A day in the life of a GP: Jennifer O’Connell spends the day with GPs

From the Irish Times >>>

Overworked, under-resourced and burning out, or overpaid, understretched and privileged?

“What I find unhelpful about those perceptions [about GPs] is that most of what we do is not measurable. We don’t know how many suicides we might have prevented by breathing exercises or just by listening. We don’t know how many heart attacks or strokes we’ve avoided by checking someone’s blood pressure or getting them to stop smoking. We don’t know how many crisis pregnancies we’ve prevented. That’s the stuff you can’t measure.”

Read the rest >>>


Patient narrative: Remembering Rory

He was generally unwell and suffered repeated episodes of tonsillitis. She wore a path to the GP’s surgery to try to discover what was wrong, but time after time was dismissed as an over-anxious mother. The attitude she got was very much ‘there there dear, calm down it’s just tonsillitis’. But she knew.

Rory was given an appointment to see an ENT specialist, but it was months away. Eventually, in desperation, Mary took it upon herself to phone the consultant at home at the weekend. He wouldn’t hear a word of apology for calling him at home, and agreed to see Rory the following week. When Mary brought her son to the outpatient appointment, she also brought an overnight bag for him. Because she knew. (Catherine from Raise the Glass blog >)

Doctor in the Dales, by JD O’Connor

Source: O’Connor Br Med J (Clin Res Ed).1983; 286: 772-773

Jane from a group photo of the Royal City of Dublin Hospital Resident Staff in 1925

“When my husband bought a practice in the Yorkshire Dales in 1933, our two children were very young so I did not intend to practise. Optimistically, however, we had my name put on the brass plate at the gate. The country folk had scarcely ever heard of a woman doctor. Worse, we weren’t even Yorkshire, but complete foreigners – it takes at least 10 years to become a local in those parts.

There were two surgeries a day, six days a week, initially with no half day, and fees were very low: a visit cost 3/6d; with a bottle of medicine it was 7/-, and a consultation in the surgery was 3/-, so money was not plentiful.

The Dales people were shy and reserved, but the women felt that they could talk to me and confide in me. By degrees a few came to consult me, and soon I was looked on as a family friend. The children always gave me a warm welcome, even when they had to have an injection.

The country people were good hard working folk who called a spade a spade. If they didn’t like someone they said so, and you knew where you stood. I did a week’s locum once in another dale even more remote than ours. My first visit there was to an old lady of 80 who greeted me with: “We did hear that our doctor was ill and he had a woman doctor doing his work, but we’ve got to be thankful for anyone these days.”

In the same practice a man aged over 70 with bronchitis asked “Are you married?” “Yes.” “Is your husband alive?” “Yes.” Oh well, in that case you can look at my chest.”

Before I learned to drive I walked to visit patients in the town and my husband drove me to any further away. My mongrel dog, who had one leg shorter than the others, hopped along after me everywhere I went and sat outside on the patients’ doorsteps.

Everyone knew Billy, so when I came out I would often find someone waiting with him with a message, perhaps just for a prescription but frequently with a request for a visit. Billy nearly overdid his waiting once. When I was on holiday he went out in the car with my locum, also a dog lover. On one visit the doctor went in by the front door and left by the back door. He didn’t miss Billy for four or five hours. He drove back the six miles and Billy was still waiting on the doorstep.

Jane's husband, Leo, from the same Royal City of Dublin Hospital photograph

When the Second World War started, my husband was still in the Air Force Reserve so he volunteered for duty. Then early in 1940, the first bad snowfall arrived, and the roads in the country became blocked. The day before my husband was due to leave he was called to a confinement and could only drive the car one mile. He and the nurse had to walk along the tops of the walls to get to the farm, where they delivered twin girls successfully.

I got a bad start taking over the practice just then, but everyone was very kind and helpful. I had to learn to drive the car but lacked for volunteer teachers. There was very little traffic on the roads, and the lorry drivers soon got to know my car and gave me a wide berth.

