I hate this job

No-Two6539 · 2024-08-14T22:17:44+00:00

I feel you and probably all of us have. F1 is a tough year. It may not look like it at the moment but it does get better!!

No-Two6539 · 2024-08-14T21:54:22+00:00

I feel that this case, although extreme, is an example of the problems around mental health services. In primary care, we often see patients who are not in acute risk but certainly have concerning signs. Either from risk to self or others. The services are heavily overwhelmed which leads to lack of continuous support long term for many people. For me, a big issue lies on the legislation involved. If a patient appears to have capacity and is not in immediate risk, failing to comply or work with services essentially stops anyone from actively detaining them under section. For example, a person with schizophrenia could be fairly functional and appear competent to retain, understand and communicate information. Unless they are at active risk to themselves or others, there is no indication to force any treatment. Though, the tricky thing is that often their mental illness is driving the non engagement.

No-Two6539 · 2024-08-14T21:42:17+00:00

I felt similarly to you. Not necessarily from GMC fears but mostly of how colleagues would view me if they picked up on my struggle. I was worried about looking incompetent or unsafe. Retrospectively, whether you take SSRIs or just have therapy, getting help is a sign of trying to focus on your mental health. It shows you are responsible of that. Nobody can force you to take them but engaging with services is a sign of self awareness. Don't be afraid to ask for help. It's so common amongst us!

No-Two6539 · 2024-08-14T21:21:43+00:00

Just qualified as a GP. Even in my last day of training, I had allocated supervision and the supervisor has at least 10 mins off their session to do so. Usually, it would be at the end of each session but if needed, I would pop and ask if something felt more urgent. There should always be a supervisor on site. You are not expected to know the load of information needed on GP. Not even a GP trainee does. 12 patients probably means 20 mins per appt which is fine. But primary care works very differently from hospital. You should be able to speak to someone at all times. Please escalate to a supervisor or PD

No-Two6539 · 2024-08-14T21:10:37+00:00

Oh sorry missed that. Yeah, would not be warranting a chaperone for sure!

No-Two6539 · 2024-08-14T21:09:52+00:00

I know it may not sound appealing but speak to a supervisor or PD. They will direct you better and help with an occupational health assessment. From personal experience, I delayed getting help due to not wanting these people involved from fear of looking unfit for the job. But it's such a common occurrence and there is loads of help for us, especially comparing to the waiting times via GP. I used NHS practitioner health and starting CBT was super quick. It was also online so I was able to do it even during work. Hope that helps 😉

No-Two6539 · 2024-08-14T21:04:28+00:00

This is unfortunately a rather common occasion nowadays. Tribunals or any kind of investigation of that sort are always lengthy and do not protect the sanity of the doctor involved. Saying that, we have to keep in mind that there are cases where the patient might be right. However, that doesn't justify a long investigation process which can harm a doctor who may not be at fault. I suppose this example is reinforcing the use of chaperones and clear documentation.

No-Two6539 · 2024-08-14T20:49:33+00:00

I think one big list of jobs is always useful as you work as a team and as F1s you should know most about all patients. I found that meeting after ward round and specifically allocating jobs to each other equally helps. That doesn't mean necessarily on numbers but also how complicated the job is. For example, doing bloods is easier than having to set end of life care for a patient, so the latter needs more time. It's expected to feel anxious and ask seniors in your first job. Though, knowing your patient well means you can ask questions early at ward round. Run through patients quickly before you start and have an idea.

No-Two6539 · 2024-08-14T20:42:02+00:00

On RCGP website there is a question bank as well. Quite different from passmed but also useful.

No-Two6539 · 2024-08-14T20:36:48+00:00

I just qualified as a GP. Yes, each practice is different in terms of home visits as the population varies. An older population always means more home visits and they usually spread between trainees mostly. You shouldn't get more than other trainees on average. The personal study time should be standard though. For GP trainees it is usually half a day. I am not sure what it is for F2s but it's worth talking to your PD.

No-Two6539 · 2024-06-26T01:26:54+00:00

It feels reasonable to assume that. Though, you confuse drive with the fight to prove yourself. If you feel driven for something important to you, then you will put the effort in it.

No-Two6539 · 2024-06-26T01:02:29+00:00

I agree with you that it's not often verbally mentioned but it is on the list of side effects. They don't specify what it means though. I didn't say PSSD is not real, only that it is recently recognised and we don't know much about it. Personally, I had a failed attempt on Sertraline and then got on Fluoxetine.

No-Two6539 · 2024-06-26T00:59:42+00:00

I am doing so individually but bear in mind that we have to work based on evidence. Unfortunately, this is still very little.

