Notes from a GP

Tag: mental-health

  • Making the Most of Your GP Appointment (and why it matters more than ever)

    Making the Most of Your GP Appointment (and why it matters more than ever)

    When I first became a GP, consultations felt very different.

    Patients booked an appointment with their doctor. They arrived, sat down and we talked.

    Often they came with a list.

    Sometimes it was a very long list.

    There might be a sore knee, poor sleep, concerns about an elderly parent, a changing mole, a prescription query and a question about a child’s behaviour all in the same consultation.

    As doctors, we would usually listen to everything first and then decide what was connected, what needed investigating and what could safely wait.

    It wasn’t a perfect system.

    But it was a personal one.

    For many years I worked in a single-handed practice. Every request for an appointment came through me. I knew my patients, their families, their medical histories and often what was happening in their lives long before they entered the consulting room.

    That knowledge mattered.

    If somebody attended with anxiety, I already knew whether this was completely out of character or something we had discussed before.

    If an elderly patient was struggling, I knew who lived nearby and who might be able to help.

    If somebody came with a list of concerns, I could often see how the pieces fitted together before they had even finished speaking.

    Sometimes I would arrange a longer appointment. Sometimes I would ask somebody to come at the end of surgery so neither of us felt rushed. Sometimes I would visit them at home.

    Continuity did not make medicine easier, but it often made it better.

    It allowed relationships to develop and trust to grow over time.

    Over the years, however, general practice has changed enormously.

    Demand has increased. The population is older. People are living longer with multiple medical conditions. General practice is managing more complex care than ever before. 

    At the same time, resources have become increasingly stretched.

    Today many practices use online forms, telephone triage and systems designed to direct patients to the most appropriate clinician. Patients may be offered appointments with pharmacists, physiotherapists, nurses, mental health practitioners and many other skilled healthcare professionals.

    These changes have brought benefits.

    But they have also changed the experience of seeing a GP.

    Appointments are often ten minutes long. Continuity can be difficult to achieve. Many practices operate what is effectively a one-problem-per-appointment approach because there simply is not enough time to do everything.

    Patients are not the only ones who sometimes find this frustrating.

    Doctors do too.

    Many patients miss seeing the same doctor each time, but continuity benefits doctors as well. It is much easier to care for somebody when you know their history, their family circumstances, their personality and how they usually respond when life becomes difficult.

    Increasingly, doctors find themselves consulting with people they have never met before.

    The appointment may be ten minutes long. The list of medical problems may fill several pages of notes. Important information may be buried within years of records.

    Before the patient has even sat down, the doctor may already be trying to review previous consultations, blood results, hospital letters and medication lists.

    Once the consultation begins, they are simultaneously listening, assessing risk, documenting the consultation, arranging investigations, generating prescriptions, completing referral letters and deciding what should happen next.

    Most surgeries run back-to-back with very little time between appointments. The administrative work often continues long after the last patient has left.

    This is not a criticism of individual practices or clinicians.

    It is simply the reality of a system under increasing pressure.

    If I am honest, I often found working in a large practice surprisingly difficult.

    After spending so many years knowing my patients so well, I felt oddly vulnerable making important decisions about people I had never met before.

    I realised how much I relied upon the thing that never appears in a medical record: the relationship.

    One of the highlights of my day was often seeing somebody I recognised from my single-handed practice days. The consultation immediately felt different. There was familiarity, trust and continuity. We were not starting from scratch.

    I realised how much I valued that.

    Perhaps that is one of the reasons I enjoy what I do now.

    Having the time to listen.

    Having the time to explore concerns properly.

    Having the time to understand not only the symptom but the person experiencing it.

    And perhaps most importantly, leaving at the end of a consultation feeling that I have done the best job I can, rather than wondering what more I might have uncovered if there had simply been a little more time.

    The direction of travel within healthcare is increasingly towards larger systems, more sophisticated triage processes and greater use of technology.

    Some of these developments are undoubtedly positive. Better triage can help ensure patients reach the right clinician more quickly. Artificial intelligence will almost certainly improve many aspects of healthcare in the years ahead.

    But there is a risk too.

    The more efficient a system becomes, the easier it is for people to feel as though they are being processed rather than cared for.

    Healthcare is rarely just about symptoms.

    One patient’s skin lesion is not necessarily the same as another’s.

    A photograph of a mole may look identical on a computer screen, but the context may be completely different. One person may simply want reassurance. Another may have just watched their partner go through treatment for melanoma and be carrying weeks of anxiety and fear.

    The technology sees the lesion.

