Wednesday, August 31, 2011

The Locum Motion

(to the tune of the loco-motion)

Everybody's doin' a brand new job now
(C'mon baby do the locum-motion)
I know you'll get to like it
If you give it a chance now
(C'mon GP do the locum-motion)
The little NP can’t do it with ease
It's easier than understanding ABGs
So come on, come on,
Do the locum-motion with me

You gotta swing your tubes now
Come on patient, sit down, be quick
Oh hell, dont think I'm a quack

Now that you can do it
Let's write a line now
(C'mon baby do the locum-motion)
rub a rub a lotion on an itchy rash now
(C'mon baby do the locum-motion)

Mrs Smiths feeling dizzy and is off her feet
A little bit of admin and a lot of slots
So come on, come on,
Do the locum-motion with me

You gotta swing your tubes now
Come on, come on,
Do the locum-motion with me

Move around the town in a locum-motion
(C'mon baby do the well formed-motion)
Do it wearing gloves if you touch the motion
(C'mon GP do the locum-motion)
There's never been a patient that’s easy to please

SSRIs makes you happy
When you're feeling blue
So come on come on
do the locum-motion with me
You gotta swing your tubes now

Thursday, August 25, 2011

Hidden Gems

One of the great challenges of being a GP locum is finding things in the consulting room. You can tell a lot about the owner of the room just by what you can find, or more specifically can’t find

For instance if you decide to be a good little locum and decide to do some of your own phlebotomy and cant find any equipment with which to perform the task, then it doesn’t need Sherlock Holmes to deduce that not much phlebotomy normally goes on in that room

Of course there’s the family photos; I would have thought it was bad enough being married without having to look at pictures of the wife/husband whilst at work as well; but then as a divorced cynic maybe I am too clichéd in my opinions

Neatly arranged, and labelled ring box files with appraisals listed by year always intrigue me. I couldn’t usually fill my wallet with the paperwork for my appraisal, far less a box file. I secretly like to think that these contain bottles of vodka, but I feel its an invasion of privacy to look, which if course it is, but more importantly I am not sure I could face the disappointment that they were in fact full of attendance certificates and the like

Out of date drugs are not unusual, and large stashes of MST are not as unusual as they perhaps should be. They are usually labelled with a patients name and date back from 1974; presumably taken from the patient’s home with the good intention of disposing of them correctly, but instead shoved in the back of a cupboard and long since forgotten. I am quite sure the practice CD register didn’t list these

One of my personal favourites was when in my (then) appraisers practice; I had to go off in search of a peak flow meter and mouthpiece. I discovered, much to my amusement that all of the meters in the practice were old style non EU PEFR meters which had been phased out 6 years previously. This included the peak flow meter in the asthma nurses room.

Second to that was a practice where every surface in the consulting room was piled high with unopened medical magazines that dated back 10 years; under the desk, on top of the desk, on top of the filing cabinet, in every cupboard and even the sink draining board was weighed down. It probably won’t come as a surprise to hear that the doctor I was covering was off long term sick.

I don’t go looking out of curiousness or nosiness, I go looking out of clinical need, on the seemingly naïve assumption that the cupboards will contain the urine/blood/faeces/sputum and other bodily fluid/part receptacles I seek. . When I was a partner I shared my room with locums and other visiting doctors and midwives. I, admittedly, had some personal touches, which didn’t include a picture of my wife (now ex), but did include a picture of my dog just to remind me there was someone who would be pleased to see me when I got home. It was a clinical area first and foremost; I kept the closet skeletons firmly under lock and key.

