Only time will tell and I can't make any predictions. Another four and a half chapters are waiting to be written before I reach the end. Maybe even more than that. For a first draft, do I want to also finish the back matter? I have not yet decided this, but it would be ideal if everything was finished by then. An epilogue will probably follow the main part of the book and I will need to write quite a bit more than I have so far.
But now to the progress report for today. A slow day as I needed to visit an open morning for my son today. He needs to decide on the next steps in his education soon.
Today I have only written 2033 words, and I am now at a total of 83982 words. Although this sounds like a lot, it is not in the grand scheme of things. I have not yet touched 'Growing Love' today, and I am not sure I will. A headache makes me want to take it easy and relax instead.
As usual, you will find the image of the progress below as well as an excerpt from the work in progress. This time it might be slightly boring as this is what happens in her free time. No interesting tales of meeting patients. Still, I hope you'll enjoy this little insight of what a General Practitioner will do with his or her free time, or at least part of that time.
It is still quiet upstairs and I allow everyone to enjoy a lie-in this morning. In the meantime, I get out my laptop to check any new results, tasks or prescription requests that may have come in after I shut down the laptop yesterday. With those out of the way, I check the unassigned tasks. Reports from the Out-of-Hours Service arrive here too. Amongst these is a task from Out-of-Hours regarding two-year-old Jack, the boy I saw yesterday as an extra. His mum was concerned Jack had tonsillitis, but everything was fine when I examined him. I was not convinced mum believed me when I told her, and the contact with the Out-of-Hours Service last night appears to confirm this.
As I read through their report, I notice how mum told them about Jack’s severely sore throat, his massive tonsils and his sky-high temperature. All, of course, without the help of a thermometer. Jack and his mum were invited for a reassessment and the same diagnosis I reached earlier in the day was reached again. Since a few hours had passed since I saw him, Jack’s condition could have changed, but it appears it was unchanged when he visited Out-of-Hours.
Okay, the basic work is out of the way. Not every weekend I will do this. After all, the weekend is time off and I am not expected to work. Instead, the weekend should be time to spend with the family.
To continuously monitor and improve the quality of the care we provide to the patients, General Practitioners need to do audits. An audit is a short research we do on at least an annual basis. There can be more of those in one year. The audit I am working on relates to the care of the diabetics in the practice and looks into the diabetic control of diabetics diagnosed in a one-year period and whether any action was taken if the control was unsatisfactory. To help me do this research, I run a search for type two diabetics diagnosed in the last year and then realise this will not give me the data to work with. After all, if someone is diagnosed with diabetes in the last month, this will not tell me if the results were acted on and changes in treatment took place and what the results of any changes was. So, instead I run a search for patients diagnosed in the period between two years ago and one year ago. The search is run, and it shows me eighty-four patients were diagnosed in this period.
Now the rest of the work starts. In the ideal world, 100% of these patients should have the initial results and this is an appropriate standard to set. The next standard to decide on is which percentage would be appropriate for a re-test at three, six and twelve months following the diagnosis and I set 80% for this. In the ideal world this also would be 100%, but not all patients will follow the advice given.
From research, it is known the first year following diagnosis is important. Reaching a good control within this first year greatly reduces the risk of long-term complications of diabetes and we obviously want the best possible for our patient group. A good diabetic control would be below 48 mmol/mol, and I set 50 as the cut-off where treatment should be intensified. Intensification should happen in at least 80% of the patients with a level above 50, I decide and now I have set all the standards for the audit; I go through the notes of the eighty-four patients one at a time to search for the data required.
This is a long and boring job, but it needs to happen by hand. Only the search for the new diabetics can be done by the programme. When I find the required data, I enter them in a spreadsheet, NHS number in the first column to enable me to see which patient’s notes I have processed already. In the eventual spreadsheet, this column will be removed to ensure patient confidentiality.
Joni
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