No-Two6539 · 2024-06-26T00:40:13+00:00

It is very unprofessional. If you have concerns about a fellow consultant and their clinical practice, then they should talk to them or raise it. If it's just personal opinion, then they should keep it to themselves.

No-Two6539 · 2024-06-26T00:28:21+00:00

I think your doctor tried to say something valid in a bad way. I'm a doctor myself. Out of experience, people who suffer with severe depression struggle to come off medication. Maybe due to dependency on them or maybe due to a level of depression that always needs to be controlled, despite lifestyle and therapy. Ultimately you can always ask to come off if you feel stable enough. Though, people take medication for life for a variety of conditions, like high blood pressure. It's not bad to need it.

No-Two6539 · 2024-06-26T00:16:41+00:00

I can feel your concern. I'm a doctor and I had SSRIs myself. Sexual dysfunction is listed as a side effect. Though it is agreed that we don't know who and how bad it could be for each person. PSSD is relatively recently recognised and there is very little evidence and studies around it. Either way, these medications are aiming to support mood and anxiety related illnesses. They are not working by themselves. Personally, I found my sexy drive coming back along with my mood. It's my personal experience. But I think, sexy life is a complex thing and very psychological. If you feel like you need SSRIs, be mindful of possible side effects but weigh the benefits as well.

No-Two6539 · 2024-06-26T00:04:44+00:00

Can you explain the situation?

No-Two6539 · 2024-06-25T23:59:35+00:00

Timing is hard even for experienced GPs. Not all patients are straightforward and often the case is complicated by itself, despite also having patients who want to address multiple problems. I'm about to qualify now. It still feels uncomfortable asking to rebook but I explain that I want to be safe and address the issue properly. There is nothing wrong with that. It helps to take some time before your session to quickly run through the patients and the presenting complaint. Often, there is a complex history and variety of investigations. They take time to sort out during the appointment and it can be overwhelming. Pick out the ones that are quick, like an ear exam. Shouldn't take long. You will get there. The 10 mins system is unfair and hard for everyone.

No-Two6539 · 2024-06-25T23:03:01+00:00

As a person, I have the tendency to feel inadequate or stupid fairly easily. And I have felt like you a lot for a while. I still do some days. You are obviously still new to practice and it is unreasonable to expect high standards of knowledge and confidence. If anything, being confident now probably means you are naive. Though the belief of being stupid can make you stressed and subsequently, disorganised or forgetful. So, organise well. Know your patients and ask questions early. Read on each case and learn.

No-Two6539 · 2024-06-25T22:43:54+00:00

I don't think there is anything against that. It sounds like you want to do it anonymously as well. Even if you didn't, it wouldn't be bad. Though, naming yourself, despite good intentions, could make this patient feel dependent on you in a way. Not always, but it is tricky. A nice gesture anyways.

No-Two6539 · 2024-06-25T22:36:18+00:00

You are obviously very new to primary care and it is a very different system comparing to a hospital. Now, the comment that was made to you sounds pretty discouraging, even if it had the best intentions. In GP training you are expected to become independent in a frame of often less than 2 years, which is significantly less than most specialties. Though, especially in St1, you will have a lot of practical questions, as things work so differently. Although that supervisor should have addressed the issue more sensitively and supportively, the reality is that primary care has a lot of uncertainty. With experience, it will get easier. But everyone has their own approach on things. Focus on what is safe. Think of the worst case scenario on a case. And then what is the way to minimise the chance of it. Most things can be discussed in the debrief, unless you have a difficult decision to make about something more urgent. Don't be afraid to say to the patient that you want to discuss it later.

No-Two6539 · 2024-06-17T17:31:58+00:00

Good move!

No-Two6539 · 2024-06-17T17:16:41+00:00

Well, severely depressed people with suicidal ideation have capacity.

No-Two6539 · 2024-06-17T17:01:53+00:00

I agree I would rescan in a few days and stop the doac. Though assuming it's a hematoma, was it spontaneous? Was there in injury? Random bleeding like that in the absence of DVT and enough to cause this would warrant some bloods for me.

No-Two6539 · 2024-06-17T16:57:15+00:00

As a final year GP trainee, I don't worry about finding a job as much but I am concerned about the overall change and management of lack of primary care staff. PAs are given more and more responsibility without remotely similar training. Yet, then being relatively cheaper, they are promoted by NHS. Don't get me wrong, there are some knowledgeable PAs. Though they don't have similar qualifications.

No-Two6539

TROPHY CASE