    The conversation reveals the person.

    That is the part of medicine I hope we never lose.

    One of the biggest changes I have witnessed during my career is the increasing complexity of the problems people bring to general practice.

    Many appointments now involve anxiety, low mood, loneliness, caring responsibilities, relationship difficulties, work pressures, financial worries, housing concerns, ADHD assessments and social isolation.

    Often there is no prescription that can solve these problems.

    Sometimes what people need most is somebody to listen, help them make sense of what is happening and guide them towards the right support.

    Modern general practice has become as much about navigating mental health services, social care, community support and voluntary organisations as it is about diagnosing disease.

    The consultation is often the beginning of a journey rather than the end of one.

    Following the Covid pandemic, I also noticed more people becoming concerned about their appearance, their skin and aspects of themselves they had never previously noticed.

    Perhaps it was spending so much time looking at ourselves on screens. Perhaps it was social media and increasingly filtered versions of reality.

    Whatever the reason, people seemed to emerge from the pandemic looking at themselves differently.

    So what does all of this mean for patients?

    It means that most GPs are doing their very best within a system that often feels stretched for both doctors and patients.

    It means that consultations need to achieve more than they once did.

    When I was running my own practice, I often knew the patient before they sat down. I knew their history, their family circumstances and the wider context of their lives. The consultation could start where we left off last time.

    Today, that is often not the case.

    Many consultations begin with both doctor and patient trying to understand each other from scratch.

    The reality is that neither patients nor doctors created this system, but both have to work within it.

    It is also worth remembering that doctors cannot always solve problems immediately.

    Many conditions require time. Some diagnoses only become clear as symptoms evolve. Mental health concerns, ADHD assessments and complex medical problems often need more than one conversation.

    Even when a GP knows exactly what needs to happen next, the process is not always within their control.

    Waiting times for scans, specialist appointments, community services and mental health assessments are often determined by wider NHS pressures rather than the individual doctor.

    This can be frustrating for patients.

    It can be frustrating for doctors too.

    Receptionists are sometimes told, “It will only take the doctor five minutes.” In reality, many problems are more complex than they first appear. What starts as a straightforward consultation can quickly become something requiring careful discussion, examination, safety-netting, referrals or follow-up.

    Most doctors want to give patients the time they need. The challenge is balancing that with a waiting room full of people who also need help.

    The current system is unlikely to disappear any time soon. The wider shift towards larger practices, centralised services and so-called “super surgeries” is probably a discussion for another day.

    Whether we like it or not, this is the system many of us now work within.

    Understanding that reality does not remove the frustrations on either side, but it can sometimes help patients and doctors work together a little more effectively.

    And whilst we cannot always control how long an appointment lasts, there are things that can help make the most of the time available.

    Making the Most of Your GP Appointment

    1. Help Your Doctor Understand the Bigger Picture

    Symptoms rarely exist in isolation.

    Tell your doctor what has been happening in your life, what has changed and what concerns you most.

    The symptom is important.

    The context is often just as, if not more, important.

    2. Mention All Your Concerns Early

    Many patients save the issue that is worrying them most until the final moments of the consultation.

    Most GPs recognise what is sometimes called the “door handle consultation.”

    The plan has been agreed. The appointment is ending.

    Then comes:

    “Actually doctor, before I go…”

    What follows is often the real reason they booked the appointment.

    Sometimes it is chest pain.

    Sometimes it is anxiety.

    Sometimes it is a breast lump or a symptom they have been worrying about for months.

    I always tried to ask patients whether there was anything else they wanted to discuss before we finished. Over the years I learned that many people use the first part of the consultation to decide whether they feel comfortable enough to talk about what is really concerning them.

    Trust takes time.

    People need to feel heard before they feel safe enough to be vulnerable.

    Whenever possible, try to mention your main concerns early in the consultation.

    3. Write Things Down

    Symptoms have a habit of disappearing from memory the moment we sit down in the consulting room.

    A few notes on your phone or a piece of paper can be invaluable.

    This is particularly helpful for people attending with anxiety, ADHD concerns, multiple symptoms or problems that have been present for some time.

    4. Tell Your Doctor What Worries You

    Sometimes somebody will spend ten minutes discussing symptoms before finally saying:

    “What I’m really worried about is that it might be cancer.”

    Or:

    “I’m worried I have ADHD.”

    Or simply:

    “I’m struggling to cope.”

    Knowing what is worrying you helps your doctor address those concerns directly.

    5. Young People Can Speak to a GP Alone

    Many teenagers are surprised to learn that they can see a GP without a parent being present.

