How To Help Manage An Unwell Passenger On An Overcrowded Train As A Claustrophobic Doctor

Last weekend I ended up on a train with double the amount of passengers that should’ve been on it due to train cancellations (classic), and was faced with having to stand for the whole journey.

About 5 minutes in, I realised I couldn’t see any open windows, and then it dawned on me that this was a straight route without stops, so it would be atleast an hour before the doors opened again. This was when I started to panic.

I’m claustrophobic, you see, meaning that tight, enclosed spaces freak me out a bit. Especially when I can’t see outside, as I start worrying that there won’t be enough air for everyone, which then makes me feel like I can’t breathe, then the panic worsens.

When this started on the train, I tried to remind myself that it was in my head, and more people would be struggling to breathe if there wasn’t enough oxygen. So taking long, deep breaths, and looking around at everyone else around me, I hoped that seeing them chatting away would help me start to calm down.

Unfortunately it didn’t, as looking around made me see how close together we all were, and the conversations around me were about this, which made my throat start feeling tight. Oh NO.

With reason failing me, I went to my next option, distraction, and turned away to face the door I was stood in front of, which luckily had a window, albeit closed, but meant I could see the views outside.

I then put my headphones on to listen to music, then remembered I have Disney+ on my phone, so loaded my comfort watch – High School Musical.

By the time Troy and Gabriella were about to sing Start of Something New, I was already feeling more calm and relaxed, thinking to myself, I just need to get to Stick To The Status Quo and this will all be over, but ofcourse life doesn’t always go according to plan, because I then heard shouting behind me – a passenger had become dizzy and unsteady on their feet.

Reader, I completely forgot my claustrophobia in that moment and had a bit of an out of body experience as I watched myself LOCK IN to doctor mode to help. I was able to do a quick A to E assessment – airway and breathing okay as the passenger was still talking while we helped them to the floor, pulse slightly raised and looked sweaty, but alert and coherent with no pain or palpitations reported. They were also able to give me a quick medical history, and confirmed they’d had something to eat that morning, so my impression was that this was likely a presyncopal episode due to heat.

The other passengers were amazing and so helpful, trying to make more space for the unwell passenger, helping to get their feet up, as well as getting them something to drink, some wet wipes to help cool down and offering snacks to eat. YAY for the kindness of strangers.

I kept an eye on the passenger for the rest of the journey, which was pretty uneventful after that, thank God! We were laughing and joking by the time the train reached our destination, and all very glad when the doors finally opened.

So yeah, another ‘is there a doctor here’ moment on public transport for me. STRESS as always, but I definitely feel like my confidence is growing when it comes to managing these situations, so all glory to God! Looks like I’ve found the ultimate claustrophobia distraction now…

My Baby Brother Started University Last Week

One thing about having a younger sibling with a big age gap is that over time you start to see them as your child in a way. With 12 years between you there’s less of the sibling rivalry and bickering, and more of a maternal instinct because heck, you helped raise this kid, you know?

I’ve always felt this way about my youngest brother, and my friends find it hilarious that I still refer to him as my ‘baby brother‘ when he is now 6ft4 and towers over me, but old habits die hard, I guess.

He started uni last week, and ‘proud’ would be an understatement because he really did that, with how much work he put into revising for his A levels. I always say that he’s the best of us, because how level headed and focussed he has stayed over the last couple of months has been truly something. Especially with balancing his other commitments ranging from making time for his different friend groups, playing piano, part-time jobs, driving lessons, and playing football for a local club.

G is going to blow us all away, and I’m so excited for him as he starts this new chapter, and praying that God will continue to be with and watch over him.

I’ll end with these two photos – the first is from when he came to visit me as a 1st year medical student, and the second is from when I helped move him into halls last week. MY HEART.

That Time I Ate More Than 3 Slices of Pizza – The Importance of Celebrating The Seemingly Mundane

This blog has been more heavy on the medicine than the Tai side of my life recently, so here’s some non-GP related news: I ate multiple slices of pizza tonight.

Some context: Pizza is usually low on my list of preferred takeaway options because of how quickly it makes me full, which always feels like a waste to me. But making pizza with pals is always fun, and it was great spending time with some of my church family – Singapore Sis, The Other Actuary, Mousakka Pal and her husband, Film Friend, as well as Moana and The Weather Guy.

As mentioned in this post’s title, I ended up eating way more than my usual 3 slices of pizza, which to me is kind of a Big Deal because I’m not really a pizza person, but looks like I’m now able to eat more when it comes with great conversation and laughs.

