A unique and bustling practice where one third of patients are children, and one quarter are non-nationals.
PRACTICE NAME: Riverside Medical Centre, Mulhuddart Village, west Dublin
PRACTICE PROFILE Practice founded by Dr Linda King in 1984 , Dr McGinnity joined in 1995. Moved to Riverside Medical Centre in Mulhuddart village in 2005
PATIENT PROFILE Large practice of 3000 GMS , up to 2000 private (but they represent about 10% of the work, don’t attend much) .High proportion of young people – 1/3 of our GMS patients are under 18 (vs ¼ nationally). Not many elderly. Lot of non nationals – 25% here vs 11% nationally.
STAFF PROFILE 3 partners, one assistant,. 2 registrars, 2 practice nurses, 5 Administrative staff , one manager
DIARY OF A TYPICAL DAY AT THE PRACTICE
SOME DETAILS HAVE BEEN CHANGED TO PROTECT IDENTITIES
Morning: 4 GPs, 2 nurses Afternoon: 3 GPs, 1 nurse
117 consultations with patients (80 with doctor, 37 with Nurse)
42 prescriptions. So over 150 people passed through the practice as the scripts are all picked up
About 15 phone calls
DIARY OF DR EDEL MCGINNITY on a typical day at the practice
MORNING (emergency, walk in clinic supposed to be for one problem only)
Elderly n bad chest infection
Young woman for contraception and sexual health screen, high risk of pregnancy – not taking pill right
Man, with Sx of IBS but also feeling very bloated and like she had gained weight but hadn’t,. meed to r.o ovarian cancer, refer scan. Do bloods and gastro referral
Man.. Thrombosed pile, v painful, incised and drained
Woman bad facial eczema, irritable bowel waiting over a year for colonoscopy. Asked will I write to hurry it up
Woman. Methadone, child protection and development concerns,. Missed paediatric appt ; tries to rearrange.
Man with fungal nail infection with infected toenail and soft tissue of the foot complicating it
Man needed cert for 2 days for tummy upset. Checked bloods and medications.
Between patients, Liaising via email and phone with hospital, PHN and homeless service about a patient who needs cancer surgery
Young man, severe fatigue, bowel symptoms. Previously queried coeliac disease. BP borderline today. Bloods done, refer for scopes, discuss mood,. Arrange BP monitor
Messages from reception re unstable psychiatry patient wanting a house call, advised her to come down
Woman with breast pain, thyroid problems. Memory issues becoming apparent in visit.
Multiple prescriptions involving review of charts. Arranging appointments or blood tests for some.
Primary care meeting over lunch, due to start 1.15 we didn’t get down til 1.25/ social worker and occupational therapist there, we discussed multiple patients
AFTERNOON
Met the homeless man on his way to hospital for surgery, he is very anxious about everything. Email and phone call to his keyworker afterwards
Methadone patient for detox
Left that patient to advise GP registrar re complex case involving breaking bad news and concerns about addiction relapse related to that
Phone to call to the psychiatric patient from earlier who said she was very sick and still demanding a house call, Then call to community psychiatric nurse about that patient as we are all concerned about her
Unstable drug user who had presented requesting treatment for tablet problem 2 weeks ago. Hadn’t gone for counselling as I had requested then said he had had a seizure yesterday, possibly from tablet withdrawal. Refusing to go to hospital. Gave him a letter anyway, need to do addiction psychiatry referral after surgery to consult re best management of his addiction
Methadone patient with severe weight loss who missed a critical appointment last week. Was to go for an Xray, said he did, I spent 10m on the phone trying to get the result to be told he hadn’t actually had it, by which time he was gone and difficult to arrange another as he’s unreliable on the phone.
Methadone client. Discussion re his housing situation which is very stressful and when will he go in for detox.
Long phone call from local hospital OPD supervisor about appointments, I had sent a letter to the CEO objecting to the validation system and how a patient had been discharged from an important clinic despite never getting a letter and calling to say she didn’t get it. They had insisted on a new referral.
Son of a very sick man came in between patients to fill me in and sort out his prescription
Methadone patient, ongoing issues with chest infections
Phone call from a patient going away tomorrow and wants prescription for antibiotic to bring away with her
Woman with poorly controlled diabetes, low mood, problems in work, .
Stopped seeing patients 5.30 pm
Now going to do all the letters generated by today’s visits, review messages from reception with queries, go through the lab results from 2 days (50 different results) and letters that came in today (16). Many jobs generated by the lab results , try not to phone people (because they want to tell me about all the other things going on; so that might be a letter and new prescription or an appointment. )
Check printout of upcoming appointments that came in on Healthlink, and mark those who need reminders because a lot of our patients don’t look after themselves and need a lot of prompting to keep appointments.
Check the GMS patients who have been removed off the list this month to mark those who need to be chased about it because they will need prescriptions and now can’t get them. Some of them we can reinstate on exceptional grounds, a lot of them not
Left at 8.25pm still a lot of paperwork undone