    If you would prefer to speak privately, you can.

    As a GP, I often encouraged young people to write down their concerns beforehand. Some would even hand me a note if they found talking difficult.

    There is no right or wrong way to start the conversation.

    6. Understand That Mental Health Assessments Take Time

    This is particularly relevant when it comes to anxiety, low mood, burnout and ADHD concerns.

    Many people expect an immediate diagnosis or prescription.

    Sometimes that happens.

    Often it doesn’t.

    That does not mean concerns are being dismissed.

    Good medicine often involves taking a step back and understanding the wider picture.

    Sleep, relationships, family circumstances, work pressures, physical health and life events all influence how we think, feel and function.

    Sometimes the consultation is the beginning of a journey rather than the end of one.

    7. Ask Questions

    Never be afraid to ask:

    • What do you think is happening?
    • What happens next?
    • When should I come back?
    • What should I look out for?
    • Is there anything I can do myself?

    You should leave understanding the plan.

    8. Remember That Healthcare Is a Partnership

    The best consultations happen when doctors and patients work together.

    Your doctor brings medical knowledge, training and experience.

    You bring knowledge of your body, your symptoms and your life.

    Neither is complete without the other.

    Medicine has changed enormously since I first qualified.

    Some changes have undoubtedly improved patient care. Others have made it harder to preserve the continuity and relationships that many patients and doctors still value.

    But one thing has not changed.

    The best medicine still begins with a conversation.

    The suggestions above are aimed at patients because that is the side of the consultation most people see.

    Doctors have plenty to learn as well.

    In fact, the list of things that doctors could do better might be long enough for a separate article entirely.

    Perhaps that is a discussion for another day.

    And if there is one thing I learned during more than twenty-five years in general practice, it is this:

    The question you were not going to ask is often the one that matters most.


    I hope these suggestions help you feel a little more confident the next time you need to see a GP.

    You can find more practical health articles elsewhere on the blog, covering prevention, wellbeing and some of the everyday health questions that don’t always fit neatly into a ten-minute appointment.

    Thank you for reading.

  • How to create a life of Intentional Happiness

    How to create a life of Intentional Happiness

    After losing my parents there was a period of time when I felt overwhelmingly sad. Not sad every minute of every day perhaps, but empty. The life I had known for years had changed completely and there was a huge hole where my parents had been. I missed them both terribly and although I knew I was healing, I couldn’t honestly say I felt happy.

    It got me thinking about happiness itself. What actually makes people happy? And perhaps more importantly, how do we find happiness again when life has dealt us a blow that feels impossible to recover from? As I started reading around the subject, I came across the concept of the happiness pie chart. The exact percentages vary depending on which study you read and some researchers question them altogether, but the overall message fascinated me. The theory suggests that around half of our happiness is influenced by our genetics, something we have little control over. Only a surprisingly small amount appears to be linked to our external circumstances such as wealth, status, possessions or where we live.

    The rest comes from us. From our habits, our choices, our mindset and the way we choose to live our lives. That idea stayed with me. If happiness wasn’t determined primarily by what happened to us, perhaps there was something I could do to help myself heal. Perhaps happiness wasn’t something we simply found. Perhaps it was something we could create. And so began my road back.

    The first thing I did was rest. Properly rest. For the first time in ages there was nowhere I needed to be and nobody needed anything from me. For years I had measured my days by what I achieved. Suddenly I found myself sitting with a book for an hour, spending an afternoon doing a puzzle or taking a long walk with the dog and my phone switched off. At first it felt uncomfortable. Then it felt liberating. I stopped feeling guilty for doing very little and started appreciating the space that doing very little created. Looking back now, I think many of us have forgotten how to rest. We fill every moment with activity, noise or distraction and then wonder why we feel exhausted.

    What surprised me was that once I stopped rushing, I started noticing things again. Not big things necessarily, but the small things that had always been there and which I had somehow stopped seeing. The warmth of sunshine through the window, a conversation with one of my children, a walk with the dog or a cup of tea with a friend all seemed more significant than they had before. 

    At the same time I found I had something else I hadn’t had for a while: time. Time to think, time to read and time to be curious

    I became fascinated by understanding why some people seemed happier than others and whether happiness was something that could actually be learned. So I studied. I have always been interested in non-Western philosophy and ideas around mindfulness, spirituality and the way our thoughts influence our lives. What changed during this period wasn’t the interest itself but the amount of time I had to explore it.

