolate. In short, a woman…