Samir Dawlatly: The ills of general practice

“Have a seat; sorry to keep you waiting. I’m Dr Dawlatly. What brings you here today Mrs, err, Practice?”

“General,” she replied grumpily.

“I’m sorry, what?”

“General. That’s my title. I’ve risen through the ranks to General, so I would be grateful if you would address me properly, doctor,” she answered curtly.

“OK then, General Practice, what brings you here today?” I asked, half expecting her to say “A tank!”

“I need a sick note, doctor,” she stated matter of factly.

“I’m sorry, what?” This was getting weirder.

“Are you, like a foundation year 2 doctor or something, or a hospital registrar on a shadowing placement? Don’t you know what a Med3 certificate is? And sit up properly, don’t slouch!”

“No, no I’m not, and yes of course I know what a Med3 is,” I protested as I straightened my back in my lumpy chair, “What exactly do you need a sick note for?” I asked, trying to regain composure.

“You’re not very good at this are you? You’re supposed to ask if I have been off work for seven calendar days, otherwise I’ll have to pay for a private note, which strictly speaking is not a Med3,” she corrected me.

“Of course, yes, but with you being General, err, Practice I thought you would be aware of the rules and wouldn’t dream of coming for a sick note in the first week of illness. Would you? Unless your boss asked you to come for a note?”

“I doubt very much that my boss realises that I am sick . . . ” she had a pained expression.

“Yes, well I guess the less said about him the better. Tell me about your symptoms, General,” I asked, more gently.

“Well, doctor, the problem is that I am simply tired all the time. When I wake up I feel drained and I just don’t want to go to work. I have no energy and I don’t feel that I can cope at all with all the pressures of work. I really think that something must be wrong. I’ve just had a holiday, been to a conference, and I’m feeling no better.”

“And you think going on the sick will help?”

“What else do you suggest? My latest investigations show a chronic shortage of new blood.”

“Don’t you mean new blood cells?” I interjected.

“No, new blood. Sad isn’t it.”

“How about a may be fit for work note, with some amended duties and workplace adaptations?” I proffered.

“What would you suggest?” she asked.

“How about, ‘Not to carry out the job of the Citizens’ Advice Bureau, a social worker, a teacher, a chaplain, a parent, career advisor, or counsellor’,” she nodded as I continued, “And entitled to work in a supportive environment?”

“That just might work,” she said hopefully, “Could you also stipulate that I need longer appointments and less tick box regulation?”

I nodded and tapped away at the computer, entering the information into the computer template for her.

“You don’t think I am over-medicalising a social condition, do you doctor?”

“I’m sorry, what?” I asked for the third time. I’ve never been that good at typing and listening, despite my best efforts to pretend otherwise.

“We both know that the problem is the day job, not anything medical. What I need is a change in my job description.”

“Well, that is what we are doing with your Med3 today,” I explained.

“Yes, but that will run out and I’ll be back where I started,” she was looking forlorn again.

“Well, why don’t you use this time to work out your options and then speak to your boss about it?” I was aware of the irony that I was now giving career advice.

“As you put it, the less said about my boss the better. I have to say, I don’t quite know what the future holds for me and how long I can carry on like this,” she said philosophically.

“Neither do I General, neither do I,” I said as I handed her the Med3.

Samir Dawlatly is a GP partner at Jiggins Lane Surgery in Birmingham. He combines clinical practice with being a part time house husband and an interest in social media, as well as publishing poems, essays, and blogs. He can be found on Twitter as @sdawlatly.

I have read and understood BMJ policy on declaration of interests and declare the following interests: I am a member of the RCGP online working group on overdiagnosis.