    For the first time in years I wasn’t rushing on to the next thing. I had the time to read more deeply, to listen, to reflect and to question things I had previously accepted without much thought. I read books, listened to podcasts, watched videos and disappeared down more rabbit holes than I care to admit. The more I learned, the more curious I became and before long I found myself spending hours exploring ideas I had only previously touched on. I was searching for answers and I was open to finding them.

    One of the things that resonated with me was the idea that where we place our attention matters. If we spend our lives focusing on what is missing, we notice more absence. If we focus on what is good, however small, we begin to notice more of that too. That idea led me to a daily practice.

    Every morning before I did anything else, I listened to a manifestation recording on YouTube. The focus was on raising your vibrational energy and being consciously grateful, bringing a positive emotional state of being into the day. I would consciously thank the universe for another day, for my existence, for my family, for my breath, for the trees, for all the small things that I took for granted. I would focus on what was present in my life rather than what was absent. It wasn’t something I did occasionally. I did it every day. Gradually it became part of who I was. The more I practised, the more positive I felt. The more positive I felt, the more hopeful I became. And the more hopeful I became, the easier it was to imagine a future that looked different from the life I had lost.

    Manifestation became less about wishing for things and more about clarity. I became fascinated by the concept of identity shifting. Put simply, it is the idea of becoming clear about who your future self is and then making choices that move you in that direction.

    I started asking myself what came next. Who did I want to become now? What did I want my life to look like? How did I want my days to feel? What sort of work did I want to do? Who did I want to spend my time with? The more I sat with those questions, the clearer the answers became. And once they became clear, opportunities started appearing that I might not even have noticed before. Perhaps they had always been there. Perhaps I was simply ready to see them Either way, one thing led to another.

    Today I have a private GP clinic opposite the road where my old surgery once stood. I work with my son, my daughters help out too and most days work doesn’t feel like work.

    Whether you call that manifestation, mindset or simply being clear about where you want to go in life doesn’t really matter. What matters is that it changed the direction of mine.

    I became much more selective about relationships. That sounds harsh when I write it down but the last few years have taught me that time is precious. One of my daughters said something to me after Dad died that has stayed with me ever since.

    “Mama, not everyone who comes into your life is meant to stay there forever. Even family.”

    At the time I was sad about a relationship with a family member who had once been very important to me. Life had happened, we had drifted apart and there was no obvious way back.

    We spend so much of our lives holding onto relationships because of history, obligation or guilt. Sometimes people grow in different directions. Sometimes relationships simply belong to a particular chapter of our lives. That doesn’t mean they weren’t important. It simply means that chapter has ended and it’s ok to let go of them. My daughter gave me the simple explanation for something I had been mulling over for so long and told me it was ok to let it go. And I instantly felt lighter. 

    These days I spend my time with people I genuinely enjoy being with. People who make me laugh. People who bring energy into my life rather than draining it. I no longer feel guilty about saying no. If I have an empty weekend, that’s perfectly fine too. I like having empty days. I’ve stopped filling space for the sake of it and, ironically, having the space makes me feel happier and more content.

    Perhaps because of that, I have come to appreciate even more the people I choose to spend my time with. Seeing them happy genuinely makes me happy and I think that has always been true of me. Perhaps that is why relationships have always mattered so much and why I have always enjoyed looking after people.

    I love spending time with my family. I love creating memories together. I love celebrating things, however small. I love seeing people succeed, achieve something they have worked hard for or simply enjoy themselves.

    And yes, I love buying gifts. Not expensive gifts necessarily, but thoughtful ones. The sort where you’ve listened to somebody mention something months ago and remembered. The sort that tells somebody they were heard.

    There is something lovely about seeing somebody realise that you’ve paid attention. Perhaps that’s why giving has always brought me so much pleasure. There is something deeply satisfying about making somebody else’s day a little brighter, not because you expect anything back but simply because you can.

    And if you can, why wouldn’t you?

    I suspect that is one of the reasons I became a doctor in the first place. Looking after people, helping them, solving problems and making life a little easier where possible has always given me a sense of purpose. The older I get, the more convinced I am that happiness grows when it is shared.

    Creating memories has always been important to me too. If I’m honest, I’m probably not the world’s greatest saver. I’m sure there are people my age who are much better prepared financially than I am. Some may already be retired. Some may have second homes and investment portfolios that would make a financial adviser very happy. I’ve never really been motivated by those things. Instead I have spent my money on experiences. Family holidays. Days out. Meals together. Theatre trips. Weekends away. Sometimes holidays I probably couldn’t really afford at the time. If there was a choice between buying something sensible and saving, or creating a memory, I almost always chose the memory. When I look back over my life, I don’t regret that for a second.