Tuesday, August 23, 2011

The Ultimate Sin as a locum

“Forgive me father because I have sinned”. I have committed the ultimate of sins as a locum and for reasons I cannot fathom managed not to put a booking for an afternoon in my diary. What made this worse, if there is a worse sin, is that I, thinking I was free, had done an overnight shift at short notice the morning of my sin, and then gone to bed with my phone on silent, blissfully unaware of the list of patients waiting my attention. By the time I woke the practice had closed and my name was mud

“Yes father, thank you for that, I will recite the 7 deadly sins of a locum and say three hail GMCs”

Thou shall not make errors with your diary
Thou shall not criticize the partners that pay you
Thou shall not moan when asked to do work
Thou shall not bark at the practice staff
Thou shall not fornicate with the practice staff
Thou shall write your name after each entry in the notes
Thou shall not eat the last digestive biscuit

“But father, do you think this means I shall never get to enter the pearly gates and pass in the land of partnership. Will I have to spend forever in the purgatory of the locum world?”

“Thank you father, I understand you – and of course it makes sense when you say it is easier for a camel to pass through the eye of a needle than it is for a locum who has committed any of these sins to enter the heaven of partnershipdom”

Oh woe is me!

I am sure we have all done it, a simple administrative error, either one of omission or forgetting to save properly an entry in a diary can have disastrous consequences. Even though I insist on email booking, or at least confirmation by email, and all my entries are synched on my phone with my Google desktop calendar, we have to accept that mistakes will happen.

The one thing about being a locum is you can’t share the blame; you can’t shift the locus of fault. Because it falls fair and square at your own feet.

Thursday, August 18, 2011

August Rollover

It’s that time of year again, August. The death month ,when it’s the merry go round of doctors rotating, is as enshrined in medical culture as it is notorious for patients. Medical alumni get their first bleep and are excited by it. Junior doctors rotate into new specialities, careers in speciality jobs are born and its time for everybody to move on to pastures new. This of course means there are hundreds of newly qualified GPs, the majority practicing as locums. Some might describe it as embracing new challenges, getting to use their newly perfected skills of sharing management options, responding to cues; fresh faced and eager they arrive on the locum scene

Yes some might describe it as that, but the reality most of them are bricking it! The cosy and coveted role of being a GP trainee, having regular income, sick leave, holiday pay and a regular place of work, all protected by training guidelines and standards is replaced by the grim and slightly less comfortable world of being a GP locum

In one day it is off with the water wings, there’s no more stabilisers and out of nappies! It’s a time when these fresh faced and innocent hot shots suddenly find out all about being a locum.

Of course its an annual cycle and we have all been through it at some point. For those of us who are established locums there always a slight dip in demand for work – the combination of a flooded marketplace and all the partners returning from their holidays. For most newbies being a locum is a stop gap – something to pay the bills and a way of expanding their abilities and skills before they take the plunge (or retreat) into the depths (or safer waters) of taking a more secure role. The marketplace product becomes the consumer.

By Christmas the numbers of locums will have dwindled markedly and by next summer practices will be desperate again, taking the scraps from the diaries to manufacture a patchwork quilt of holiday cover

I would heartily recommend taking a holiday in august – and not getting sick

Friday, August 12, 2011

Introduction - Locum post 1

I am not new to being a locum, I have been a GP partner in the past and prior to this I did a stint of locuming. My reasons for choosing this line of work are fairly simple - I like the job of seeing patients - I dislike meetings and I like variety. I enjoy doing the job i was trained to do; some dont and seek other avenues such as being an appraiser or more often - those that cant (or dont like to) do, try to manage.

This post will serve mostly as an introduction rather than anything else - witty or otherwise.

My working pattern is rather random - I do some shifts in A&E, I do daytime practice work and I do some out of hours sessions too! Filling my diary as a general rule isnt a problem, although I do get the odd quiet month - but fallow days where i would want to work and cant get work are few and far between. Of course I may have to choose a day off during the week instead of a week day, or an evening instead of a day session, but as I am single and only see my offspring on a fortnightly basis this doesnt interfere with my life too much. I guess if I wanted I could choose daytime work only, and by doing so would amass a larger number of practices that use me regularly - but I choose not to work this way

In terms of my income - hour for hour I probably earn less than a principal in General Practice, but I supplement that with more profitable out of hours sessions and because I am not worn down by seeing the same old patients every week and a 'change being as good as a holiday' and all that, i am able to work a little more and still not feel stressed or strained by it.

Anyway - a bientot