What is in a name?

13 November 2020 

How do you introduce yourself? It is a difficult and personal question. Our calling names and how we identify ourselves have been widely debated in life and literature. Think when Shakespeare’s poor heroine Juliet decried: "O Romeo, Romeo! Wherefore art thou, Romeo?"

Juliet wasn’t wondering where Romeo physically was, but rather why he was called 'Romeo' and more specifically - belonged to the house of Montague, rather than a Capulet like his beloved. She then famously moved onto talking about 'what’s in a name?' - an issue I think about frequently.

While my father was affectionately known as 'Dr David' and my grandfather 'Dr Eric' by their patients, I went with the slightly more distant and potential barrier forming 'Dr Dorman' when I started partnership in Kilkeel. 

Last year a new patient to our practice started to call me by my first name and I must be honest - it made me very uncomfortable. I like to think that I am not into hierarchy or titles, but this threw me.

Anytime he spoke to me on the phone using the familiar 'Laurence' I could not work out whether he knew me personally, or if I had met him in a previous role. Eventually I had to come clean and advise him that I was not comfortable about it and asked politely if he would use my full title. How are you known to your patients?. I would be interested to know.

What I do know is that when I speak to my consultant colleagues, I now always use my first name. While I was happy to set up a bit of a barrier with my over-familiar patient, I do not want to hinder respectful communication when I contact my hospital colleagues, and I have recently experienced some great support enabling me to manage my patients better in my surgery.

Palliative care webinar

On Tuesday 17 November 2020 between 19:00-20:15 our MacMillan GP Facilitators and GPNI are hosting a Palliative Care Update which will be presented by Dr Tracey Anderson, Consultant in SEHSCT.

Tracey was my flatmate in final year in Queen's University Belfast and I was lucky to work with her in Newry Hospice. She is an excellent doctor and will be sure to host an interesting talk.

You can understand that using anything other than her first name when asking for her specialist advice would feel strange but even with hospital colleagues, we don’t know personally we must feel like equals with a common purpose - our patient’s care.

We are indebted to our MacMillan GP facilitators - Dr Graeme Crawford, Dr Sharon Morgan, Dr Yvonne McGivern, Dr Gerry Millar and Dr Selina Mellon - who work hard behind the scenes to help improve care for our patients needing palliative care. If you want to know more about their work, please get in touch. They would be happy to share their story.

Our own College hub with many resources for end of life care continues to grow and now has many links to useful external documents.

Flu and COVID-19 vaccines

On Wednesday, Dr Alan Stout and I met with the Public Health Agency (PHA) on the back of the flu vaccine shortages. It was a frustrating meeting.

Every year there is a shortage of flu vaccinations and the lack of adequate information on stock supplies makes our job of delivering the flu vaccine, which is a statutory function of the PHA, much more difficult.

We pressed to the PHA that general practice needs to be regarded as valued partners and more included in planning decisions. Further stock of almost 200,000 doses of the quadrivalent (for those under 65 years) have been ordered but there was a lack of clarity about when exactly this will arrive in Northern Ireland.

PHA will request clarity from our Chief Medical Officer to gain insight on whether the quadrivalent vaccine can be used in patients over 65 years old.

This issue is frustrating as the PHA assured us and the public at every step that supply was not an issue. If we had some warning that supplies were at risk, practices could have performed risk stratification to ensure those in most need received it first, not to mention the considerable inconvenience to our teams who have done such amazing work.

It is vital that if you have not completed your flu campaign and are waiting for vaccine stock please do not proceed to appoint clinics until the vaccine has been delivered to your practice. If any practice has accidently overstocked on the vaccine, please contact the Health and Social Care Board as soon as possible to ensure this is transferred between practices and not wasted.

As we have heard this week, Pfizer have published data of their eagerly anticipated COVID-19 vaccine indicating it has achieved over 90% disease efficacy. It is important to remember this is different to epidemiological efficacy which will show how the vaccine affects transmission.

Added to this, we still need full data on the vaccine’s safety so there is still a long way to go. Delivering the vaccine will not be easy. The cold storage chain will be difficult requiring storage at -70 degrees and the vaccines will only be available in batches of 970.

