u/Worldly-Chicken-307

I try my hardest with patients but in my experience this cohort of patients can tricky to treat. I try to stick to recommended treatments but there’s often a negative view of pharmacological and psychological interventions, and I’m finding that a lot of the patients with this diagnosis also have a large amount of medication sensitivities. Often, they go from doctor to doctor- particularly registrars. I don’t really understand why some of them need regular reviews and the conversations seem more suited to something they could have with a friend and a cup of tea, rather than updating me with non medical information about their life since they last came it a week ago.

When it came to step 1- seemed to be easy to find what materials are the absolutes and which are recommended.

But what about step 2? Which reference books are handy? Where do I find off line NBME forms (step 1 had some google account where a load of resources were stored, which was absolute gold but I don’t know if it had step 2, or where to find it anymore!).

So far I’ve done Amboss daily since passing in December- about 10Q a day, but then I also see around 30 random cases in gen med clinic and read up on them. But I need to lock into a proper plan now.

Keep getting letters saying they will see patient in clinic in 3 months, or whatever, and they have asked patient to have their bloods done at the GP, or simply ask us to ensure the blood test is done. Typically this is an ‘up to date’ U&Es, PSA, HbA1c, repeat chest X ray, TSH, BNP, LFT etc. We already do our own annual blood tests or whatever is needed as part of our own health checks etc. it’s causing issues as I then have to text patient as it’s not always clear who initiates the reminder or if patient definitely knows, I have to request the bloods on ICE, then the patient has to call in to book the appointment with the phlebotomist. Often the request is lost due to system updates so someone has to request it AGAIN when the patient actually attends. Then there’s the interpretation- the reviewing doctor at the practice might be different and then has to look through the notes to see what’s going on. That’s a LOT of extra steps to them having bloods in hospital. And annoying thing is we get a copy of bloods that hospital have done and that requires some digging to find out who initiated it and will follow up- as it gets flagged by the lab. I’m tempted to just start to file the bloods and put consultant/patient to initiate the blood test, and then they can attend and myself or a colleague will make sure a request is put on when that happens. I feel like as GPs we have our own bag, and I’m not the hospital’s bitch. Even nurses who are under ‘specialist clinics’ are putting requests for bloods every few months for their clinics- fuck off. Pardon my language, and I might get downvoted for this, but it’s pissing me off no end- and we’re getting A LOT of these bloody requests. Recently Respiratory started a patient on a biologic which shagged the patient’s kidneys. They wrote saying ‘we tried to contact patient but no answer’ and they wanted us to sort admission or daily blood tests. Fuck off! I wrote back stating it’s an interstitial nephritis and patient refused daily bloods and that we’d do them when they were actually able and willing to come in to have them. Bizarre part was they wanted us to stop any meds which were renal toxic- yeah- like the one you started! Separate letters from the nurse specialist and then consultant dumping on us to sort out issues they’d started.

In the last 15 years things have gotten increasingly complex. I remember doing discharge letters in hospital and everything was simply written, drugs started, stopped and any actions for GP- which was usually nothing. Now I’m getting discharge letters and clinic letter which have war and peace monologues, and it’s hard work to decipher what has gone on. I realise this might also be the area that I’m in, and some departments in our hospital are really struggling. In our general practice we’re offering and delivering more than ever- minor ops, ear suction, irrigation, joint injections, all kinds of injections, skins checks with dermoscopy etc etc. But patient demands are also going up, and this is in addition to those demands by hospital. We had a discharge letter saying ‘GP to repeat U&Es within 5 days. Got the letter through on Thursday night. Now how the hell and I supposed to see this, decipher what the reason is by a cryptic discharge letter, having to logon to the hospital results system to see what the blood results were and then request it at my end, and then get the patient to agree to a date and time to come in and have it done. I’m not the hospital’s junior doctor, and also there was no reason to recheck so soon- considering that it was a mild AKI at best. Fucking nuts, and this is the tip of the iceberg with the shit we’re dealing with. And there’s visiting homes after paramedics have flagged the person, we arrange blood tests, refer to social services- only to have them call up and demand to speak to me before they finish their shift, telling me that despite the person is living in squalor with dementia- that I have to go out again and do a formal capacity assessment, and that I can’t merely state that they clearly don’t have capacity given x y and z. Patients always attending with 3 issues, sometimes they’re interlinked or 2 issues take a minute to lay to rest. But that all still causes decision fatigue. The bloody system is totally shagged. I’ll probably get downvoted by the part time champagne supplying elite.

