More than my money’s worth

I recently bumped into a former patient at the bank, who was seeking to rejoin my practice

Many GP practices have not been accepting new patients in recent years. This is mainly due to a shortage of GPs and an ever-increasing workload. In Killenaule, we have not limited our practice size and have continued to sign patients on. The rationale is to develop a business that will support at least three to four GPs, ensuring high-quality work-life balance for those who come after us.

Once the word got out that our lists were ‘open’, patients began to arrive from surrounding towns and villages. Patients whose doctors have retired, or moved on, and who no longer have a GP, or have had a succession of doctors, none of whom are interested in staying. Patients from areas that are being serviced by visiting GPs where consulting hours are reduced and services limited, unless they (the patients) are willing to travel to the main centre of practice.

The demographic of those applying is varied: Elderly people with complex needs, who say they cannot get regular prescriptions; children who have not had vaccinations; pregnant women who cannot register for shared antenatal care. Many of these people, especially the older cohort, are accustomed to having their own personal doctor for many years, and now feel unmoored and fearful as they grow older and suffer from chronic diseases and multimorbidity.

Every so often, a name appears on an application form that I recognise. Someone who attended the practice for a time when we were just getting established, but for some reason decided to move to another GP. The reasons for leaving were rarely stated. Perhaps we were perceived as too young, too inexperienced, coming from the wrong part of the country, or perhaps they simply didn’t like the cut of our jib. Thirty years ago, when we first arrived in Killenaule, to take over from the preceding doctor, practically every GP was accepting new patients, so it was easy to move between practices. Not so easy nowadays and it seems it’s any port in a storm.

I met one of these ex-patients recently on a rare trip to the bank. (Remember those august buildings that dominated the streetscapes of most small towns in Ireland? Well, some of them are still functioning and people do still go there.) I have missed going to the bank, standing in the queue, exchanging low-key pleasantries, overhearing snippets of others’ conversations. Nowadays, just entering the building feels like an admission of failing intellect or advanced age; a public declaration that I cannot manage my apps, cannot verify that I am not a robot, have, once again, forgotten my password and can’t retrieve it without human input.

On this particular day, it was none of those things; I didn’t need a human, but still had to queue to withdraw cash (remember cash?) from the machine. Before me in the queue was a woman who had attended our practice almost 20 years earlier and I had probably not seen her since then. But I had noticed her recent request to rejoin the practice, but hadn’t yet replied. It took her a few minutes to recognise me, and when she did, she let me know that it was me who had changed (aged) rather than her who had faulty memory.

“I never would have known you,” she said scrutinising my face for some sign of the younger woman she would have visited frequently. Finally, satisfied that it was me, she went on.

“Are you still doing the doctoring?” she said, emphasising the ‘you’ as if she just couldn’t believe this was possible.

“Doing the doctoring,” I said with a quizzical look. “What do you mean?”

“Are ye still in Killenaule?” she said.

“Oh, we are,” I replied. “Still working away.”

“Will ye ever retire?” she asked with a sigh, as if she couldn’t wait for the day. “I thought it was your daughter that was in charge up there now.”

So that was what had prompted her to come back. I took some satisfaction in being able to say that, despite appearances, I wasn’t quite at retirement age yet and wouldn’t be considering this for some time.

“But I seem to remember that you left us a long time ago, didn’t you?” I added.

“I did,” she said, lowering her voice.

She shifted uncomfortably, and when I didn’t speak, she must have felt the need to explain herself further.

“Well, Dr Meagher never got me,” she said, referring to my husband, even though she had usually attended me and not him.

“Oh, was that it?” I said. “Interesting.”

“Yeah, he was all about….”

Her voice trailed off as she escaped to the machine. I became aware that a queue had formed behind us. People nodded and smiled politely. I’m sure that, like myself, they would like to have heard the rest of that last sentence.