The Good, The Narcotics and The Truly Ugly

Being a doctor here is mainly a good thing. This seems like a short and simple statement but the intricacies of modern medicine make it difficult to say whether it is enjoyable, or frustrating or well and truly disheartening. With the central pressures on the NHS in the UK - governmental targets which are impossible to meet with lack of funding and doctors - and the postcode lottery of treatment, medicine ceased to be 'fun' even at a basic level. 

A family doctor in a small town can expect a whole different set of pressures - a long workday which does not necessarily end, even when not 'on duty'. A large investment in the emotional as well as the physical well-being of patients and even families. A very different kind of doctor-patient relationship than I have been used to up until now, will less formality and no clear-cut boundaries. And the proverbial buck stops with you, as you are the end of the lifeline.

I like this most of the time - my patients call me Bella, and if they are feeling more formal, Doc Bella. They feel comfortable to share their lives and vulnerabilities. They are complimentary when they feel as if they have been taken care of and listened to, even if no obvious solution is forthcoming. I look after them through pregnancies, family crises, severe pathologies and even death (or I hope to, as I have not been here long enough yet to achieve all these things). This was how I wanted to run my practice in the UK, but was hampered by time limits (no sign on my wall here that says 'YOU HAVE 10 MINUTES ONLY', and there would not have been one in England if I had not been found to have removed mine surreptitiously), ridiculous targets and a high patient turnover in the area. 

More difficult are the times you are buying a bunch of incredibly unhealthy food at the store (usually an assortment of chips and baba ganoush, which is more like garlic mayo here), when you are flagged down by a patient who asks for test results. To be honest, unless I see them regularly then I usually will have trouble recalling their name, never mind the intricacies of their head CT. I have to wave this off currently 'not sure if I have seen them yet, why don't you give the girls a call on Monday and see if they have arrived....' , which I always hope will elicit a nod and an appreciative smile. At least they can pass me off as the eccentric English doctor who calls everyone 'sweetie' - a euphemism for 'I have no idea what your name is' more often than I care to say.

Another problem crossing the pond is the narcotic use here. Although I am sure that Canada is not on a par with the US, where it seems narcotic scripts are a part of life (see Woody Allen and Diane Keaton's great conversation in Play It Again Sam, a 1970's film where they are discussing the relative merits of various narcotics and anxiolytics with certain soft drink combinations or in more modern times the addictions of House MD), it is still far beyond the UK where such potions are tightly regulated. The only patients I had on anything stronger than codeine were palliative care patients who were dying of cancer or other disorders. Here hydromorphone (have never used this before) is given out like smarties and oxycodone is massive on the black market (physician's triplicate script pads are worth around $3000 dollars).  Patients who are addicted and even selling the tablets will 'doctor-hop' to get more tablets than they will or should use. I have generally been unwilling to give out these and the patients who I have inherited who are on them, I am trying to wean off or transform their pain by other means. 

And lest I had forgotten I am English, as we have been so welcomed here and feel almost part of the community already, I ran into a little 'racism' the other day. I was working hard in the ER and a man came up to me while I was note-writing and asked me if I was going to see his child. I replied that yes, she was next in line and I apologised for the wait - I had been seeing a stroke patient, a heart attack and an elderly gentleman who had fallen (such is the importance of triage). His face changed from passive to aggressive in the space of a heartbeat - the hospital and all the doctors were accused of unbelievable behaviour and he obviously felt that he had been ignored at other times. Incidentally, his daughter was suffering from a minor problem much better suited to the GP's office. I attempted to apologise for myself and my brethren and again reiterated that I would see her very shortly. He refused and dragged the uncomfortable-looking child out behind him. As he went, he uttered 'and piss off back to England'. My immediate reaction was to utter something equally outrageous to his departing back, but luckily he did not hear me as this was marginally unprofessional. 

This has stuck with me - if only to remind me that there is only one race still - mankind.