GP TechLead

Aging can cause normal things to look seemingly abnormal, and can make even experienced healthcare professionals fluster and worry, even those that see older people on a daily basis. The care home rounds are one of my highlights of the week, it breaks up the normal week and allows for the continuity of care that is sorely missing in primary care these days. We start with a morning coffee, or in my case Mocha, and I run though the list of patients to see with the nurse in charge. One of the patients was an elderly lady whom the nurses had noticed a lump on the right side of her groin. They wash and dress her and apparently had not seen it before. Wasn't causing her any issues but the carers seemed worried about a hernia. 

The healthcare system in the UK is under immense strain. Hospitals are full, emergency departments are facing 12 hour waits and GP practices are closing. The ones remaining are facing huge workload pressures, of patient's demanding appointments from a dwindling numbers of doctors. A browse of GP facebook groups more recently have been discussions on how to manage this workload, from allowing unlimited emergency slots, to triaging carefully once all the appointments of the day are used up so only certain demographics are allowed an urgent slot (children, end of life, etc.), to just closing the list totally and directing all calls to 111. Which one to choose is very individual to the practice, a balance on providing what you can to your patient demographic to protecting your doctors from burnout. 

On Disney+, there is currently a great dramatisation of the opiate epidemic that started in America called Dopesick. It explains the unscrupulous methods that this pharmaceutical company used to market their drug Oxycontin to physicians: nice meals out, filling up their fuel tanks, trips to Florida to listen to pain lectures. It shows the devastation that uncontrolled opiate prescribing can do to patients and seemingly to those around them. In this country, we do get drug reps around here but they don't seem to have as much power to do that sort of thing here. When in hospital, I remember the makers of Vesicare took the urology team out for a curry one evening, and our consultant gave us a talk on the drug. It clearly had an effect, as I remember it clearly and it is front of mind for overactive bladder. In primary care, its more limited to 'educational lunches', the big companies bring M&S and waitrose food, smaller companies bring in tesco meal deals - definitely not...

 Doing a weekly ward round at a nursing home is interesting that you get to see people in their home and you get to see them very regularly. You tend to remember the patients a lot better and generally build a better relationship because of it. Because of that, you can tend to talk to the residents a lot less formally than you may do a regular patient. I had a elderly man who had a long term catheter whom i was seeing regularly for his skin ailments on his legs. The catheter was due to him not being able to pass urine freely, so it wasn't going anywhere. It normally was getting changed 6-7 weeks by the district nurses but more recently it was needed to be changed several times a week. The nurses at the home had an idea what was causing it however they felt they couldn't broach it with the patient. Every day after lunch, the patient was given 'alone' time with himself and his iPad and then following that, the nurses noticed cloudy sediment within the tubing and bag of t...

Primary care is getting busier and busier post-covid, the floodgates of people waiting to see their doctors have been open and staff have been wiped out with sickness, not least more covid. There has been a bit less GP bashing in the media which is a change, though I'm sure its coming soon. The new GP contract states that there will be Saturday 9-5 opening from October onwards - though how this will be staff will be very interesting indeed. I imagine this may be contracted out, and locums will have a good time if they don't mind giving up a Saturday.

Sometimes face to face is much needed to get a better idea of what is going on with a patient. Usually there are obvious reasons to bring a patient in for a face to face consultation: young children, chest pain, abdominal pain, shortness of breath and more. However the hard part of this age of remote consulting is deciding on when someone needs to come down. It could be the ambiguous history or the story that doesn't quite make sense - sometimes it's better to bring them down. However there is the constant thought of not creating too much covid-19 risk in your practice or putting too much pressure on your clinic.   One lady called in complaining of a weird smell from her armpits, she was smelling onions there. It wasn't just her though, her husband had also been smelling it. It was causing understandable anxiety and also meant they had to sleep in separate bedrooms, which was causing issues in their relationship. She had tried all manner of body washes and deodorants but t...

Prostate - a gland surrounding the neck of the bladder in male mammals and releasing a fluid component of semen. Prost r ate - lying stretched out on the ground with one's face downwards. Men's prostates inevitably get bigger as they older and inevitably most men would probably need their prostate's checked. I got one such man in my clinic. He had somewhat managed to avoid anything like that until he got to 90, but time finally caught up with him.

Whenever you go to get a X-ray at the hospital as a patient, you may be able to see the image if you ask the radiographer. However it definitely is not the norm and some radiographers may say it's best to wait for a doctor to review it and tell you the results. That's generally because whilst radiographers can identify some pathology on a scan, their role is not to interpret the scan and they may not be able to tell you what is on the scan. Also patients may see something they may not like on a scan and they will unduly worry themselves with what could be a normal scan.

Being a GP at the moment is not a popular profession. The perceived impression with the public is that we aren't doing any work and that we're just hiding in our surgeries. Media bashing and Daily Mail articles such as this  are fueling the hatred toward the profession at the moment. The government don't help - their new 'support package' aims to force face-to-face consults and demonise the bottom 20% of practices that don't see patients face to face. GP leaders have told practices to boycott this package and not give NHS England the information to vilify them. I imagine this won't be the last we hear about this package as several urgent BMA meetings are taking place regarding it's implementation.