    The things that make me smile aren’t possessions. They are memories. Family holidays that didn’t quite go to plan and somehow became funnier because they didn’t. Conversations that lasted long into the evening because nobody wanted them to end. Dancing with my children late into the night. Sitting around a table with people I love, laughing so much that nobody can finish a sentence. Or having deep conversations about whatever the topic was that day. When I lost my parents, it wasn’t possessions that brought me comfort afterwards. It was memories. Thousands of them. The conversations. The holidays. The family gatherings. The ordinary afternoons that didn’t seem particularly important at the time but became precious afterwards. Perhaps that’s why I still choose experiences over things whenever I can. The older I get, the more I realise that memories are one of the few things in life that become more valuable with time.

    Looking back now, I don’t think happiness is a given for everyone. For the lucky few, possibly. But I think it is something we can cultivate. Something we can build slowly through our habits, our relationships, our choices and the way we choose to view the world around us.

    One of the biggest things I have learned is that happiness and sadness can sit alongside each other. Losing my parents remains the hardest thing I have ever been through and there are still moments when I miss them terribly. There are still days that feel harder than others and I suspect there always will be.

    I am not suggesting that I feel happy every day. That would be unrealistic. What I have learned, however, is that I can usually bring myself back to that place. Sometimes it takes effort. Sometimes it takes conscious thought. Sometimes it means returning to the very things that helped me heal in the first place; gratitude, connection, purpose, creating memories, helping others and reminding myself of all the good that still exists in my life. And accepting that I may not always feel happy is ok too. We all have bad days and that’s ok.

    For me, happiness wasn’t something I found after losing my parents. It was something I slowly rebuilt after I lost them. And perhaps that is the real lesson. Not that life becomes easier. Not that difficult things stop happening. But that even in the midst of sadness, happiness remains available to us if we are prepared to nurture it.

    So can we learn to be happy?

    Yes. I think we can.

    Thank you for reading.

    You can find more reflections on medicine, health and life in the Posts section.

  • What matters most

    What matters most

    The opportunity that came along was almost too good to ignore and what happened next changed the course of my career.

    A local GP was approaching retirement and was looking for somebody to join the practice with a view to taking over when he stepped down a year later. His son had originally been expected to take over but had decided instead to move to Australia, leaving the future of the practice uncertain.

    For me, it felt like a remarkable opportunity.

    The surgery was within walking distance of home. The children were older, life looked very different from when I had made the difficult decision to let go of my first practice and, for the first time in years, I could see a way of combining practice ownership with family life.

    It wasn’t a decision I took lightly. Taking over a practice meant increasing my hours considerably and accepting a huge amount of additional responsibility. As a family, though, we talked it through and decided it was an opportunity too good to miss. In many ways, it felt as though life was giving me a second chance.

    My husband, who had been made redundant and had started his own management consultancy, initially agreed to spend a couple of weeks helping me review the business side of the practice. Two weeks became a month, a month became several months and before long he had become an indispensable part of the team. Eventually he gave up the consultancy altogether and became my practice manager.

    Looking back now, I honestly don’t know how I would have done it without him.

    Together we developed the practice and gradually grew the patient list. By the time I eventually left, we were caring for around 4,000 patients with a very small and dedicated team. It was general practice as I had always known it and I loved it.

    The children spent a lot of time at the surgery. We were both working and there were many afternoons when they would arrive after school, appearing in reception, doing homework in spare rooms or helping themselves to biscuits and cakes that patients had baked for us. At times it felt strangely familiar and I would often find myself remembering my own childhood.

    Without consciously planning it, I had recreated something remarkably similar to the world I had grown up in. It wasn’t just a practice. It was part of family life.

    There were a lot of hats to wear. On any given day I might be a GP, a practice owner, a wife, a mum and a daughter to ageing parents. Like most working mothers, I spent years juggling surgeries with school runs, parents’ evenings, sports days, packed lunches and trying to work out what everyone was going to have for dinner.

    It wasn’t always easy. Running a single-handed practice was hard work and the responsibility never really left you. We rarely took proper breaks, the days were often long and there was always another problem waiting to be solved. Yet there was also a freedom that came with it. I planned my own diary, I knew my patients well and, although there were difficult days, there were many more good ones.

    The practice gradually became our second home. More than that, it was ours. We grew it together and, despite all the challenges, there was something deeply satisfying about creating something that reflected our values and the way we believed general practice should be.

