First day at school

I was dropped off at the Hoy and Walls Health centre in the early morning of my first full day on the island. Rucksack and notebook in tow, with a feeling and appearance reminiscent of my first day at school(minus the hat), I was welcomed in to meet the gang. The healthcare team on Hoy includes one GP, a relief GP for when the resident GP is off the island, one practice nurse, a receptionist and relief receptionist. A small but perfectly formed group.

After sipping a glass of tepid water through the morning meeting( I really must learn to like tea or coffee and why does no one else consider hot chocolate a morning meeting drink?) I spent the next hour with Iain, resident GP, discussing his initial thoughts on medical practice on the island. Delighted to find someone equally enthused about communication skills and consultation models, we had soon delved into his experience of the doctor-patient relationship within the community, namely the complexities of treating a population one also regularly socialised with as well as the challenge of managing patients; half of whom often present very early in an illness through easy access to their doctor and the other half of whom present late through a reluctance to bother the GP they are friends with.

My first impression of the clinic that day was how different it felt to what I was used to experiencing in a London practice. With a population of just below 400, booked clinics tend to be quieter, allowing for a feeling of time and space that seemed quite alien. Because of this, walk-ins are common place and welcomed, adding to a sense of mostly calm unpredictability.

But unpredictability is the name of the game here. Taking on the role of island GP means being 'on call' 24 hours a day, 7 days a week and not leaving the all..unless for an emergency transfer where a doctor is absolutely required, or if a locum is arranged in advance and instilled on the island to cover.

To my protestations, after hearing this news, of 'what if you wanted a spontaneous trip to Paris?' or ' We've all had those nights where one G&T becomes three!' Iain replied 'It's fine, I'm used to it. I've always done on calls'. And so have I, I thought, we all have.. on calls to me are those 12 hour stretches of incessant bleeps, minimal food intake, sparse but luxurious trips to the bathroom(where you can't be found for two minutes) and a step count that would make any pedometer proud. But those shifts end, the bleep is handed over and one can go home and not be bothered. Times have changed, for the most part, the days of one in two on calls are in the past. Yet here I was with someone who, whilst on the island, permanently wore a bleep, who could be disturbed at any moment. Had I stepped into the past I thought? and what would be the impact on patients? I would have to wait and see...

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