Domhnall MacAuley on being a GP on Christmas Eve

Domhnall MacauleyChristmas Eve. Its a Monday.

It will be dark leaving home but, with no morning traffic, the drive to the surgery should take just a few minutes. Few people around—a few early shoppers collecting their turkeys or in a last minute panic to pick up a late gift. With businesses closed and no schoolchildren, it will feel like a Sunday. But, like every practice, the waiting room is seldom empty.

After a quiet start, it will be the usual Monday mayhem—but, with a touch of excitement in the air, sweets on the reception counter, and the Christmas tree in the corner. With a weekend, and two days off to follow, patients will be anxious—feeling cut off from healthcare by the Christmas break. There will be the usual last minute consultations—time too precious in the rush up to Christmas, but needing to be cured for Christmas Day. Coughs and colds, tummy bugs, and croupy children. Runny noses and dry throats that people don’t want to upset their holidays. Lots of consultations, just in case. Excited children—no problem examining children’s ears with Santa Claus looking on. But, hidden among the minor illness will be pathology; illnesses known to be serious but saved up for a day off. And, on top of the usual chronic illness and seasonal infections many distant relatives will, I expect, return the weekend before Christmas and see Monday as an opportunity to sort out their loved ones health problems while they are home. I always feel anxious on Christmas Eve: in the past, I’ve seen so many complex problems, serious illness, psychiatric emergencies, and situational crises. I am sure I am not alone—general practice is the same all over. Its much more than just another working day.

Our staff, of course, would rather be with their families. We will, hopefully, be able to let them off early but patients discharged for Christmas will need services organised, there will be prescriptions to be issued, and, perhaps, a dressing, an ECG, or ear syringe. Healthcare doesn’t conform to the calendar. Its about meeting patients needs and we wouldn’t like to see anyone stuck over the holidays.

In late afternoon, with the last prescription collected, the traffic will slow to a trickle on the road outside and a rare quietness will embrace the building. Time to switch off the Christmas tree lights and pull the door on the December rush—until Thursday. Happy Christmas to all.

Domhnall MacAuley is primary care editor, BMJ