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Dr Richard Crane

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As I write this I am lying in bed feeling awful. Awful as in ill and awful as in guilty, in equal measure. I’m feeling ill because I have gastroenteritis and guilty because it is Monday morning and I should be at work. I should be tackling the post-weekend triage list, doing my share of the home visits, and wading through the small tree’s worth of out-of-hours contacts from the weekend, but instead I am curled up under a duvet, drifting in and out of sleep.

Despite spending the last few days nursing my two sick children, then later my wife through the same, I thought I had got away with it. I smugly assumed my hand hygiene technique must be better than the UV lightbox suggests but it was not to be. Largely, I am sure, because sick children want to be hugged and held close; unlike with patients, quarantine is not an option.

Today is my second day off sick from the practice in 8 years. So why do I feel so guilty?

General practice, as a collection of mostly small, independent businesses, rely upon running with ruthless efficiency. There simply isn’t the resource to build in huge amounts of slack to allow for occurrences such as this. Almost every bit of work I am not doing today will have to be done by somebody else. The routine patients I was due to see will have waited around 3 weeks for their appointment, only to have it snatched from under their noses at the eleventh hour. Little wonder then that many will decide their problem is now urgent enough to warrant being seen by today’s duty team; a duty team already under extra pressure from the urgent appointments I am no longer doing.

Equally frustrating is that there are a million things I could do with a day off work. The decking needs staining before winter kicks in, the hedge needs trimming, and my study needs a tidy of epic proportions, but I am not feeling up to any of it.

So what have I learnt from my day in bed?

The sick role is a lonely place to be and not one I want to be in for a moment longer than necessary. No matter how caring those around you might be, being relieved of your responsibilities in work, family, and domestic life does not sit comfortably with most of us. As health professionals, we spend a disproportionate amount of our working lives around those who find themselves living permanently in the sick role. As challenging as these patients may be, it is clear that they must have strong psychological, social, or personality-related problems (if not biomedical ones) to remain comfortable in their role. I count myself lucky that I have such powerful motivators to get back to ‘normal’ life.

Secondly, nobody is indispensable. My colleagues will have survived and gone home, albeit slightly later than planned. All the patients I was expecting to see today will have been sorted out perfectly well by somebody else. There really is no need to be a hero.

Finally, the working day really does feel a lot shorter when you are not making important decisions every 30 seconds. I often think as I leave work in the evening that the journey in feels like a lifetime ago. Eleven hours seems to pass much faster when you are reading a book and having a regular snooze, intermittently punctuated with the physiological consequences of gastroenteritis.

I am not due back to the practice this week until Friday, meaning that, thankfully, I don’t have the dilemma about whether I really ought to stay at home until I’ve been fighting fit for 48 hours. I don’t think I’d have been much use to anybody today anyway. Imagine the added guilt of being sat at home and feeling well, waiting for the window of potential infection to pass—at least the decking might have got stained though.

Dr Richard Crane

GP, Andover, Hampshire