Rebecca Quinn is a GP in London. She has an interest in narrative medicine and the use of creativity in healthcare, and enjoys using poetry as both a tool for reflection, and as a means of capturing what is precious and unique in primary care. She is on instagram: @beccajanequinn
8am Triage Shift
Fever, child
Raised red rash,
Chest pain.
Chest pain.
Swollen finger
Cough that lingers
Chest pain.
Chest pain.
Short of breath
Results of tests
Can’t get over my father’s death
Me again.
Foot’s lame.
No prescription
Eyes are itching
No one cares about my affliction
Appointment date
Can’t wait
Chest pain.
No details.
See email.
Swollen knee
Cannot pee
Ears that pivot
Housebound patient requesting visit
Cannot sleep, in Italy
This form is ridiculous.
Why can’t I just see my GP?
In our climate of ever escalating demand, total triage has been subsumed into the skill set of GPs out of necessity. Our survival mantra dictates that triage is needed “…to direct patients to right appointment with the right person at the right time.” Nevertheless, it presents us with a dilemma.
For we are clinicians with a craft, rather than protocol driven call-handlers.
Can we really derive job satisfaction on a shift allocating appointments or signposting in quick succession, based only on the information shoehorned into the triage forms before us? How can we reconcile this to our innate instinct to connect and care for the person behind the form? What actually transpires when we monologue instead of dialogue with our patients?
As GPs we are trained to data gather, and to notice things. We are trained to appreciate complexity.
As GPs we are trained to data gather, and to notice things. We are trained to appreciate complexity. We are keepers of patients’ stories and often we cannot help but open the Pandora’s box : who has written this – was it a relative, an obliging receptionist or a tech savvy grandchild? Why have they used those words, what does it mean to them? “Dizzy and weak” have turned out to mean a range of things. “Completely black toe” – which generated some consternation for me, turned out on arrival to be a discoloured toenail. But we also want ensure equity and hence triaging quickly and accurately is key.
The reality is that on triage we engage different gears depending on demand; sometimes we are actually the right person to intercept a triage form and interpret it correctly, giving a quick reassuring text or call to the patient to explain things. But sadly, as the avalanche of increased access continues to gather pace, the days on which we can ‘deal with something quickly on triage’ appear to diminishing. Clinicians are being forced to adopt a distance in order to cope with the flood of forms. We resist the urge to pick up the phone and learn the judicious deployment of triage questionnaires. We are obliged to allocate patients as if they were parcels to other clinicians to ‘unpick’.
Ultimately there will always be a tension here. But perhaps this is where our identity as part of the practice team is vital. A key part of our job satisfaction is now derived from directing patients to trusted colleagues who share our ethos and who share our load.
The role of a GP is now more than ever intrinsically linked to the body a practice team.
And where better to nurture that sense of team but in the holistic and multi-professional ever evolving organism that is general practice?
Featured photo by ThisisEngineering on Unsplash.
