Venue: GP Surgery 1
Today, I went to a GP Surgery to gain some work experience. I was pleasantly surprised by this experience as I thought General Practice would involve the doctors engaging in a very repetitive role and would be slightly monotonous. However, I was very engaged during my time there no I found it incredibly interesting listening to the patients as I found they all came with different issues and not just the common ‘coughs and colds’ as I had previously assumed.
At first I spent my time in the Reception area and I noticed the way the administration team dealt with patients as they came for various reasons whether it was to book an appointment, for a consulatation, drop off requested samples or pick up prescriptions. I learnt that the receptionists in a surgery are becoming increasingly more busy and are involved in collaborating with a range of different health institutions. There was a Chemist which was situated a couple of doors away from the Surgery and I got the opportunity to see how these two institutions collaborate to provide care to a patient. The patients would go to the Chemist to request a certain type of Medicine. If that medicine had to be prescribed by a doctor and couldn’t be bought from the chemist they would add the request to a list along with the patient’s name. Every morning the list is brought to the Practice and the receptionists send a request to the doctor’s asking them to prescribe the medication of they think it would be suitable for that patient. The doctor must then check it and he/she believes it is appropriate; the prescription will then be signed and placed in an alphabetical filing system for the patient to collect and take to the Chemist to collect the Medicine. I was really grateful to have been able to gain this incredible insight into how the Chemist and the Surgery cooperate and am able to reflect on the significance of all the people involved in checking the medication and playing their role properly when dealing with prescriptions.
During my time in the reception area, I was taught how to deal with the prescriptions and check if the doctor had signed them yet. I took the responsibility of sorting these prescriptions so when the patient came for collect it, it would be all ready for them. If a patient came to collect their prescription I had to find the relevant one, check the signature and then hand it over. Although my role was only small, I am able to understand the importance of this job being done correctly as if it wasn’t, the relationship between the doctor’s surgery and the chemist wouldn’t be so well established and it would cause confusion among patients. When carrying out this role, I was able to gain a deeper understanding of confidentiality within the medical profession too as parts of the old prescriptions were often kept in the office as scrap paper. However, I had to be careful which parts of the prescription I placed in the scrap pile as any pieces with names of patients or any other identifying information had to be placed in a separate metal box so they could be disposed of carefully without revealing any confidential information to anybody who shouldn’t have access to it. This made me realise the level of awareness that is needed when dealing with private information of patients.
During my time at the Surgery I was also able to learn about the introduction of a new policy regarding taking urine samples of patients who believe they have a urinary tract infection. All NHS services are trying to save money by doing jobs more efficiently and I was able to experience this in the GP environment as this new policy was aiming for less urine samples to be sent off for testing. It was explained to the administration staff that too many samples are already being sent unnecessarily and this was causing the process to become slower for patients who actually needed it testing.
I also learnt that doctors spent their time in Clinic in blocks, and in this particular surgery had a 20 minute break in between. I realised the importance of this as doctors must be alert for all their patients so it’s necessary that these breaks are out in place. However, most of their breaks were being filled up with emergency appointments and with patients who had come in thinking their appointment was today and had pleaded with the receptionists to get squeezed in. I noticed the way the doctors and the other staff were willing to bend their schedules in order to fit a patient in and make them feel satisfied. I know that this is a good trait to have as doctors are here to serve the needs of the patients, however it is also very important they they do no overwork themselves in this manner and are also ensuring that they are able to take on this workload.
After one of the doctors had finished their first break, I went into clinic with them and was able to observe some consultations. I had to introduce myself as every patient and gain consent that I was in the room. They were all happy for me to stay and watch, but I still recognised the importance of making sure the patient is comfortable with this patient-doctor consulatations are often very personal and confidential.
The first patient I saw was an elderly lady who had a chest infection. The doctor listened to her chest using a stethoscope. I was also given the opportunity to listen to her chest and noticed a significant rattling sound in her chest which indicated that she was experiencing some breathing difficulties. I think it’s very important to be quite observant when examining a patient in order to look, listen and notice anything which may indicate the patient is unwell. I noticed that the doctor asked her what she wanted to achieve from the consultation which I thought was very important as it focussed the attention on her and allowed her to communicate her worries. She said that she wanted to be prescribed some antibiotics. The doctor asked her a few more conditions in order to be sure that the diagnosis was correct as the antibiotic crisis is currently already an issue and a patient shouldn’t be prescribed any unless it is absolutely relevant for them. He concluded that it was appropriate to provide her with the antibiotics and then informed her of the importance of finishing her course of antibiotics. I think communication is a key skill to posses as a doctor as you just be able to pass on important information such as finishing a course of antibiotics without appearing patronising or making the patient feel inferior.
