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The other side of the desk

Coalface tales

James Booth

Thursday, 23 January 2020

AdobeStock_136191409_blog.jpgA bit of a different blog this month, to the one I’d planned, and one written after a rather unexpected turn of events. I’m sitting at home writing this, having spent Monday on the local ambulatory care unit and yesterday at the Essex Cardiothoracic Centre, getting a CT coronary angiogram. I started my working week by developing a rather startling degree of left sided chest pain, and with the somewhat strange experience of seeing my experienced and caring practice team clustering around ME. Now, one ambulance journey, several ECGs, multiple cannulas, some GTN and aspirin, and a couple of very impressively high-tech cardiac investigations, I’m at home with the dust settling and unpacking the events of the last 72 hours. 

First and foremost, the care I have had was just fantastic. My partners have all rallied round, one of my colleagues in particular has been truly kind and dedicated in stepping up, and I was helped by a few calmly professional paramedics, nurses, and met each step of the way with professionalism and excellent support. I’m truly grateful to the local cardiologist who organised some speedy investigations (and let me look at the incredible scan images in the reporting room after). People are quick to knock the NHS, especially during times of struggle, and whilst there are undoubted difficulties in the system, I genuinely felt that everyone I met was doing their utmost to provide a first-rate healthcare, and succeeding. The gratitude I feel is made all the more sincere by the fact that I know just how busy and pressured the system is at the moment. 

It’s disorientating being a patient. I’m used to hospitals, I’m used to medical tests, but I found I lost complete track of time and had a sense of bewilderment throughout. There’s a sensory overload to a busy ward, and this is made all the more acute by a feeling of lack of control. It’s made me reflect that my feelings must be vastly amplified for those with dementia, with autism, with a sensory impairment, and I now wonder how my own surgery appears to these people and those like them, especially when busy and noisy. The most useful thing when my nurse and fellow GP made me lie down and have an ECG was being told firmly that they were in charge; I do wonder whether a bit of friendly paternalism has a role here. Patient choice is crucial, but there’s something to be said for being allowed to be directed. I wasn’t able to choose what sandwich to have for my lunch, I was so overwhelmed.

Good communication is so vital. My wife isn’t a healthcare professional, and explaining to her what was happening made me realise how easy it is to take a level of knowledge for granted, and a new insight into how vague some medical terms can seem – “heart disease”, “a heart tracing”, “the ACU…”  There is such a gap sometimes between the precision with which we can communicate with other professionals and how we speak to patients and their relatives. I think this is a real primary care core skill; I often seem to act as a sort of post-event clinical interpreter. It can feel frustrating at times to have to do this, when busy, but I have really seen the need for that this week.

We also work in a time of clinical wonders, and the technology that can be marshalled for our patients is incredible. I’ve now seen my heart in 3d, and watched as a PC created a virtual image of my stretched out coronaries. My acute echocardiogram was carried out with a device the size of an iPhone and a fountain pen. As I looked at the incredible imaging, I rather geeked out over it, and that was met with a rather dismissive comment that the new one would be even better (“This one needs four heartbeats to get the data, the new ones only need one.”) I rather love the hands-on clinical examination skills of primary care, and have really enjoyed teaching that to students this year, but it’s easy to feel some distance from the cutting edge during morning surgery. There’s some incredible stuff being done out there.

Anyway, I’ve seen my own GP today to get my statins, and sort my blood pressure out. It’s odd to be sitting in a waiting room, and I had some particular envy about his ability to run to time! Again, though, I was taken by how comprehensive the care has been, and how important primary care is in the NHS equation – I’ll be seeing him a bit more regularly in the future, I think. I reflected, though, as I saw so many people pass through the surgery whilst I waited, just how much we do in the NHS, day by day. My experience today is replicated over 300 million times a year in the UK; I was one of thousands who needed A&E on Monday. How remarkable, then, that everything felt so personalised to me. We do a good job for our patients, and we need to remember that. We also sometimes, I think, benefit from being on the other side of the desk ourselves.

One final note:  I can’t finish this without thanking all of my colleagues at Chelmer Medical Partnership for rallying around this week, in particular my colleague Paula, who has been a complete star bearing in mind that her first patient of the week was – unexpectedly – me. I am very fortunate to be part of such an amazing team. 

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James Booth

James qualified from UCL in 2002 and has been a GP partner in Chelmsford since 2006. He is also the named GP for Safeguarding Children locally. All views expressed are his own.
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