Driving at night with only sidelights, as required in wartime, was very hazardous. One night a farmer’s wife cycled in to tell me I was needed at a cottage near her – telephones were not plentiful then. She came back in the car with me and kept saying “this is a dangerous corner,” “sheep sometimes lie in the road here,” and so on. At the cottage a young girl, an evacuee, had had to use the chamber pot, to which she was not accustomed. It broke and cut her buttock, which had to be stitched by candlelight. She and her mother returned to the city next day.

A doctor had other uses in those years of petrol rationing. I took the daily papers to the distributors in some villages, and always took medicines – and even groceries – to outlying farms and houses. People were very considerate during those awkward years. There were very few non-essential calls, and I found out how good and kind everyone was. I got many gifts of food.

On one visit to a hill farm, two large rams tethered together at their horns rushed past me as I opened the gate into the farmyard, nearly knocking me down and bumping into the car in their haste. Some months later I saw early lambs at that farm and said to the farmer “You don’t usually have lambs so early,” and he replied “Those are thanks to you.”

When the war ended my husband came home, but about a year later he got a slipped disc, a rarity at the time, so treatment was on trial. He had to lie flat on his back for 10 weeks but this did no good and traction was tried. Still no relief. Then he had to live in plaster cast for three months, but the pain persisted. He insisted on an operation, which finally relieved the pain. That was the first operation of its kind in Leeds Infirmary.

The worst snowfall for many years was in 1947, when roads became blocked and impassable. One afternoon at the beginning of this I was called to an emergency in a village six miles away. I had to dig three times to get the car out of drifts and was rather shaken when I finally got to the house.

The husband of the patient offered to drive back with me but I said: “I may not be able to get home but you certainly would not get back,” so I set off alone. To my relief after a short distance I saw in the mirror the snowplough behind me. I pulled into a cutting that had been dug to allow cars to meet or pass, thinking I would have an easy run home behind the plough. But the plough itself soon got stuck in a huge snowdrift. As the men shoveled the snow out the blizzard blew it back, and things looked hopeless.

Then the men from the quarries began to arrive on their way home from work. They took shovels from their cars (everyone carried a shovel at that critical time) and fell to work cheerfully in spite of the adverse conditions. Eventually a track was cleared and the snowplough started. The rest of the cars followed slowly and carefully, taking the easier road back to the town. No car, no pedestrian, went up that road for the next nine weeks.

The railway was our lifeline for many weeks. All sorts of things went by engine – day-old chicks, then food and other feedstuffs, groceries. Sometimes the goods had to be dropped at inconvenient places, to be picked up by the locals. I had to be dropped once on top of an embankment and slide down it, carrying all my essentials in a haversack, as I had been doing all those weeks.

As I walked back from that visit the road was blocked by an enormous snowdrift so I climbed to the top of the wall and made my way along it. At one stage I put my foot suddenly wrong and was up to my thigh in snow. At the top of the hill I found the road had been cleared. A huge snowplough, making its first appearance in the district, was turning round to go back to Horton as it couldn’t tackle the drift that evening. A workman who lived nearby had just got off the plough so he heaved me up in his place and I rode to Horton at a high altitude, with a new view of familiar country covered in snow.

I had one very alarming experience about that time. A farmer’s wife was having weekly injections and had had three or four without a reaction, but on my fifth visit she collapsed completely and slid out of her chair onto the floor, apparently dead. There was no one anywhere near, but while trying to support the patient I managed to get a drug from my bag and gave her one, two, three injections, with no response. So I tried another. After two  injections there was a feeble flicker of the eyelids. I gave her a third injection, and the pulse began to return.

It seemed hours before my husband arrived to pick me up on his way back from another remote farm, and we could move the patient to a settee. I was more shaken than the patient, who remembered nothing of the emergency.

In a country practice, a lot of time was spent on the road. One afternoon I noted the mileage, 53 miles, but I had done only three visits and had been out three hours. Luckily it was beautiful country – harsh but beautiful – which made the long drives enjoyable, and the patients were all friendly and pleasant. So when the time came to retire and leave, there were sad farewells and tears.

Five years ago the brass plate with our names on it was still on the gatepost below the plate put up by our successor – and 45 years on the people of Settle still had a woman doctor looking after them.”

J.D. O’Connor

(My grandmother)