You might be reading this and thinking that this wasn’t interesting enough to do a blog post about, and you know what? Fair. But more dedicated readers of this blog will know that for a while I used to think I would die young, and spent so much time worrying about this.

I don’t think like that anymore (thank God!), and in the last two years I’ve really had a new lease of life, so I feel appreciative of and grateful for the gift of it.

I intend to celebrate the little things, as dull and insignificant as they might seem to others, because life is short. So here’s to romanticizing the small details in the day-to-day! My life might not seem interesting to others, but it is to me because I am ALIVE, amen to that.

So there you go, dear friends, and hopefully you now understand where I’m coming from when I say I fully back that my life is interesting enough for weekly updates. So are all of yours, and I’ll continue asking you questions (and answering them first, HA) to find out more about your lives, because what a blessing it is to have you in mine.

Today Makes It A Year Since I Became A GP

So here are some ways I’ve made a difference this week, to remind myself that I’m not a bad doctor:

• Wishing happy birthday to a patient after confirming their date of birth and realising it was the day’s date. It sucked that they had to have a GP appointment on their birthday, so they said they were grateful for the well wishes.
  
• Running late because a patient needed to have a good cry about their recent heartbreak and felt like they had no one else to speak to about it.
  
• Pausing my care home ward round to watch a performance by an Elvis Presley impersonator with the residents, because they’d been looking forward to it all day and the Manager thought it’d be nice if a doctor joined them.
  
• Highlighting the hard work of the Reception team, who have to deal with so much unfair criticism and abuse. The team at my practice are phenomenal, and I really couldn’t have gotten through this year without their support and encouragement.

I’m so grateful to God for getting me through the last 12 months because my goodness, it’s been hard, but what a year it’s been. I love my job SO much; it really is such a privilege and honour to have such a front row seat into the lives of my patients, and I will never take this for granted. I feel so motivated and determined to continue to work hard so that I can improve, be better, and be a good enough GP for them.

1 year down, 30 or so more to go…

That Time Someone Was Racist To Me In A Church

A haiku:

Questioning my faith

No other black people here

Just want to go home.

I Worry That ChatGPT Is Making Doctors Lazier

I have never used ChatGPT.

Does a bit of me judge people who do? Absolutely.

As someone who writes for fun and loves sending hand-written notes, cards and letters, the thought of using it to write or make my writing sound a certain way is just not right for me. I love that my writing voice sounds like me, and it might not be the most polished or “slick,” but it’s mine, and I take great pride in that. And don’t even get me started on the environmental impact of it all, but this post is not about that.

With growing concern, I’m seeing more doctors use it to diagnose and come up with treatment plans for patients, and this can be risky if sources aren’t being checked properly. As was the case recently when I was supervising a resident doctor, who told me that they had come to a management plan because “That’s what ChatGPT said.” I was aghast at this, as not only was the plan wrong, but the confidence that they’d replied with this made me realise that they saw nothing wrong with it.

I’m also part of a GP support group, and I’m seeing more responses to clinical queries starting with “ChatGPT said…” and this is concerning. Evidence based medicine and clinical reasoning should still be applied, and I worry that ChatGPT is reducing critical thinking and making doctors opt for an “easier” approach, instead of doing research in medical databases and looking up clinical guidelines from recognised sources.

I fear we’re going to be seeing a lot more of this with time so my final question is this – if patients can also use ChatGPT to diagnose themselves, what is the point of your medical degree? If you’re a doctor relying on it and not able to go back to clinical reasoning to get to your differentials and management plan, we might as well just get rid of medical schools then.

Or maybe I just need to get with the times and stop being such a technophobe. We’ll see.

How To Decline A Job Offer But Still Be Considered For The Future

I literally Googled this because I really had no idea what to do. But before I go into that, a quick recap on the last couple of months:

• Had my first external appraisal as a GP last month and was SO nervous about it because I didn’t know what to expect, and was worried that my portfolio didn’t have enough evidence. Turns out my worries were for nothing because my Appraiser told me that she was really impressed by the depth of evidence and reflections I had on there (apparently I’m quite good at writing about how I feel, who would have thought, eh?), and the colleague feedback I received was the most positive she’s seen in nearly 10 years of being an Appraiser. Praise God!
  
• I’m now responsible for looking after a care home at work, which means I do a weekly ward round there as part of my job plan. Getting to an agreement about the logistics of this took some back and forth and me having to initiate discussions about pay (I really REALLY don’t like talking about money), but it all worked out and we were able to come to an updated contract that I was happy to sign. Yay for growth!
  
