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The canary in the coalmine

Dr Paul Heslin, a GP and occasional locum based in Dublin, looks at the misunderstood life of a GP locum

Being a GP locum has long been misunderstood and undervalued. The specialty of GP locum is the Cinderella of medicine.

Once thought of as the poor ragged cousin of the medical family, locum work was seen as being suitable for doctors at the beginning and end of their careers. No proper doctor should see it as a real career path. It was ok for the young, inexperienced doctor before he got a real job for life; it was also ok for retired doctors after a life of experience, a sort of reward after a life of service, being put out to pasture.

A “real” GP was totally committed to their 24/7/365 “calling”, with personal continuity of care to “his” patients being a badge of honour. General practice made way for group practice, patients seeing different doctors, and sessional practice.

The specialty of GP locums have being doing this for years: treating complex patients in brief, discontinuous interventions; sometimes picking up things the GP has missed; bringing a fresh perspective; fitting in and adapting to each practice. The emergent and modern, high-quality locum often brings new ideas from their travels among the many tribes and subcultures of general practice within Ireland and overseas. And it is this wider experience from medical travel that makes locums an underused resource to practices that want to use their diverse font of knowledge.

It is also one of the risks of being a locum. You see that things can be done differently in other places, and sometimes better, but the practice you are working in today might not fully appreciate the gift that you are offering them and may well bite back. No-one likes change, but for the lowly locum to come into a practice, and announce that they have seen things done better, or differently elsewhere, it can be taken as an insult.

It was a simple thing, a small thing, when I offered a Carlow practice (before computers became the rage), the idea that it might be better to write the constantly changing addresses of their patients in pencil rather than pen on the front page of their paper records so that five addresses were not overwritten in mad, unreadable scribbles.

This Carlow GP practice took the new idea to heart and found great benefit from it. Other practices can be more wary of new ideas from the new kid on the block. Specialist locums feel the added vulnerability of being a short-term locum. Like walking into a well-designed kitchen, where you just “know” where everything is, some well-organised practices “flow” and are easy to adapt to.

Other practices are hard work – and have added risks for the transient doctor. Locums experience both the safe and unsafe practices in various GP practices. They have not yet become accustomed to the idiosyncrasies that each practice develops over time and which each practice comes to think of as normal.

Locums have to deal with the fact that many practices do not recognise the particular risks for locums as well as the unique expertise that they bring. These local solutions can become real challenges for locums, or real bonuses and new ideas to be spread by bumble bee locums to other receptive and flowering GP practices. In this way, specialist locums can become the mediators of good practice and alternative practice, spreading the good news like travelling storytellers of Irish folklore. They can be the cross-fertilisation seeds of new possibilities to other GPs who do not have the same privilege of medical travel and diversity.

Like the canary in the coalmines, the locum can be an early warning sign of risk in your practice

Small things matter when you are a locum, like the much used computer keyboard with the letter “C” worn away and unreadable. The locum finds himself asking: “What is the letter to the right of “X”? It is “C”. (By the way, the most used letter in the alphabet is “E”.) The permanent GP is happy to work with the worn keyboard and has adapted over time, but the locum is completely put off by this added risk. And this can sometimes be just one of the cumulative risks that a locum has to adapt to, in swift time. This is the unique skill and talent of the professional locum.

If a GP needs to know a little about every specialty of medical practice, then a GP locum needs to know this as well as something about every type of general practice, with different computer software, different habits and different risks. But most of all, locums have to deal with the fact that many practices do not recognise the particular risks for locums as well as the unique expertise that they bring. Like the canary in the coalmines, the locum can be an early warning sign of risk in your practice.

Please note: This article represents the personal opinions of the author and not those of MPS.

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