{"id":32957,"date":"2014-12-10T13:40:03","date_gmt":"2014-12-10T12:40:03","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=32957"},"modified":"2014-12-10T13:42:58","modified_gmt":"2014-12-10T12:42:58","slug":"samir-dawlatly-the-ills-of-general-practice","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2014\/12\/10\/samir-dawlatly-the-ills-of-general-practice\/","title":{"rendered":"Samir Dawlatly: The ills of general practice"},"content":{"rendered":"

\"\"<\/a>\u201cHave a seat; sorry to keep you waiting. I\u2019m Dr Dawlatly. What brings you here today Mrs, err, Practice?\u201d<\/p>\n

\u201cGeneral,\u201d she replied grumpily.<\/p>\n

\u201cI\u2019m sorry, what?\u201d<\/p>\n

\u201cGeneral. That\u2019s my title. I\u2019ve risen through the ranks to General, so I would be grateful if you would address me properly, doctor,\u201d she answered curtly.<\/p>\n

\u201cOK then, General Practice, what brings you here today?\u201d I asked, half expecting her to say \u201cA tank!\u201d<\/p>\n

\u201cI need a sick note, doctor,\u201d she stated matter of factly.<\/p>\n

\u201cI\u2019m sorry, what?\u201d This was getting weirder.<\/p>\n

\u201cAre you, like a foundation year 2 doctor or something, or a hospital registrar on a shadowing placement? Don\u2019t you know what a Med3 certificate is? And sit up properly, don\u2019t slouch!\u201d<\/p>\n

\u201cNo, no I\u2019m not,\u00a0and yes of course I know what a Med3 is,\u201d I protested as I straightened my back in my lumpy chair, \u201cWhat exactly do you need a sick note for?\u201d I asked, trying to regain composure.<\/p>\n

\u201cYou\u2019re not very good at this are you? You\u2019re supposed to ask if I have been off work for seven calendar days, otherwise I\u2019ll have to pay for a private note, which strictly speaking is not a Med3,\u201d she corrected me.<\/p>\n

\u201cOf course, yes, but with you being General, err, Practice I thought you would be aware of the rules and wouldn\u2019t dream of coming for a sick note in the first week of illness. Would you? Unless your boss asked you to come for a note?\u201d<\/p>\n

\u201cI doubt very much that my boss realises that I am sick . . . \u201d she had a pained expression.<\/p>\n

\u201cYes, well I guess the less said about him the better. Tell me about your symptoms, General,\u201d I asked, more gently.<\/p>\n

\u201cWell, doctor, the problem is that I am simply tired all the time. When I wake up I feel drained and I just don\u2019t want to go to work. I have no energy and I don\u2019t feel that I can cope at all with all the pressures of work. I really think that something must be wrong. I\u2019ve just had a holiday, been to a conference, and I\u2019m feeling no better.\u201d<\/p>\n

\u201cAnd you think going on the sick will help?\u201d<\/p>\n

\u201cWhat else do you suggest? My latest investigations show a chronic shortage of new blood.\u201d<\/p>\n

\u201cDon\u2019t you mean new blood cells?\u201d I interjected.<\/p>\n

\u201cNo, new blood. Sad isn\u2019t it.\u201d<\/p>\n

\u201cHow about a may be fit for work note, with some amended duties and workplace adaptations?\u201d I proffered.<\/p>\n

\u201cWhat would you suggest?\u201d she asked.<\/p>\n

\u201cHow about, ‘Not to carry out the job of the Citizens’ Advice Bureau, a social worker, a teacher, a chaplain, a parent, career advisor, or counsellor’,\u201d she nodded as I continued, \u201cAnd entitled to work in a supportive environment?\u201d<\/p>\n

\u201cThat just might work,\u201d she said hopefully, \u201cCould you also stipulate that I need longer appointments and less tick box regulation?\u201d<\/p>\n

I nodded and tapped away at the computer, entering the information into the computer template for her.<\/p>\n

\u201cYou don\u2019t think I am over-medicalising a social condition, do you doctor?\u201d<\/p>\n

\u201cI\u2019m sorry, what?\u201d I asked for the third time. I\u2019ve never been that good at typing and listening, despite my best efforts to pretend otherwise.<\/p>\n

\u201cWe both know that the problem is the day job, not anything medical. What I need is a change in my job description.\u201d<\/p>\n

\u201cWell, that is what we are doing with your Med3 today,\u201d I explained.<\/p>\n

\u201cYes, but that will run out and I\u2019ll be back where I started,\u201d she was looking forlorn again.<\/p>\n

\u201cWell, why don\u2019t you use this time to work out your options and then speak to your boss about it?\u201d I was aware of the irony that I was now giving career advice.<\/p>\n

\u201cAs you put it, the less said about my boss the better. I have to say, I don\u2019t quite know what the future holds for me and how long I can carry on like this,\u201d she said philosophically.<\/p>\n

\u201cNeither do I General, neither do I,\u201d I said as I handed her the Med3.<\/p>\n

Samir Dawlatly<\/strong> is a GP partner at Jiggins Lane Surgery in Birmingham. He combines clinical practice with being a part time house husband and an interest in social media, as well as publishing poems, essays, and blogs.\u00a0He can be found on Twitter as @sdawlatly<\/a>.<\/em><\/p>\n

I have read and understood BMJ policy on declaration of interests and declare the following interests: I am a member of the RCGP online working group on overdiagnosis.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u201cHave a seat; sorry to keep you waiting. I\u2019m Dr Dawlatly. What brings you here today Mrs, err, Practice?\u201d \u201cGeneral,\u201d she replied grumpily. \u201cI\u2019m sorry, what?\u201d \u201cGeneral. That\u2019s my title. I\u2019ve risen through the ranks to General, so I would be grateful if you would address me properly, doctor,\u201d she answered curtly. […]<\/p>\n

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