• I’ve started doing locum work, in addition to my Salaried GP role, and it’s been great so far. Just seeing patients in clinics and not having to do admin or file letters or investigation results has been a breath of fresh air. And getting paid more for the locum clinics has been nice too – I can see why some GPs only do locums…

So those are the relevant updates to know about before I get into explaining about the job offer I’ve gotten recently. Again, this was so unexpected because work-wise I’m in a pretty good place right now, and feel very content, so having a practice reach out to me with the generous offer of a GP role with view to partnership really took me by surprise. That brings me up to three job offers in less than a year, and in a GP unemployment crisis too? All glory to God!

I didn’t know how to respond, as partnership is not something I’m interested in right now, but would consider it down the line, so I wanted to decline in a way that would still let them consider me in the future. So I put the title of this post into Google for some inspiration on how to respond, and went with this:

I really appreciate being considered for this role, and though it’s not the right fit for me at the moment as I’d still like to have more experience as a Salaried GP where I am, I’ll definitely still be around and would love to keep in touch re: any future roles down the line.

And they took it really well! I received a very positive response back about how they’ll keep me in mind for future opportunities, yay! So yeah, life feels pretty good right now – God is good, and as always, forever grateful.

I’m 31 and I’m Happy

Last week was my birthday and compared to how big I went with celebrations for my 30th, Tai and Kenny Day was a much quieter affair this year.

What’s definitely not been quiet though, is the love I’ve gotten from the people I’m blessed to have in my life. To be loved really is to be known, and my heart is SO full.

Officially in my 30s – grateful to God and excited for what the future will bring. Life is truly a wonderful gift, and I intend to appreciate every moment.

Am I Becoming Less Empathetic?

I’ve been asking myself this since my oncall last week, when a patient triage response from me had me backtracking because of how harsh it had come across.

I talked about it with one of my colleagues for a second opinion, and she agreed that I’d been too harsh and ‘by the book’ in how I’d approached this patient, and could have shown some more understanding.

Even though I went back to the request only minutes later and changed my initial response, I’ve been reflecting and ruminating over it for the last week, and not going to lie, I’ve been feeling really awful about it all.

That was so unlike me, and I’m now worrying that the new GP contract requiring same day appointments for urgent requests through total triage is making me more cold, and less empathetic. This is because during oncalls we can get up to 200 patient requests to triage daily, in addition to seeing face-to-face emergencies, urgent prescription requests, responding to 111 and ambulance service calls, care home and District Nurse queries, and literally anything else that comes through as urgent, so it can be very overwhelming.

Due to this, I’ve noticed that I can go into ‘triage mode’ where I try to clear them in a regimented manner that allows little room for nuance. So it can be easy to stop seeing the actual people behind the patient requests, especially when the requests feel never-ending and I’m under pressure to get the numbers down.

As I’ve written about here, the day I lose my empathy and compassion is the day something needs to change because without these, who even I am?

So, a proposed change: To spend no more than 10-15 minutes going through patient triages in one go, to enable me to take breaks and do other oncall work, so that I can avoid becoming detached and robotic in my responses. I’ll continue to check in with my colleagues for accountability and second opinions because that’s the kind of GP I want to be – one who reflects on their practice, where they could have done better, and most importantly, treating patients and leading with not just empathy, but compassion as well, which is empathy with action.

My First Time As An OSCE Examiner

I’m going to sound SO old for writing this, but medical students definitely have it a lot easier these days. (From my recent experience, anyway.)

For anyone who’s new here, OSCE stands for Objective Structured Clinical Examination, and these are practical exams for medical students. They range from history taking and consultation skills, to clinical examinations, data interpretation, and prescribing stations that can be 5 to 15 minutes long, testing skills required to progress to the next stage of medical school.

My medical school was BIG on OSCEs – we had at least three a year from 1st year all the way to finals, and I’ve documented extensively on here about how much work they were during my medical school days. But boy am I grateful for them now that I’m a GP, because constantly practising for OSCEs and keeping on top of clinical skills has most definitely made me a better doctor.

Which brings me to my point at the start – medical students these days have it SO much easier compared to what I went through. I was examining a Respiratory examination station this week, and was shocked that students were given over 10 minutes to do it, with some of them not completing it in time – WILD. Back in my day (gosh, I really do sound old now), we had to be able to do it in 5 minutes, so I know from experience that it is most definitely possible!

It was also interesting to see the clear difference between students who had been practising and those who hadn’t, as some of them had written down the different aspects of the examination and kept referring to their notes throughout?? Again, WILD. I just kept thinking throughout, Do these students not know about Geeky Medics?

So yeah, it was definitely a surreal experience being on the other side of an OSCE station. Would I do it again? Absolutely yes – so much fun!