Twelve Snapshots from Freshers’ Week

Freshers’ Week is a bit like the 60s – if you can remember it all, you weren’t there. So these glimpses will have to do:

1 Mists and mellow fruitfulness.

redcurrants

2 Not knowing where anything is, and trying to get there by bike, if you can remember which one’s yours.

bikes against a wall

3 Existentialist conversations with a swan.

swan on the Cam

4 Signing up for everything at the Freshers’ Fair.

5 Blood-red Virginia creeper.

Sidgwick Hall, Newnham College

6 Smiling at everyone in case one of them becomes your best friend.

7 Buying lots of instant coffee and biscuits for all your new friends.

FreeImages.com/Rositsa Jeliazkova

8 Ridiculously cheap booze at the Freshers’ Disco.

9 Kebabs and puke.

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10 Reinventing yourself (because you can).

11 Staying up till 3 a.m. (because lectures haven’t started yet).

12 Getting a meningitis jab (because it’s really important).

So many new beginnings, but for some things it’s an end. Goodbye, Strachey Building. I won’t be there on Friday when the wrecking ball comes for you and the Porters’ Lodge.

Strachey, Newnham College

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Warning: A Doctor Rants

Vaccines had a bad press a few years ago, but things have changed, or so I thought. That’s why I was surprised when this week a university student refused the freshers’ dose of meningitis C vaccineFreeImages.com/Antonio Jiménez AlonsoI was even more surprised when he told me that his father, a doctor in another European country, was against vaccination.

What would you have done?  

University students are at higher risk of meningitis. One in four 15-19 year olds carries meningococcal bacteria in the back of the throat, as opposed to one in 10 of the general UK population. And, if you haven’t been a fresher for a while, imagine all that mingling with hundreds of other young people, often in crowded conditions.  

There’s lots of useful info on meningitis, and on vaccines.  Alas, I only know sites for fluent English speakers, and the lad in front of me wasn’t one of them.

I jokingly told him I wanted words with his dad. But in reality that was never going to happen. In general practice there’s barely time for a long discussion with a patient, let alone with family. Photo by Jean Scheijen FreeImages.com/Jean ScheijenConsultation rates with GPs have gone up in the last 20 years to around eight consultations per person a year. Along with that, patient expectations have risen. No bad thing in itself, but it requires more time.

Many areas are bulging with an influx of new patients. London has a particularly mobile population but it’s not the only place where there are migrants, refugees, or simply new housing. Some arrivals speak little English, so interpreters are needed, and the consultation takes twice as long as a result.

The pattern of work has shifted. As hospitals shed more care onto general practice, and send patients home sooner, GPs inevitably must do more. Around 90% of medical care now takes place in surgeries, by GPs, nurses and other members of the health team.

National Health Service logo

The structure of health care has changed with the advent of clinical commissioning groups (CCGs). In my view, that work takes a lot of good GPs away from face-to-face patient care.

Professional development makes demands too. I have to keep up to date, and these days I also have to prove it via appraisal and revalidation. People believed something had to be done post-Shipman, so now we spend time counting lots of things that don’t count. I hope that changes, but meanwhile preparing for annual appraisal takes two hours a week.

Providing good medical care is now a real struggle. GPs are retiring, and a sizeable chunk of medics are leaving the country.

Australian and UK towels on the beach

There’s nobody to replace them.

Like many GPs, I teach medical students. That time too must come out of a busy week. But here’s what really worries me about teaching.  

In the last 10 years I’ve noticed that fewer students now want to be GPs. Yet not so long ago new doctors were falling over each other to join practices.

It’s no wonder that doctors in the UK are angry and fed up. New changes imposed by government are likely to make things worse. In many areas, NHS general practice can barely provide a decent service five days a week. How can it stretch to seven days?

I’m not against change. General practice changes all the time. That’s part of its attraction as a speciality. But the developments I’ve lived through now make it almost impossible to do the job properly.

doctor's bag

You may like to read: 

Numbers of NHS doctors registering to work overseas could reach unprecedented record in the Independent, September 21, 2015

A fictional GP reflects on What They Don’t Teach at Medical School

I muse on What Happens when You Become a Doctor.

Easy tweet: What’s wrong with general practice? http://wp.me/p3uiuG-15w A #doctor rants #NHS via @DrCarolCooper