{"id":32957,"date":"2014-12-10T13:40:03","date_gmt":"2014-12-10T12:40:03","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=32957"},"modified":"2014-12-10T13:42:58","modified_gmt":"2014-12-10T12:42:58","slug":"samir-dawlatly-the-ills-of-general-practice","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2014\/12\/10\/samir-dawlatly-the-ills-of-general-practice\/","title":{"rendered":"Samir Dawlatly: The ills of general practice"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/2013\/07\/05\/samir-dawlatly-times-have-changed-for-me\/attachment\/27570\/\" rel=\"attachment wp-att-27570\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-27570\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2013\/07\/samir_dawlatly.jpg\" alt=\"\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2013\/07\/samir_dawlatly.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2013\/07\/samir_dawlatly-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><\/a>\u201cHave a seat; sorry to keep you waiting. I\u2019m Dr Dawlatly. What brings you here today Mrs, err, Practice?\u201d<\/p>\n<p>\u201cGeneral,\u201d she replied grumpily.<\/p>\n<p>\u201cI\u2019m sorry, what?\u201d<\/p>\n<p>\u201cGeneral. That\u2019s my title. I\u2019ve risen through the ranks to General, so I would be grateful if you would address me properly, doctor,\u201d she answered curtly.<!--more--><\/p>\n<p>\u201cOK then, General Practice, what brings you here today?\u201d I asked, half expecting her to say \u201cA tank!\u201d<\/p>\n<p>\u201cI need a sick note, doctor,\u201d she stated matter of factly.<\/p>\n<p>\u201cI\u2019m sorry, what?\u201d This was getting weirder.<\/p>\n<p>\u201cAre you, like a foundation year 2 doctor or something, or a hospital registrar on a shadowing placement? Don\u2019t you know what a Med3 certificate is? And sit up properly, don\u2019t slouch!\u201d<\/p>\n<p>\u201cNo, no I\u2019m not,\u00a0and yes of course I know what a Med3 is,\u201d I protested as I straightened my back in my lumpy chair, \u201cWhat exactly do you need a sick note for?\u201d I asked, trying to regain composure.<\/p>\n<p>\u201cYou\u2019re not very good at this are you? You\u2019re supposed to ask if I have been off work for seven calendar days, otherwise I\u2019ll have to pay for a private note, which strictly speaking is not a Med3,\u201d she corrected me.<\/p>\n<p>\u201cOf course, yes, but with you being General, err, Practice I thought you would be aware of the rules and wouldn\u2019t 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?\u201d<\/p>\n<p>\u201cI doubt very much that my boss realises that I am sick . . . \u201d she had a pained expression.<\/p>\n<p>\u201cYes, well I guess the less said about him the better. Tell me about your symptoms, General,\u201d I asked, more gently.<\/p>\n<p>\u201cWell, doctor, the problem is that I am simply tired all the time. When I wake up I feel drained and I just don\u2019t want to go to work. I have no energy and I don\u2019t feel that I can cope at all with all the pressures of work. I really think that something must be wrong. I\u2019ve just had a holiday, been to a conference, and I\u2019m feeling no better.\u201d<\/p>\n<p>\u201cAnd you think going on the sick will help?\u201d<\/p>\n<p>\u201cWhat else do you suggest? My latest investigations show a chronic shortage of new blood.\u201d<\/p>\n<p>\u201cDon\u2019t you mean new blood cells?\u201d I interjected.<\/p>\n<p>\u201cNo, new blood. Sad isn\u2019t it.\u201d<\/p>\n<p>\u201cHow about a may be fit for work note, with some amended duties and workplace adaptations?\u201d I proffered.<\/p>\n<p>\u201cWhat would you suggest?\u201d she asked.<\/p>\n<p>\u201cHow about, &#8216;Not to carry out the job of the Citizens&#8217; Advice Bureau, a social worker, a teacher, a chaplain, a parent, career advisor, or counsellor&#8217;,\u201d she nodded as I continued, \u201cAnd entitled to work in a supportive environment?\u201d<\/p>\n<p>\u201cThat just might work,\u201d she said hopefully, \u201cCould you also stipulate that I need longer appointments and less tick box regulation?\u201d<\/p>\n<p>I nodded and tapped away at the computer, entering the information into the computer template for her.<\/p>\n<p>\u201cYou don\u2019t think I am over-medicalising a social condition, do you doctor?\u201d<\/p>\n<p>\u201cI\u2019m sorry, what?\u201d I asked for the third time. I\u2019ve never been that good at typing and listening, despite my best efforts to pretend otherwise.<\/p>\n<p>\u201cWe both know that the problem is the day job, not anything medical. What I need is a change in my job description.\u201d<\/p>\n<p>\u201cWell, that is what we are doing with your Med3 today,\u201d I explained.<\/p>\n<p>\u201cYes, but that will run out and I\u2019ll be back where I started,\u201d she was looking forlorn again.<\/p>\n<p>\u201cWell, why don\u2019t you use this time to work out your options and then speak to your boss about it?\u201d I was aware of the irony that I was now giving career advice.<\/p>\n<p>\u201cAs you put it, the less said about my boss the better. I have to say, I don\u2019t quite know what the future holds for me and how long I can carry on like this,\u201d she said philosophically.<\/p>\n<p>\u201cNeither do I General, neither do I,\u201d I said as I handed her the Med3.<\/p>\n<p><em><strong>Samir Dawlatly<\/strong> 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.\u00a0He can be found on Twitter as <a href=\"https:\/\/twitter.com\/SDawlatly\">@sdawlatly<\/a>.<\/em><\/p>\n<p>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.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u201cHave a seat; sorry to keep you waiting. I\u2019m Dr Dawlatly. What brings you here today Mrs, err, Practice?\u201d \u201cGeneral,\u201d she replied grumpily. \u201cI\u2019m sorry, what?\u201d \u201cGeneral. That\u2019s my title. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2014\/12\/10\/samir-dawlatly-the-ills-of-general-practice\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-32957","post","type-post","status-publish","format-standard","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Samir Dawlatly: The ills of general practice - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2014\/12\/10\/samir-dawlatly-the-ills-of-general-practice\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Samir Dawlatly: The ills of general practice - The BMJ\" \/>\n<meta property=\"og:description\" content=\"\u201cHave a seat; sorry to keep you waiting. I\u2019m Dr Dawlatly. What brings you here today Mrs, err, Practice?\u201d \u201cGeneral,\u201d she replied grumpily. \u201cI\u2019m sorry, what?\u201d \u201cGeneral. That\u2019s my title. 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