Diary of a GP: Mistletoe musings

5 minute read

The column where we ditch the doom for a minute and celebrate the positives to come out of this year.

It seems, all of a sudden, that Christmas is just around the corner.

You’d think after all these decades on this earth I could avoid this sense of panic that hits me in early December when I realise my to-do list has once again become my impossible-to-get-done list!

But despite the panic, I love Christmas. I love it all – not only the actual day but the whole time of year. It seems such a celebration for all the good things in life, not only ham, real Christmas trees and Bing Crosby but friends, family, pets, passions and home.

I have always been like this, but it has got worse since covid. Those lockdowns were certainly a great reminder of how lucky we are to be able to get together and enjoy life.

Even general practice takes on this softer patina at Christmas. We all know it’s a hard time for some of our patients – and there is the inevitable rise in rates of depression and anxiety. But overall, our tinsel covered reception desk and constant supply of chocolates and shortbread from patients, chemists and specialist services just creates its own benevolent ambience.

The other thing about Christmas is that it represents the end of the year, even in the ongoing continuum known as general practice. This is silly because nothing really changes from the last week of December to the first week of January but it does feel like we close one chapter and start on a whole new book. We all do it. How did 2023 treat you? What were your wins? How did it rate in terms of years? In terms of general practice?

Maybe I’ve been sipping too much of the Christmas pudding sherry but I feel the GP me definitely had some wins this year. Certainly, the triple bulk-billing incentive was a much-needed financial boost (albeit a long time coming) but there were also some other less obvious improvements to my clinical practice that have had a disproportionally positive effect on what I feel I have to offer to patients. 

Just for starters, the self-collection CST has been such a bonus. All my terrified first-timers and stoic post-menopausal regulars have such a look of relief when I present the swab and send them to the loo. Even with the understanding that they may need to come back for the speculum swab should the self-swab come back positive, they all jump at the chance to self-collect. What’s more they’re telling their friends … win, win. Seemingly a minor change but it has significantly impacted my practice.

At the other end of spectrum there have also been some incredible big picture medical advances this year. The improvements in cancer treatments continue to astound me – not only in their effectiveness but also in their refinement. It wasn’t very long ago that if a cancer had spread to the lymph nodes it was considered metastasised and treatment was basically palliative. Now they talk cure. I have two lung cancer patients that are effectively in remission and feeling well – I reckon less than 10 years ago these patients would have been dead by now. I also have a patient with a nasty lymphoma apparently cured with a stem cell transplant and prostate cancer patients treated with radiotherapy alone.

Then there are the advances in biologics. New mabs are being used effectively in patients of mine with pulmonary fibrosis, another with chronic migraine, and even one with overwhelming atopic dermatitis – all previously thought to be untreatable.

And vaccines! We now have Shingrix and can hopefully save so many frail and vulnerable patients from that bloody awful intractable post-herpetic neuralgia. What a plus!

The other big advance, in my opinion, is the freely available genetic testing looking for carriers of cystic fibrosis, spinal muscular atrophy and Fragile X. Can you imagine – in one generation it could be a reality that no child would be born with full-blown cystic fibrosis. One generation. And we, as GPs, have the opportunity to offer this to our potential parent patients. This is just such a gift.

Back to advances with a little a. I’ve had a couple of techy wins this year, not in the same league as carrier state genetic testing and probably cringeworthy for most of you who have been across this for years, but they are advances for me nonetheless.

First is the expansion of the online HealthLink referrals to the local hospital outpatient clinics. We had a few clinics online last year, but now there are a whole range of specialties available and even though wait times are still pretty outrageous at least we know the referral has been received and the patient is in the system. In the past, it was a fax that often went God knows where because when you rang to chase it up two weeks later no one had ever seen it. This online system just works and I am so grateful.

The other techy thing I’ve done this year – and I know many doctors were on to this in covid – is remote access to my practice files from my home computer. Of course, it would be better to leave work at work but this remote access has saved me so many trips back to the surgery just to check on a result or finish some report. It doesn’t seem nearly so bad to do this paperwork at home compared to being the only one left in the surgery at the end of the day.

And so that’s my Pollyanna report card for 2023 (or at least some of it). Hardly the good, the bad and the ugly – just the good, the small good and the big good. But gratitude even if it is accompanied by rose-coloured glasses can’t be a bad thing especially at Christmas. Hope you all enjoy the festive season. Take care and see you next year.

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