America has been a dream idea and everything’s shattered, especially me. I didn’t smash Step 1, and now I’m exhausted. I spent a whole year out studying for step 1. I even spent 6 months working and studying and it left me broken. Why even bother?! How is this even life?!

What’s this corruption I keep hearing about when it comes to the ferries?! People mention it like I’m supposed to be aware, but I don’t know the ins and outs of any corruption going on. If anyone can fill the gaps- many thanks!

When a colleague leaves and you’re already in a practice where the bosses block out clinics to go faff around on meetings every other day, how do you stop your clinic becoming even more untenable? Maybe it’s a suck it up and see. But I rather like having the occasional free slot to try and tackle the mountain of admin, but now I doubt I’ll get any form of respite. Especially once summer is over and autumn looms. I fear I’m totally cooked.

I think probably yes! Our histories are intrinsically linked. Best of luck in the sorld cup.

I often get the ‘so where are you from?’. And then ‘where are you originally from?’. Then ‘where are your parents from?’ And then ‘where are you originally from?’. And then proceeds to tell me about a holiday they went on to a completely different country where they think I’m from. Do all you GPs?

I love the curiosity, and my patients feel confident and comfortable enough to ask my ‘heritage’ as someone put it. But here’s the thing, no one ever asks an ethno British or ethno-Dutch South African South African where are you originally from. Or maybe they do?

I feel like having a slight tan and being mixed, a boring south east accent and having an Irish surname makes people confused. But who cares?! I used to get asked that a lot in Australia too. I just want to do my job without the questions and comments. Even someone who who’s dad was Ugandan and mum was English said I cant have any East African connection despite both my parents being from there and being born there because ‘you’re not black’. My son is American and there’s never any doubt about that. Sure, he’s not Native American, but no one is saying he’s ethno-‘blah blah’-American. Reminds of a New Zealand lass who was on an elective in a pacific island, but people used to ask her where she was really from, despite being of Māori descent. I remember being in a northern hospitaland someone asked ‘I bet it’s hot where you’re from’. And I replied ‘Cambridgeshire?’… Then I eventually realised what he meant but I was already halfway down the corridor.

Have an exam which I’m looking to sit within the next year. I’d made the commitment a couple of years ago and I’m keen to finish this medical exam. Tired after work, so i lose a few days a week of study.

Around 2018 myself and a friend travelled extensively around the W.Bank and that region of the Middle East. We visited some of the holiest sites of three major religions- all within a short distance of each other. However, I fall short on commenting my opinion on any of this as I am not brave enough. I was interviewed by the BBC a few years ago and my take was that leaders had to come together and discuss these issues to avoid blood shed of innocent lives, but that’s my only take on it as I don’t know enough about the complexities. I spent 3 years working in refugee medicine, so I’ve seen some of the fallout of war when it comes to healthcare. I’ve also visited the North of Ireland and I was surprised but not shocked to see the murals relating to the Middle East- with a bit of that ‘enemy of my enemy is my friend’ situation. I’ve seen some cases of people getting reported to the GMC for commenting on this stuff. Seems the atmosphere is getting increasingly hostile, and meanwhile regular folks suffer.

Pt asked to read consult notes and I had to redact certain parts regarding MH issues they’re having due to concerns that it’ll affect insurance, especially with their intentions to do extensive travel. They intend on returning to discuss these issues in more detail in near future.

My thoughts: these are medical notes that we use to keep track of patient care, which patients have access to but can’t dictate. I also don’t want any complaints as I’m ‘just’ a salaried doc, and my practice doesn’t have my back it seems (PM is ‘customer focused’ and previously not from hc b/g).