A day in the life of a GP
By Dr Nicholas Hamilton
So its lunchtime, I’m quite hungry and it’s been a fairly typical day in general practice……….
8am The day starts with a regular patient with long term lower back pain, hypertension and gastric reflux. He’s done very well to lose about 15kg over the last 6 months which has helped all 3 issues but his back pain is starting to limit his enjoyment of walking now which is affecting his weight. I’ve referred him to a good local exercise physiologist for some specific exercises to do at home for his back, organized a repeat gastroscopy with a specialist due to some cellular change he has in his oesophagus at endoscopy 2 years ago and we’ll continue his current dose of blood pressure medication with the hope that further weight reduction will keep that issue in check.
8.25 My next is a new patient, a 13 year old who reports a long term desire to change gender. The concerned mother has gotten my name from some online forums as someone who’s hopefully able to help the family navigate this difficult problem and the medical system which has been slow to catch up with patient needs in this area. We have long discussion about the issues and I give them some advice about future directions, some resources I’ve gathered in this specialized area over the last few years and make some referrals to a good local psychologist and a Sydney-based specialist.
9.00 Next on the agenda is a 90 minute teaching session with one of our excellent registrars. She’s in her final year of general practice training so these sessions are more of a discussion around approaches to particular patients and navigating the health system. A large part of the teaching session consists of me asking testing questions of our registrar around her professional boundaries and obligations. She handles all of the questions very well. She has a good knowledge base for general practice but some of these things can’t be read about and learned from a textbook.
10.30 Next appointment is a regular patient for an influenza vaccine. She is concerned about her kidneys as she’s been getting pain in the region and has long-standing kidney problems and a friend recently died of kidney failure. To add to the complication, she is off on a 6 month walking holiday through Russia in a week. Not bad for someone in their 70s. I take a careful history, undertake a clinical examination and some office-based tests and feel that I can adequately reassure her that she will be fine to leave next week and the pain is just a muscular issue which should get better with some stretches.
1055 Next appointment sets me behind by half an hour. I’ve asked the husband of a long-term patient with dementia to come in for a consultation just with him and me. We talk about the future care needs of his wife, what community supports are available to keep her at home for as long as possible because that’s what they both want. Her dementia is worsening and there is no effective treatment for it. We try to plan early regarding advanced care directives, legal processes and nursing home options so that if my patient’s care needs escalate and she can’t continue in her own home, things are set up and ready to go in the months or years ahead.
1130 Next on the list is a 3 year old girl who has been unwell with fever recently. She hasn’t been sick enough to require hospital review but we’ve seen her at the practice 3 times in the last 5 days to monitor her. Her urine cultures have been negative, meaning she doesn’t have a urinary tract infection as first suspected. Her examination today is improved with no temperature, normal heart, lungs, ears, throat, abdomen and no rash. She’s back to her usual self today and ripping my room apart which is a good sign, it looks like it was a simple viral infection.
1145 Two brief consultations next, one for a repeat script and then someone with a cold who needs a few days off work and then I get called to our nurses area. A patient is back for stitches to be removed after I excised a 2cm cancer from her back last week.
1200 My final patient for the morning is another long consultation. It’s a regular patient who has battled with a lower back injury sustained at work 5 years ago. She’s seen over a dozen specialists, had back surgery, seen physiotherapists, chiropractors, massage therapists and psychologists. She continues to be in pain and unable to return to work. She is finding the whole process very mentally exhausting. We explore her remaining options to get her work conditioning back which will be difficult through the insurance processes but I am confident with the right push in the right direction, the right support and some adjustments to her medication, she will be able to return to work in the next couple of years.
1300 Time for lunch. I make a few quick calls to chase up results for some patients and then unwrap my sandwich. I take a few bites but then the receptionist comes into the tea room to let me know a patient has walked in after cutting their hand at work. They’ll need a few stitches and a tetanus shot so the sandwich goes back in the fridge for now………..