We are indebted to our General Practice Committee (GPC) colleagues who are involved in negotiating the contractual issues around delivering the vaccine which will help practices meet the inevitable extra costs but delivering this will require more than just money.

To achieve cold chain security, we will have to work across our practices and will likely have to work collaboratively with our hospitals who will have access to the specialist freezers and equipment required. 

I honestly feel general practice is the best team to vaccinate our patients, who know and trust us, but this work simply cannot be done without adequate resource, so we will work constructively with government and take the lead from our GPC colleagues.

Adolescent mental health

Last week it was great to meet Dr Richard Wilson who is the new Chair of Royal College of Psychiatrists in Northern Ireland.

Richard was great company and it was interesting to learn that he is the first adolescent psychiatrist to be appointed to his role. We were able to discuss several issues where we have common aims and I look forward to working more with Richard in the future.

One of the conditions we are all witnessing in our practices is the rise of adults with ADHD. We hope to be able to perform some education in this pervasive and difficult condition, so watch this space.

In the meantime, we are running a full-day conference on Adolescent Health which will cover issues such as adolescent brain function, sleep and how to address issues such as LGBTQ in this patient group. You can register now.

We discussed the issue of conversion therapy with Richard which I mentioned in last week’s blog and it was interesting to hear his experience of young patients with gender and identity issues as a specialist in young person’s mental health.

Richard was appalled by our colleagues Gareth and Gary’s experience of conversion therapy and has offered his College’s support. I hope to meet Gareth and Gary at the end of the month to see how we can progress this issue further.

I am aware that in September this year our Minister for Communities Carál Ní Chuilín convened an all-party group with Minister for Health, Robin Swann and Minister for Justice, Naomi Long to make plans to ban this harmful and derogatory practice, so we will happily lend our influence on this important issue.

New lead in North Belfast Federation

I was delighted to see Dr Carla Devlin take over her first AGM in North Belfast Federation and see so many experienced and talented GPs take positions on the directors committee.

We wish Carla and her team every success and offer our support.

Federations have such a vital role in supporting our practices and can make a massive difference in delivering local healthcare. If you haven’t considered getting involved and would like to know more, please get in touch with me personally.

There are many ways to take part and I know you would find it interesting.

We are pressing the Department of Health for more clarity on the hotly anticipated question of 'who goes next' for MDT roll out. There are no easy criteria to set but it is important that funding is allocated quickly, and this important model of care is implemented for all practices soon.

COVID-19 assessment centre shift

On Thursday I did my first COVID Centre shift in a long time. I’m very lucky to have great partners in my practice who make it easy to fit in my sessions and to have such excellent leads in our COVID Centres who have managed to keep the rotas down to an absolute minimum.

The shift was straightforward, and I was struck by a patient who needed assessed, but after examination was able to manage safely in the community.

The ability of the centres to offer a safe space to perform face to face examination are so important as we know that patients with COVID-19 infection can deteriorate very quickly and I have spoken to GPs whose patient appeared "not too bad" but quickly deteriorated and required hospital admission by the time they arrived at the COVID-19 assessment centre.

We are valued

The more I think about it, the less I get hung up on what I am called by my patients. What I would prefer to witness is how Rose (Billie Piper) called Dr Who (David Tennant) at the end of the series in 2014: "You are my doctor." I still love my job and regardless of 'what is in a name?' the thought that people in the community I serve think of me as "their doctor" still makes me grin!

I aim to run a theme in next week’s blog about a different perspective. Have you made a double take on a patient’s point of view by having to get down and experience their perspective? Let me know - it would be great to get your input.

Post written by

Dr Laurence Dorman, Chair of RCGP Northern Ireland

Dr Laurence Dorman took office in November 2019 after three years as Deputy Chair of Policy for RCGPNI. A GP principal in Mourne Family Surgery, Kilkeel, Co Down, since 2007, he is the fourth generation of GPs in his family. He was also, until recently, the Chair of Newry and District GP Federation. 

Laurence has particular interests in new ways of working in primary care, cancer care, and inspiring the next generation of GPs. He set up the successful Dear Colleague initiative to improve the interface between primary and secondary care and has been a strategic advocate for interface and communication since September 2017.

During his time as Chair, he wants to support College members to ensure that the future of GP services is protected, supported and sustainable.

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