The importance of this care whine prescribing antibiotics was demonstrated with another patient who I was able to see today. This particular patient was an acrobat when she was younger, and now being of 83 years of age she came to the Surgery due to a suspected chest infection. She thought this as she was was finding it difficult to breathe. The doctor listened to her chest once again, but this time her chest appeared to be clear which suggested that she didn’t have a chest infection. This taught me the importance of physical examinations as a patient’s suspicions are not often right and a doctor must create the diagnosis for themselves. Looking at her medical history it could be seen that this particular lady had an operation for schemed heart disease in which the arteries carrying blood around the heart became narrowed 7 years ago. She showed me a slight scar left on her chest from the operation and said that she is very pleased with the result as the mark was much more apparent when she first had the operation. This demonstrates the value of the cosmetic aspect to surgical procedures on the behalf of patients. This patient’s issue was definitely not due to an infection and therefore prescribing antibiotics was not necessary. I am able to reflect that a person’s medical history should always be checked before making a diagnosis as that can provide very important clues for their current state of health.
As well as diagnosing and prescribing patients with medicine GPs are also involved in follow up appointments. I was fortunate enough to be able to sit in on one of these with a gentleman who had a long history of high blood pressure. This particular appointment had been made to check his blood pressure and see whether the medicine he had been prescribed earlier had helped. The doctor placed an automatic blood pressure machine on his arm and and had to check for a regular pulse before the measurement was taken. After he check the pulse was regular, I was also able to feel it. The first blood pressure reading that was taken was too, high but the doctor said that this could have been due to the fact that the patient walked to the surgery and be gore a blood pressure reading is taken the person has to be sat down and resting for 20 minutes so this wasn’t necessarily an accurate reading. After a five minute wait, he measured the blood pressure again and this time it had lowered to a more appropriate level of 150/83. I noticed that everything the doctor did he recorded in his notes, even the incorrect measurement which was made when the patient first entered the room and this made me learn the importance of filling in patient records and having an attitude of willingness by not cutting any corners or trying to shorten the consultation times in any way.
One of the consulatations I watched was with alarm who couldn’t speak English so she had her husband com dingo the room with her and he was translating what she was saying. The translation suggested she was worried about a rough itch patch which had appeared on her cheek. I was able to feel this and notice that it was abnormal compared to other parts of her skin. Visibly it wasn’t clear that that there was an issue but upon examining it properly you could tell that her skin needed some attention – this again demonstrated the importance of physical examination to me. I also noticed in this consultation the difficulty of communication due to the translation. The lady was attempting to say something, but we could not have been sure that it was translated correctly for the doctor to understand. This allowed me to understand the limitations of receiving symptoms off a patient from a third perspective and I am now able to reflect on the potential usefulness of being fluent in other languages as doctors have to be able to cooperate with and relate to many different types of people from many different backgrounds.
The last patient I saw was a lady who was experiencing severe lower back pains, she came in to request a prescription of stronger pain killers as she was worried about coping on a busy Christmas Day. Later when I spoke to the Practice Manager she told me that the GP is more busy now than it normally is due to the fact that they were closing in a few days for Christmas and many people feel as though they won’t be able to cope. Her comment made me think of this particular patient. In the consultation, the doctor made her do vertical leg lifts and applied pressure on parts of her back to help identify what the problem may be. She didn’t seem to have any problems with her legs as the pain wasn’t radiating there, but was having difficulty moving from a sitting position to a standing position, which the doctor told me indicated that these pains were due to wear and tear. As he was prescribing the medication, I noticed that he checked the allergies of the patient and this meant that he couldn’t the medicine he was originally hoping to. This made me understand the need for a doctor to be alert and thorough and I learnt that these are qualities which must be demonstrated in every day work for a doctor as patients are relying on you all the time.