Before the Euro 2020 final, the whole country was excited, people had forgotten about Covid for the time-being (in a good way), there was talk about a bank holiday being held in August if England won; Boris Johnson had advised employers to allow their employees to rock up to work the next day a little late. I had been asking all my patient's whether "it's coming home" as a light ending to my consultations. I think people appreciated it. People were in a good mood.    However we all know how the story ends. 3 penalty misses later and England came crashing back to reality. No extra bank holiday and still in Covid lockdown, people were in sour moods again. The next day, I was doing a duty session at my practice, urgent call comes on the list. Mental health issues. Call up this young woman in her 20's in tears. Turns out she got a tattoo on her forearm with the words "It's coming home, Euro 2020" and the England flag the day before the final. She was n...

Since the pandemic, GP's have been under fire in the media for supposedly not seeing our patient's face to face, not understanding that most of the changes have come under direction of the higher authorities who requested we try other methods of primary care consulting given the covid pandemic. I can't speak for other practices, but in my area, face to face consultations were still going on if there was a clinical need following a telephone triage or online e-consult. E-consult is an online triage tool that many practices have used to increase access to primary care, there are many but e-consult is the one I am most familiar with. Patient's who complain may have likely forgotten pre-pandemic waiting times for a GP face to face appointment, which could sometimes be up to 3-4 weeks. In this current system, people can get a phone appointment on the day and have their issue resolved, or get a face to face consult within a few days of that if needed. The main difficulties h...

 We had a new resident this week at the care home, a 90 year old man who seemed pleasant enough but with quite advanced dementia. Hadn't met him before but was on the round for an initial meetup to see what his baseline was and to go over a few housekeeping things. Due to covid, we have to gown up, face visor and glove up for every resident, which I normally I find very laborious but in this instance, I was glad got the extra use of PPE.

As a GP Trainee, I took a call from a middle-aged lady from Eastern Europe who had some problems urinating for several days, associated with some lower abdominal pain and back pain. She spoke very little English so she had made her young teenage daughter call in and translate over the phone. This is one of the issues of phone consultations, how can things like this be kept confidential? GPs don't have an easy way to get translation services for phone consults, and not one that would be quick to get. Asking about vaginal discharge is bad enough for a male GP, let alone getting a young daughter to ask her mum. 

As a parent, there are several topical parenting questions. One such popular question is “Will you give your child a smartphone?”. When I was young the old Nokias that could play snake was very popular, but I never got a phone until I was in 6 th form (and it was not a snazzy Nokia). I guess parents back then did not have the dilemma they have now.

Headaches are a common symptom in GP land. They ironically can be a bit of a headache for a GP to manage. There are a number serious headaches that need proper attention and during this remote consulting era, it takes a lot of clinical confidence to manage them over the phone only. 

Covid has really been tough for older people, being constantly reminded that this disease is a death sentence for them and having to isolate at home. What has been even tougher is older people in the care homes. They've heard through out the pandemic that Covid has been racing through the homes and a lot of the deaths have been in them. In the care home I help look after, the social isolation has really been getting to a lot of the residents. 

Out of hours is a service that provides primary care when the normal GPs have closed, so is usually available after 18:30 on weekdays and all the weekends. It is also available on bank holidays if the GP surgeries are closed (which is most of the time but during Covid, GP surgeries have had to stay open for 2 of the bank holidays). Ideally issues that are dealt with are ones that are more urgent that can't wait until  you see your regular GP, not a long term issue that requires investigations or referrals. 

Flu season starting and people are calling up to try get them done. Normal winters, most people can't be bothered but with Covid as well floating around, people are desperate to get it (in fear that they'll be a shortage). Nursing home residents usually get top priority as just like any transmittable disease, it can spread like wild fire in an enclosed space like a home. It usually is a given that most residents will get it but one relative of a resident did not want his dad to have it.

I had a young man come to see me face to face, he was worried about his testicles. He as worried they were too big. He hadn't noticed any changes recently, no previous medical issues. After examining his testicles, they were large but not abnormal. I asked what made him feel this way. It came out that at his work in the warehouse, there was a bit of a competition amongst his male colleagues. They had decided to see who had the biggest testicles and had decided to whip them out in the back office. My patient had been the winner but was left with undue anxiety of being the biggest testicles at work.

Doctors have to make difficult decisions. GPs generally don’t have to do so as much but occasionally a hard one comes our way. On my ward round at the nursing home, an old 110 year old man was nearing the end of his life. He lived a storied and interesting life, in the army, seen the wars and was an actual rocket scientist. He had seen better days however. He had many comorbidities and had a poor quality of life for several months now. We were treating him for a chest infection, and he had 4 days worth of his second course of antibiotics. His daughter, herself an elderly woman, was concerned about his well-being, he looked unwell, barely conscious and breathless. She asked what we should do once the antibiotic course was finished. I explained that we could either try a third course of antibiotics which may clear up his chest or we could decide that antibiotics aren’t working for this infection and let nature take its course.