    Over the years it became increasingly difficult to find locums willing to provide cover as general practice moved steadily towards larger organisations and group practices. I found a couple of old-school colleagues who were happy to cover sessions, which helped build a little resilience into the system. Being the only doctor on site still meant there was nowhere to hide. If an emergency arrived, you dealt with it. If several problems landed at once, you prioritised and managed them. There was no colleague in the next room to ask for help.

    You learned to stay calm, make decisions and carry responsibility and, with all of that in mind, very little really fazes me these days. I rarely get stressed or panicked about anything. I’ve always told my children that they can tell me absolutely anything and I will never be shocked because, between life and medicine, there is very little I haven’t either experienced myself or heard about from somebody else. And they do.

    What I loved most, though, was always the patients.

    Not once in my career have I stopped feeling privileged when a patient walks into my consulting room and trusts me with their story. It is the first lesson I teach medical students. Never lose sight of what a privilege that is.

    There are very few professions where people sit down in front of a stranger and tell them things they may never have told another soul. Perhaps only priests experience something similar.

    People never cease to amaze me. Over the years I have listened to stories of courage, resilience, humour, heartbreak and despair. Some have been uplifting, some tragic and some so complicated and extraordinary that they could easily have come straight from a television drama. General practice gives you a unique window into people’s lives and sometimes I would leave a consultation thinking that no scriptwriter could possibly have invented a story quite like it.

    So the second lesson I try to teach students is that patients will teach you far more than any textbook ever can if you take the time to listen. Looking back, much of my real learning happened on the job. Not just the social side of medicine, but the practical side too. The clinical decision-making, the examination techniques, developing my own style of consulting and learning how to navigate complex symptoms all evolved over time. I often found myself creating mental maps to help make sense of seemingly unrelated problems and gradually learned that medicine is as much about pattern recognition and curiosity as it is about knowledge. Patients were some of my greatest teachers.

    I realise that what I valued most about those years wasn’t the ownership, the independence or even the flexibility. It was continuity. It was the privilege of knowing people over years and sometimes decades, of understanding not only their medical history but also something of their lives, their families and the things that mattered to them.

    Perhaps that is why I struggle with some of the changes that have taken place in general practice over recent years.

    People often ask why I chose not to continue working in the way modern general practice is evolving. The answer is complicated, but at its heart it comes down to relationships.

    I have never really believed that people can be reduced to a ten-minute appointment or a list of isolated problems because life simply isn’t that neat. One appointment, one problem sounds sensible on paper, but how do we know that problem number two isn’t connected to problem number one? How do we know that the tiredness isn’t linked to the bereavement, the headaches to the anxiety or the stomach pain to the stress of caring for an elderly parent?

    Continuity matters because it allows someone to join the dots. It allows a doctor to know what happened last year, what happened ten years ago and what might be happening beneath the surface today. I worry that something important is lost when nobody holds the whole picture.

    Patients need somebody who knows them, advocates for them and takes responsibility for helping them navigate increasingly complicated systems. Someone who notices when things don’t quite add up.

    At least, that is the sort of doctor I have always tried to be.

    I am a very emotional person. At happy times and sad times, at weddings, family speeches and all sorts of occasions, any member of my family will tell you that I am almost guaranteed to cry. My husband carries a hanky just for me whatever the occasion. The same is true in the consulting room and over the years there have been many occasions when I have sat with a patient and cried alongside them, not because I lacked professionalism, but because sometimes being human is exactly what the moment requires.

    Perhaps that is what I value most about general practice. The privilege of sharing in people’s lives at their best and at their worst.

    That is what drew me to medicine in the first place and, all these years later, it is still what keeps me there.

    The practices have changed. The NHS has changed. The way medicine is delivered has changed beyond anything I could have imagined when I first started out. But the things that matter most have remained remarkably constant. People still need to be listened to. They still need kindness. They still need somebody willing to walk alongside them when life becomes difficult.

    The story of what happened next is, in many ways, the story I told in my very first post. Perhaps I wrote the ending before I wrote the beginning.

    Looking back now, I realise that the practices, the buildings and even the different chapters of my career were never really the important part. The important part was the relationships I built, the people, their stories and what a privilege it has been to hear them.

    In the end, that is what mattered most.

    Thank you for reading.

    You can find more reflections on medicine, health and life in the Posts section.

  • What medical school didn’t teach me

    What medical school didn’t teach me

    Despite my dream of becoming a doctor, I managed to fail my final exams.

    Medical school itself is a bit of a blur when I look back now. The first two years were spent on the King’s campus on the Strand. Like many students experiencing independence for the first time, I discovered the bar, late nights, socialising and a busy social life. I made wonderful friends and thoroughly enjoyed myself.

