This was a recent day's work, and is typical of the variety of my day:

8.30 - arrive at Hope House Surgery
Find that one of my patients died during the night - I need to decide whether I can issue a death certificate - phone Coroner's Officer to discuss - he's happy for me to go ahead.
Find that the daily lab results download hasn't happened - speak to my practice manager who will sort it out.
8.40 - morning surgery
11 patients, some of whom chose to wait a week to see me (rather than have a same-day appointment to see a doctor that they don't know so well).
They mostly have a mixture of complex medical and psycho-social problems.
One woman brought in a list of 8 problems that she wanted to discuss. Surprisingly, we managed to address them all satisfactorily in 10 minutes.
Particular pleasure in seeing a 34 year-old woman's smile - two weeks ago I started her on antidepressants, and they're just starting to work.
11.00 - video tutorial
We're a training practice. Our GP Registrar shows me two consultations that she recorded in her weekly video surgery. She's only half way through her GPR year, but it's great to see that her consultation and clinical skills are already so good.
12.00 - in-tray
We've been a "paperless" practice since 1995, so much of this time is spent going through my virtual in-tray:
action 5 e-mails from receptionists and secretaries with clinical queries;
check 18 lab results (they've come through at last);
view images of 11 clinic and discharge letters (scanned in by the secretary the day they arrive at the surgery) to see whether they need action.
I also need to check and sign a pile of repeat prescriptions - a chore, but one that's important to do well.
Complete a form for the DVLA.
Eat sandwich while working. I know it's not healthy.
12.50 - visits
Typically we average a visit each per day, but today there are two:
a 92 year-old with dementia in a nursing home is more confused than usual; I think she has a UTI and treat as such;
a bravely independent 86 year-old who fell again today. She is getting less and less steady on her feet, in spite of the Falls Clinic's best endeavours. She hasn't done any serious damage, but we discuss her future.
14.00 - ante-natal clinic
Almost all of our ante-natal care is, appropriately, done by our midwives. So, my ante-natal clinic is usually pretty quiet.
17 year-old with a twin pregnancy; mother and babies are doing well.
15.20 - HGV (Heavy Goods Vehicle) medical
Not very exciting, but it's interesting to see people when they don't have medical problems sometimes!
16.00 - emergency visit
For "dizziness"
this is a patient known to have carcinomatosis; she'd been discharged after a 999 admission for similar symptoms;
she mentions that she was dizzy only when she went to the toilet – sitting & standing BPs reveal profound postural hypotension;
worry about the implications for the patient overrides any smugness at having picked it up when the medics hadn't.
16.40 - afternoon surgery
12 patients
one has had anterior chest and left arm pain for 3 days; ECG confirms an MI; he agrees to go straight to A&E (I later find that he went home instead and suffered another MI a few hours later).
18.20 - "de-brief" with GP Registrar
End-of-surgery discussion of problems with our super GP Registrar.
She has a list of things for which she needs advice.
She certainly keeps me on my toes!
19.00 - Hope House Diabetic Group
Talk to our diabetics' group (at their request) on "diabetes and insurance";
I pulled most of the info from the excellent Diabetes UK website;
oddly, I get more nervous about speaking to our patients' groups than I do about lecturing to doctors.
19.45 - leave for home
22.30 - check e-mails and update website
I'm a GP Course Organiser and much of the organisational work is done on-line:
there are 19 e-mails to download and deal with (including 3 from GPVTS SHOs and GP Registrars, 2 from Consultants about the GPVTS);
update the on-line timetable for this Wednesday's Day Release Course


So, what's the down side?
I do enjoy the variety, but wow, it can be exhausting! There's very little time when you can work on "auto-pilot", so you're concentrating on the work all the time.

You may have spotted the absence of free time during the day. Not every day is as long as this, but workload surveys show that GP principals work well over the European Working Time Directive maximum. As we are self-employed, the Directive doesn't apply to us.

I couldn't keep this surgery workload up for 5 days per week, so I work part-time: 2½ days per week in the practice, 2½ days per week as a Course Organiser.

Written by: Michael Harris

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This page was last updated on: 26 January 2008