Learning to trust your instincts

As part of our reflective writing competition, Dr Roger Charlton tells of one memorable on-call experience.

In the days before GP co-operatives, deputising services and the new GMS contract, we did our own on-call at the busy group practice where I worked.

I was on the rota for Christmas Day and I expected it to be, as usual, the quietest day of the year with the first call not coming in until about 6pm.

By Boxing Day the colds that could be put off for a day were by then in need of urgent attention and the side-effects of over-indulgence usually caused some extra consultations.

However, this particular Christmas Day we were just sitting down to our big family lunch when my pager went off.

I called the doctors' answering service and was told of a young lady a few streets away with abdominal pain. She did not want to disturb my Christmas lunch but had asked if I could give her a call with some advice.

Distressed patient
I phoned and spoke to the patient's mother and could hear screaming in the background.

I had decided before calling that the problem would probably be sorted on the phone, or if a visit was necessary it could wait until after my lunch.

The patient's mother kept apologising for disturbing us but the moaning in the background perturbed me.

Something did not seem right and, like many GPs, over the years I had developed what others call a 'sixth sense'.

I knew that the road where she lived was just a three-minute drive away, and I told the patient's mother that I would have a quick look to check it was nothing serious.

There were raised eyebrows from my family and a few comments made. I assured them that I would only be 10 minutes.

The front door of the patient's house was ajar, so I went in. She was screaming - it was high-pitched and distressing. I was thanked for arriving so quickly and the mother - and her daughter, between screams - repeatedly apologised for calling me out.

However, what I saw before me was a woman with a deathly white pallor, writhing in agony. Her partner was holding her hand and looked apprehensive.

Fortunately, I had recently been an SHO in gynaecology and I asked when she had her last period. I was very suspicious when I found her to be profoundly hypotensive with a rapid pulse. I then telephoned for an immediate ambulance.

I can imagine I was not too popular with the ambulance service.

The right decision
As she gasped between bouts of pain, she was still apologising for calling me at such a time and said that surely the hospital opinion could wait until her family had eaten their Christmas lunch.

I had to explain to her that I was 99 per cent sure that the pain she was suffering from was the result of a ruptured ectopic pregnancy and that it was an urgent matter. This was later confirmed by the hospital.

It was one of the few times as a GP when our actions can save a person's life.

I returned home to my lunch and received a few comments like 'surely, it could have waited'. But I replied 'not this one', and felt that I had done something important on a very special day.

This circumstance clearly highlighted that illness is no respecter of time or day.

Being a doctor is a privileged position, particularly in a situation like this one, although we may not always believe so on a busy day or when starting out on a potentially quiet one.

Dr Charlton is a GP and trainer in Solihull, West Midlands, and associate professor at University of Warwick Medical School

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