A GP from Birmingham on what his job is really like, why many health problems are related to social problems , and the tricks he uses to keep himself at his best while connecting with patients all day long.
If our model of general practice were not so familiar, it would sound more like a slightly sadistic game show format than a job.
Sit in a room, see 30 or 40 patients a day for a few minutes, each time determining why they are there and whether they can be helped.
In the words of those who do it, being a GP is relentless, stimulating, exhausting and exciting, often all at the same time.
It is the job of more than 41,000 doctors in the UK today including Samir Dawlatly, a Birmingham GP.
Every doctor in general practice needs a coping mechanism to do their job well, says Samir.
For him, it is ensuring that the inevitable stress caused by some consultations does not accumulate throughout the day, affecting his ability to do his work and help his patients.
“Someone comes in and I’ve got a certain amount of time to find out what’s wrong and what they want, then come to some decision with them as to whether there is anything I can do or whether I can’t, so I just focus on what needs to be done.”
There may only be a few seconds between one patient leaving the consulting room and another entering, but to make sure each patient is served well, a type of selective amnesia is sometimes necessary.
While it was important for Samir that he had that balance of work and family, the real draw in becoming a GP was the people.
“I loved the interaction with people, had a really good think about what’s best for the family, for my sanity, and that’s when I decided to do general practice.”
Samir now works three days a week as a GP.
Considering the relentless flow of patients, his working day, between around 8am and 7pm, is long enough.
But at a time when an ever-increasing demand means that almost three-quarters of GPs say their workload is unmanageable or unsustainable, he is managing.
That’s in large part due to his own resilience, but he also works in a practice which discourages doctors from staying late, so most access their work computers remotely to finish paperwork in the late evening from home, enabling some semblance of family life.
In addition the GPs at his practice regularly meet to discuss their patients. He said there are practices ‘where you go into your room, work for 10 or 11 hours a day’, and never have the chance to talk to colleagues.
It’s important to stress that no GP wants to be isolated.
But if you consider that GPs are treating 40 million more patients per year than they did five years ago, it’s not surprising that such contact – even though it has a hugely important role in reducing stress and sharing knowledge – gets neglected.
The NHS is, according to a respected international think tank, the most efficient healthcare system in the world.
A major reason for this is that the vast majority of medical problems are resolved or managed effectively in primary care, with GPs acting as the ‘gatekeepers’ for the rest of the system.
Samir identifies one overriding reason for the increasing pressure on GPs.
Every GP, every day, will see patients whose lack of wellbeing arises from something neither they nor the patient can influence – such as housing, relationships, or employment.
“When does ‘I’m unhappy with my job’ become clinical depression? That’s a real grey area.”
Health and social problems in the modern world, often do not neatly divide.
When asked what he would change about general practice, Samir cites the rolling out of a ‘neighbour scheme’ he saw in action during his training.
The programme gave patients access to an advisor who worked like a GP for everything non-medical, solving what they could themselves and referring on to other agencies for more complex problems.
Another similar scheme, ‘chaplains for wellbeing in primary care’ has been analysed and published recently.
Working like a hospital chaplain – so used to working with people of all religions and cultures – it was found to have particular benefit for patients whose unhappiness would otherwise be medicalised, for example with anti-depressants, or for patients who had symptoms that could not be medically explained.
The scheme takes the form of sympathetic listening, as Samir calls it, recognising crucially that social circumstances often inform patients’ difficulties as much as their illnesses.
The Real Reward
So how does he feel at the end of a working day?
Despite the daily challenges and resilience required to do the job, Samir says there is always cause for optimism.
“There will be something that goes well – even if it’s one patient saying thank you, a bit of appreciation, a chat with colleagues, getting something right. It’s very rewarding from that point of view.”
And like many of his colleagues, although he cannot solve everyone’s problems, he is still passionate about them being solved.
Meanwhile, back in his surgery, along with the thousands of other GPs around the country, Samir takes a breath, has a sip of coffee, and gets ready for the next patient to come through his door.
This is a repost from the wonderful Real Doctors blog run by the British Medical Association. They profile the lives of real doctors working around the country to find out what the job is really like.
We recommend you read the rest of Samir’s story there, including how he manages his mental wellbeing and his experience fighting injustice as an activist.
Photo by Dr. Samir Dawlatly.