The medical year has its internal rhythms and seasons, and autumn is a time of preparation for winter. Every GP knows that many of the people who come into them rubbing their hands and complaining about the cold are the same ones who complained about the heat in the summer.
As the weather gets colder, the GP gets ready to batten down the hatches and prepare for the storms ahead.
The summer injuries – falling off trampolines, sunburn and insect bites – make way for falling off horses, rugby injuries and wasp stings. GPs in seaside areas are relieved to see the workload drop off.
If you work in a hospital you don’t appreciate the seasons like you do in the community. In winter, the emergency departments get even busier and the dreaded winter vomiting bug will sweep the wards again, like a bad Christmas song returning.
There is the more complex task of getting your patients ready for winter as the back-to-school children exchange playdates, cold germs and head lice
Family doctors, unlike the hospital variety, turn the heating back on and come in at weekends to make sure the pipes don’t burst in the frost. But as well as preparing the office, there is the more complex task of getting your flock of patients ready for winter as the back-to-school children enthusiastically exchange playdates, cold germs and head lice.
The new parents are cheerfully told that the school does not require a note from the doctor for a missed day at school, and isn’t it great that they don’t. No, not even with an under-6s card.
The ant-iflu vaccines arrive and you decide how to get it to as many as possible. The list of who should receive the vaccine gets longer until it seems more should get it than not. GPs know better than anyone else who is at risk and can advise accordingly.
Blood tests
Often those who need it most are the most resistant to getting it. I marvel every year at the significant number of elderly people who have not needed to be seen since last year, even though they probably should have, and see in their notes that they agreed to come back for blood pressure monitoring and blood tests last October but somehow they never got round to it.
In theory, the flu jab should take about as much time as it takes to get your coat on and off and log the details in the computer. In reality the consultation can go anywhere. It’s called opportunistic health promotion – when you come in for one thing and the doctor wants to discuss something else (probably smoking).
Asthmatic kids need to have their inhalers checked. Some have done without them for the summer but need the preventative for the winter.
The average kid spends six minutes a day outside, and a computer screen makes no vitamin D
The older patients with the chronic chests also need to have their inhaler-use optimised. The trick is to reduce the number of exacerbations, which will land them in hospital or even kill them.
We test for vitamin D, which is relatively new.Vitamin D is made by sunlight on the skin – not surprisingly it appears that everybody in Ireland is low on it, except farmers. The average kid spends six minutes a day outside, and a computer screen makes no vitamin D.
We worry about our patients; those with seasonal affective disorder, who find the shortening days intolerable. And the chronically ill, who might not see the spring.
Consultants return
The consultants come back from holidays. Nobody seems to have a locum anymore, and we are told that we are lucky to have any consultants, the way things are.
The HSE will send out a memo requesting us not to send anyone to hospital unless we feel it necessary, as the place is awfully crowded this winter, which is usually good for a bitter laugh as we open the post. The sender of the memo has not had the experience of the elderly patient telling them that they would rather die at home than go to casualty, as we have nearly every night on call.
We often take the chance, patching them up as best we can with antibiotics and steroids, and agreeing that a couple of days on a hospital trolley is not really in their best interests, while the memo writer sleeps peacefully.
The standing Irish army of 3,100 family practitioners have a back-to-school feeling as they avail of the Irish College of General Practice CME network. CME means "continuing medical education", and the GPs head out in the wintery nights to sit at educational meetings with their peers. This is particularly useful to younger GPs, who find these sessions vital. There is however an autumnal feeling when GPs gather, and not just because of the weather.
You see a lot of grey heads; like the priests, we are getting older, and the newly qualified GPs are leaving the country like flocks of swallows. Unlike the swallows, they are unlikely to come back.
The only way through the winter is through it. We turn the heat on, we turn the heat off. We take vitamin D ourselves. We work through yet another Christmas, and wait for the swallows to return.