Wednesday, 21 July 2010

Why do we do it?

Like many other medical bloggers, I was invited to read 'Sick Notes' - the recently published book by GP columnist Dr Tony Copperfield (of Pulse fame). I hadn't planned on reviewing it, and I'm not going to, but I have brought it up because it has left me asking big questions about my career choice.

The book is hysterical, I really mean that. I laughed out loud on several occasions, and was often to be found chuckling in a corner, book in hand. It's funny because it is unbelievably true to life. In each ridiculous scenario that he describes I can see myself, every absurdity he mentions I too have seen. In some ways it is comforting to know that there are others who share my GP-related pain. On the other hand, hearing all of this from a GP nearing the end of his career when I am just at the start of mine, does make me feel a little hopeless.

The stark realisation is that if this book is anything to go by, things are not likely to get any better. I am always going to be plagued by patient's lists, always going to be caught out by the 'oh there's just one more thing doctor', always going to long for the last patient of the morning and the promise of lunch and a coffee, desperately hoping that no home visit requests come up.

There is one chapter called 'Things I really like about General Practice'. It's two pages long.

Friday, 9 July 2010

A dilemma

I find dealing with termination of pregnancy requests difficult.

The first problem comes with how to react to a patient's opening statement of "I think I'm pregnant". My usual response is a wide smile and congratulations all round, but clearly if the pregnancy is an unhappy mistake this is not the way to go. You do usually get some pointers that you need to tread carefully, but it's not always easy.

The next problem comes with trying to fit a decent 'pros and cons of having a baby' conversation into a surgery appointment. To be fair, most women have already decided what they want to do by the time they come and see me, but it's such an important decision that I like to be able to spend some time with them none the less.

My final problem is in signing the document. For those of you who don't know, terminations can only go ahead if they have the signature of 2 doctors, both stating that they feel termination is appropriate. Up to 24 weeks of pregnancy, termination is allowed on any of the following grounds:

a) If continuing the pregnancy poses a risk to a woman's life, or
b) to her physical or mental health, or
c) to the physical or mental health of her existing children.
d) If the baby is at substantial risk of being seriously mentally or physically handicapped.

My problem is that if we're being completely honest, many terminations go ahead without fulfilling any of these requirements. So when a woman asks for a termination because she is at university and doesn't feel that she can cope with a child in her present circumstances (a situation that I sympathise with enormously), I do wonder which category she fits into. Will it really affect her mental health if she has a baby? Might it not affect her more if she terminates and later regrets it?

It's not my position to stand in the way of a treatment that is readily available now in this country, but I'm afraid that I don't sign the form. I send the patient on to someone who will, but I don't do it myself.

Now you could say that this causes extra inconvenience for the woman and given that she will go on to have the termination with or without my signature, is there any point in what I am doing? Am I just being self righteous?

On the other hand at least I'm being honest with myself and in truth termination clinics are usually well set up for this eventuality, themselves having 2 doctors present who can sign the form. I know it's not ideal and I've no doubt there are many who disapprove of 'conscientious objectors' like myself, but it's a dilemma that I don't know how else to deal with.