    The move to King’s College Hospital in Camberwell brought another adventure. Living away from home, being close enough to pop back when I needed to and having a car gave me a freedom I had never really experienced before. I attended lectures when I could, enjoyed student life and generally had a wonderful time.

    The truth is that I wasn’t a particularly academic medical student.

    I had lots of friends, but very few of them were medics. Looking back, I think I was always drawn to people doing completely different things from me. When I moved to Camberwell, I lived in a large shared house at 95 Coldharbour Lane. It wasn’t just students living there. There were artists, engineers, people already working and all sorts of interesting characters passing through. It felt a million miles away from lecture theatres, anatomy textbooks and medical exams.

    There was something wonderfully bohemian about it all. Conversations around the kitchen table were just as likely to be about art, politics, relationships, music or somebody’s latest adventure as they were about work. Whilst many of my medical school colleagues seemed to spend every waking hour studying, I found myself surrounded by people who viewed the world through a completely different lens.

    Looking back now, I sometimes wonder whether that was part of the reason I struggled with medical school. Whilst everyone else appeared to be studying one syllabus, I seemed to be studying two. One was medicine and the other was life.

    Perhaps that sounds like an excuse, and it certainly wasn’t one at the time, but I can see now that I was learning things that would eventually matter enormously to me as a doctor. I was fascinated by people, by their stories, by the different ways they approached life and the very different paths they had taken to get there. Maybe that is why I always found it easier to learn from people than from books.

    The couple of friends I did have on the course and I would usually sit together in the back row of the lecture theatre, which looked more like a cinema than a place of learning, complete with comfortable red seats. If the lecturing became too much, there was always the second-floor bar. I spent more time there than I probably should have done.

    At lunchtime I would sometimes sneak back into the lecture theatre, put my coat over my head and have a quick snooze. On one occasion, what was meant to be a ten-minute nap turned into something rather longer. I woke up a couple of hours later surrounded by faces I didn’t recognise and listening to a lecture I definitely didn’t understand.

    It turned out I was sitting in the middle of an engineering lecture.

    Trying to remain composed, I gathered my things and quietly left, hoping nobody had noticed that I had slept through the changeover and remained there for the best part of two hours.

    Needless to say, I was never destined to be top of the class.

    Some subjects I took to naturally whilst others I struggled with enormously. Anatomy, for example, was a constant challenge. Spending a year dissecting a cadaver was not something I enjoyed and I found learning from textbooks difficult. Much of what we were being taught felt abstract and disconnected from real life.

    What I found hardest was that medicine seemed to be taught almost entirely in theory. We didn’t meet a real patient until our third year and much of what was discussed in lectures simply didn’t make sense to me because I had no context for it.

    Everything changed once I started spending time on the wards and meeting patients. Suddenly the conditions we had spent years reading about had faces, stories and families attached to them. The medicine started to make sense because it became real.

    Unfortunately, by then I was carrying the consequences of not having engaged with the earlier years as seriously as I should have done.

    When the final exam results were published, they were pinned to a board for everyone to see. I can still remember the crowd of anxious students gathered around it, all trying to find their names on the pass list. I searched once, then again and then a third time. At first I was convinced I must have missed it. I checked every line repeatedly, certain that if I looked hard enough my name would somehow appear.

    It didn’t.

    The feeling was awful. Not only had I failed, but everybody else could see that I had failed too. I remember feeling embarrassed, disappointed and frightened. For someone who had wanted to be a doctor for as long as I could remember, it felt as though the future I had always imagined was slipping away.

    More than anything, I worried about how my parents would react. I felt I had let them down.

    In reality, they were incredibly supportive. Perhaps part of the reason was that they understood exactly how I felt. Dad had failed his finals too, for many of the same reasons. He knew first-hand that a setback at the end of medical school did not define the doctor you would eventually become.

    Those were also the days when university education was free. Repeating a few months was disappointing, but it wasn’t financially devastating. Looking back, I can see that whilst it felt like the end of the world to me at the time, it really wasn’t.

    Six months later, whilst many of my peers had already started their first jobs, I found myself standing in front of the same board once again.

    This time I only had to look once.

    My name was there.

    I had passed.

    It was the most incredible feeling. Seeing “Dr” in front of my name felt surreal. I changed my bank card and cheque book almost immediately, not because I wanted to boast, but because I was proud. I had wanted this for as long as I could remember. I practised my new signature endlessly and threw myself into my first job with all the enthusiasm and confidence that only a newly qualified doctor can possess.

