Wednesday, 2 July 2014

Town Mouse / Country Mouse

I am Debbie Miller , a GP Educational Supervisor at Nairn.

Rachel Hopkins is an experienced GP who has her own practice in Central London. She wanted a change and agreed to come up to the Highlands for 4 months to be my locum, a sort of "Town Mouse ,Country Mouse" thing.....except the Country Mouse headed off to the sun in Saudi Arabia (that's another story!)
I thought that it would be interesting to get some feedback from Rachel so she kindly agreed to jot something down about her experience and she has given permission for it to be posted on this blog.

"The cows looked mournfully out of the byre at me as I picked my way across the muddy farmyard to the cottage for a home visit. It had been tricky finding the right farm with no sign of a name anywhere- fortunately I'd been able to pull in and ring the farmer for directions. The environment was totally different to my usual work as an inner city GP in London, but the experience of struggling to locate a visit and ringing for directions was very familiar. Not very used to isolated farms in London, but maze-like housing estates. Finding home visits was like most of my experience spending my sabbatical from London working as a locum in Nairn, Highlands, both strikingly different but at the same time very familiar.

While much of general practice is similar anywhere, perhaps the frequency of home visiting was the greatest difference between the two practices. In London most of our patients are young and the practice area is only a mile or so across - visits are rare, perhaps one or two a month or so and we usually walk, hoisting the shared visiting rucksack. In the Highlands, I found myself driving off on visits most days, to patients often miles away, or near but marooned by lack of transport. I enjoyed the glorious scenery and I noted how flexible general practices are to provide the right service for different practice environments and populations.

Emergencies were also handled differently. In London, most of our patients who have an emergency ( and lots who don't) go direct to A+E at one of the major hospitals nearby. In the Highlands some GPs run the A+E and cover out of hours. I found A + E quite scary at first, being hopelessly out of practice at XRays and injuries. I soon realised that the A+E nurses and the radiographer were so helpful and knowledgeable that I could increase my confidence as part of their team. But I really take my hat off to GPs who do their own on-call all the time. What a great service to their patients who get fantastic GP service 24hrs a day from their own practice. Doctors in Highlands certainly get an opportunity to practice some real acute medicine on a regular basis.

I had thought I might see some different pathologies in Highlands to London and had dutifully read up on Lyme disease. However, most of the cases were fortunately very familiar and it was sad to see that in Highlands as in London the main causes of long term ill health are chronic pain and depression. However, there certainly were differences in disease patterns with lots more “real medicine” and palliative care in Highlands looking after an elderly population and in London more sexual health and child health. I enjoyed finding out about different occupations, meeting patients who were game keepers, cheese makers or worked in factories or on oil rigs. My impression was that the Scots were very hard workers and very rarely wanted a “sick line” , while in London, “sick notes” are very popular for almost anything! The Scots were also in general much more polite, courteous, undemanding and stoic than my London patients. In four months, not a single patient in Nairn answered their mobile phone during a consultation, which is a daily occurrence in London.

So, I’m back in London, with patients chatting on their mobiles “I’m down the doctor’s… yes… no…. call me back in a minute…”, and finding I’ve got an Arabic interpreter when I needed Albanian, and patients expecting hospital referral for their smears as it’s done in Germany, or massage referral which you can have in France, and Americans wanting total body mri and patients complaining they can’t get an instant appointment for something they’ve had for months. Yes, it was very busy in Highlands too, but I miss the fresh air and the “Nae bother, Doctor” courtesy.


So if you are sat wondering whether there must be a better life out there, there is, its called the North of Scotland!  So why not apply to do your GP Training with us up here in the North.

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