Join me through a typical day in the life of a family doctor. Before we start, none of the patients in this article are real. They are aggregate patients. i.e the patients are made up but representative of real patients. This is how medical journalists, writers, and doctors deal with patient confidentiality when they discuss patients. Without further due, let’s jump right into the day.
Morning routine
It’s 7:00, my day starts with my alarm clock. The first thing I do after I get up is make my bed. It takes a few seconds. I sit down and meditate for 15 minutes. I use the loving kindness meditation by Emma Seppala. Next, I journal a few lines about things I’m grateful, what I’m looking forward to. At 7.30, I brush my teeth and do what I have for general body maintenance. I drink tea and eat granola for breakfast.
Next, I get dressed and drive to work. I get in at 8.50 and find out the consulting room I’ve been allocated. I log on the computer and have a look at my clinic list for the day. Being a generalist is interesting as I get to see wide range of cases. I look at my mails to check for abnormal blood tests that require urgent actioning.
Morning clinic
Before seeing my first patient, I usually glance at the patient’s record to get an idea of the medical history. At 9:00, I call my first patient. His wife has noticed him snoring and heard him making weird noise while asleep. The man was not worried but came in because his wife kept nagging. The patient described features of obstructive sleep apnea syndrome with daytime sleepiness. I assess him and explain my thoughts. We discuss the implications on his fitness to drive and I refer him to sleep clinic. Once the patient leaves, I document the consultation in his record and make a note of the referral.
Being a holistic doctor
I get ready for the next patient who is an elderly man presenting with multiple problems he wishes to discuss. Being a holistic doctor, I often encounter patient with whole list of problems in my practice. The man had a very long list of problems. He complains of persistent abdominal pain, eye problem, anxiety and so on. An advice I received from a senior GP is to ask the patient to hand you the list and take back control of the consultation. This sometimes help to avoid a consultation from derailing. Due to insufficient time, it is challenging to address multiple problems in a consultation. Most patients are aware that their doctor is allocated limited time per consultation. Sometimes, patients expect to have all their problems sorted in one consultation and unfortunately it is unfeasible and unsafe. I prioritise the most pressing problem and recommend booking another appointment as we need to give enough time to discuss the other problems and unfortunately, we don’t have time to go through everything in today’s consultation. The patient understands and I advise him to book a double appointment to discuss multiple problems in the future.
I’m now running late as the last consultation took longer than expected. I call my next patient, a toddler who presents with urinary frequency. Mum is worried that he has been peeing a lot. He denies any pain or burning on passing urine. Otherwise, the little boy appeared to be well. I ask mum whether we can get a urine sample to analyse. Polyuria could be due to various causes. The urine dip stick was clear, excluding a UTI. Diabetes Mellitus is a differential worth considering in this scenario.
The effects of COVID-19
The next patient is an infant who presents with fever and lethargy. I see her in our isolation room with PPE. Mum is concerned that she has been clingier and is keen to get her checked. The pandemic has drastically changed the way we work at the practice. Patients with symptoms suggestive of covid, i.e cough, fever, loss of taste or smell are triaged to be seen in the COVID Hub isolation room. I assess the patient and was reassured to see she is not as sick as I anticipated. She has a low-grade fever with coryzal symptoms but is alert and active. I explain to mum my impression, the next steps and what to look out for. She is happy with the management plan. A useful resource to improve your clinical skills in assessing children I’d recommend is spotting the sick child. I carry on my morning clinic and see 9 more cases ranging from migraine, hip pain to chest pain.
Home visit
At 12.15, I finish my morning clinic. I have a look at the house call book. GPs usually do their house calls during the gap between morning and afternoon clinic. I drive to do a home visit.
I see a frail woman with bowel cancer whose family members are concerned that her health has been deteriorating. House call is a service to people who are bedbound or are unable to come to the surgery. Visiting a patient at home enables doctors to also see the environment where the patient lives.
Admin tasks
At 13.10, I drive back to the surgery and document my house call. I dictate referral letters for the secretary, go through blood test and radiology results that have previously been requested. I action them. Admin work includes reading clinic letters from hospital that I receive and action. I sign prescription scripts and deal with queries receptionist may have. Then, I catch up with the secretary about referral and queries she may have. I have lunch at 13.45. On some days, I may attend meeting where we discuss specific cases.
Afternoon clinic
At 15.00, I start my afternoon clinic. The theme for the afternoon clinic is dominated by mental health disorders. I see a man with depression and suicidal ideas. He seems to be struggling and needed help. Psychiatry is a big chunk of the workload in general practice. Lately, I have encountered younger people suffering with anxiety and low mood.
The pandemic has caused a huge amount of stress and anxiety and affected the livelihood of many people. The next patient is a teenager with severe anxiety. She has been struggling to go out and is afraid of catching coronavirus. The parent seemed to be at a loss what to do and came to seek medical advice.
The next patient is a woman who suffers with bipolar disorder. She has been struggling to sleep due to overthinking. Having previously seen the patient, I knew her well and built rapport and trust over time. We discuss her problem and look at what can be done to support her. Having continuity of care with my patients is something rewarding. You get to know patients and develop a doctor patient relationship that enhances patients’ experience and care. I see around 10 patients in the afternoon clinic and go over some of the remaining admin work including referral letters, going over blood tests and clinic letters. At 17.30, I finish and drive back. When I’m rostered to work evening duty, I finish later at around 18.30.
Thank you for making it to the end of this article, I hope you enjoyed reading what it’s like to work as a family doctor.
