“General practice will never be the same again.” The GPs are all saying it, in medical journals, at the virtual meetings and in the WhatsApp groups. We will have different approaches to appointments, to safety and hygiene, and most of all, to technology. Apparently, we will never write a prescription or an illness cert again now we have learned to click them across the internet to their destinations. We will talk to some patients remotely, and the out of hours co-ops will be radically overhauled.
As I sit at my desk answering phone call after phone call, I make plans in the way an unhappy child in boarding school dreams about what they will do when they are released. Distance lends not only enchantment but also perspective. I promise myself that this time I will remember what was precious when I could no longer have it, and I vow not to give my attention to the distractions that will pop back up when all returns to normal.
Lots of people wish for things to go back to the way they were. I hope that my life will be the better for all this. For instance, I intend to waste a lot more time.
I have always been good at wasting time. Before the pandemic if I went on a trip down town to the bank it should take have taken me about 10 minutes. I suppose I averaged about half an hour. If you were to follow me down the main street you would have thought that I was running for election as I used to stop and talk to just about everyone. We rarely discussed health matters. That was for the office. In future, I think I will take at least the full hour and longer if I can get away with it.
Younger GPs have worked out every cost of staff and premises and see time not seeing patients as wasted. That is because they have been paying high end rents and have nothing like the remuneration they deserve. They work too long, stay too late and spend too much time on the job. Their working days have been filled with irrelevant paperwork and bureaucracy.
I have learned a lot in the last few weeks. One is that talking on the phone is exhausting
My appointments, when I could see patients without togging out in full personal protective equipment would take 15 minutes. I will increase that to 20, and longer if we have to talk about hurling, music or anything to do with the garden. I will avail of the great luxury of examining thoroughly and thinking deeply about management plans while I do so and I will not let a small child out of the office without doing at least one magic trick.
I used to cycle to work. Every Friday, and other days when I could, I would have a leisurely breakfast in a local cafe with an eclectic group of tradesmen and shopkeepers.
I enjoyed the tea time pint on the way home, especially towards the weekend. I never refused a request to write an article or address a crowd. I now see that instead of being signs of a wayward and eccentric doctor who should have been minding his business all the hours of the day, I was taking my chances to be sociable. None of us know when such simple pleasures can be suddenly taken away.
Social dissonance
I have learned a lot in the last few weeks. One is that talking on the phone is exhausting. It is caused, I am told, by social dissonance, where your brain cannot compute that a person is there but not there simultaneously. I don't dispute that, but I also realise how difficult it is to be an occupational physician, psychiatrist, public health doctor, paediatrician and everything else you can think of over the phone. Irish GPs are rooted in the community, so familiar with their patients that they can handle almost anything with courage and wisdom. Nobody else could have done what those who have spent their working lives immersed in the lives of their families have done in the last few weeks. Dr Mike Ryan from the World Health Organisation called them the thin blue line – holding back the onslaught while the hospitals got ready, young and old frantically learning new ways of working and communicating.
It is to be hoped that when this is all over and the clouds of war have cleared away, it will be finally seen how important general practice is, and it will finally be properly resourced, and we primary care doctors will be able to afford to spend our time on what matters, in the office and out of it.