    That confidence lasted until my first on-call shift.

    I remember my first night on call as clearly as if it were yesterday, even though much of those early years has now merged into one long blur of wards, bleeps, sleepless nights and exhaustion.

    In those days the junior house officer was very much at the bottom of the pile. We carried a bleep and were the first port of call for all sorts of things. Rewriting fluid charts, replacing lines, reviewing admissions and trying to stay one step ahead of whatever happened next.

    I quickly learned that one of the secrets to surviving hospital life was understanding that nurses were your friends. The young doctors who arrived believing they knew everything and that nurses were somehow beneath them often had a difficult time. I genuinely enjoyed talking to the nurses and learned a huge amount from them. They had knowledge, experience and common sense in abundance and they made many an on-call shift far more bearable.

    Despite that, it was terrifying at times. I was twenty-four years old and seeing things most people my age had never encountered. Illness, trauma, suffering and death became part of everyday life.

    I still remember the first time I was called to verify a death. Like every junior doctor of the time, I carried my Oxford Handbook of Clinical Medicine in the pocket of my white coat. It was our bible. I looked up what I needed to do before walking onto the ward.

    The lights were dimmed. The curtains were drawn around one bed.

    I remember pulling the curtain back and seeing a woman lying there looking as though she was asleep. My heart was racing. Three minutes is a very long time when you are listening for heart sounds.

    I am also an avid horror fan and a small irrational part of my brain was convinced she might suddenly open her eyes.

    Looking back now, I think about my eldest daughter, who is twenty-four, and I struggle to imagine her being expected to deal with something like that alone. We were so young and yet somehow we simply got on with it.

    Medical school had definitely not prepared me for working as a doctor. Nothing had prepared me for the fear of being called to see a patient on my own, the fear of feeling out of my depth or the responsibility of being the first person expected to make decisions.

    In those days the saying was “see one, do one, teach one”. Procedures such as inserting a line were often learned exactly that way. Looking back, it seems extraordinary. At the time it felt perfectly normal.

    Christmas on call was probably the hardest of all. Whilst family and friends were gathered together, we were often in hospital missing Christmas lunch and family celebrations. The hospitals were very different then too. If you missed the canteen opening times, that was often it. More than once I survived an entire shift on toast, coffee and tea from the doctors’ mess.

    I remember one night being on the cardiac arrest team. I had finally made it back to the on-call room at some ridiculous hour of the morning. I was fully dressed and had just lain down on the bed. I wasn’t just tired. I was exhausted beyond anything I had experienced before.

    Then the bleep went off.

    I hate admitting this, but I simply couldn’t get up.

    A whole group of us carried arrest bleeps and I knew others would be responding. As the most junior member of the team, I convinced myself they would manage perfectly well without me. The truth was that for that one moment I had absolutely nothing left to give.

    There were certainly times when I questioned what I was doing. Many of my friends worked regular hours, had weekends free and earned far more money than I did. Meanwhile I was spending nights in hospital, carrying a bleep, surviving on very little sleep and earning surprisingly little for the responsibility involved.

    Medicine certainly wasn’t a route to wealth.

    For me, and for many of my colleagues, it really was a vocation.

    And yet, despite everything, I loved it. I loved the buzz, the unpredictability and the fact that no two days were ever the same. We worked hard and we played hard. We went out, danced, drank, smoked and enjoyed ourselves. The friendships formed during those years were unlike any others because they were forged through experiences that few people outside medicine could fully understand.

    And then there was home.

    After long shifts, sleepless weekends and endless on-calls, I would return to the sanctuary of family. There I could sleep, be looked after and simply switch off for a while.

    Looking back now, I realise that the things which eventually made me a good doctor were not necessarily the things I learned in medical school. Medical school gave me the knowledge I needed and eventually, after a second attempt, the qualification I had dreamed of for so long. What it couldn’t teach me was how to sit with somebody who was frightened, how to make decisions when I wasn’t entirely sure of the answer, how to work as part of a team or how to cope when I felt completely out of my depth.

    Those lessons came later. They came from patients, nurses, colleagues, sleepless nights on call, Christmas shifts, difficult conversations and countless mistakes. They came from being exhausted, occasionally frightened and constantly challenged. They came from life.

    When I failed my finals, I thought I had failed at becoming a doctor.

    What I couldn’t see at the time was that becoming a doctor was only just beginning.

    The real education came afterwards.


    Thank you for reading.

    You can find more reflections on medicine, health and life in the Posts section.