Whatever Happened to Dr Watkins?

Zoe of the Totnes Pulse had been in touch before I left Leatside Surgery to see if I could do a piece… Sadly back then (Six months ago!) I felt too pressured, with much going on.

Now though I feel I can stop and reflect on stepping out from the health service, and out of Totnes.

I was born in Broomborough in 1968… then went to Grove, Harbertonford and then Dartington primary schools before going to Kevics.
When I was tiny we lived on Fore Street, then moved out to Tuckenhay before my mum settled us in Dartington…
After 3 years in the sixth form at Kennicott (I was never that clever so had to resit my A-levels) I eventually got in to Medical school in Leicester.
At my original interview the Professor of Medicine interviewing me had an interest in clocks and saw I was from Totnes… so the interview was largely talking about clocks and the Babbage engine.

So I started “in medicine” in 1987… qualified as a doctor in 1992 then started as a GP in 1997, starting in Totnes at Fore Street Surgery in ’98.
And I’d been there ever since…
So, what’s that? 38 years in medicine in total I reckon…
I met Deborah in 1987, married in 1990 while a student, and am still with her now. I certainly couldn’t have done the stuff that follows without her continued support.

Medicine as a career I think was very rewarding- but stressful commensurate with the rewards…

Overtime

As a junior house officer in 1992 we had some shocking rotas. 3 of us would have to cover the whole week…, and if one of us was off we would cover their shift too. So there were times I would work 19 days without a day off, and the 2 weekends in that time, I would be in the hospital continuously for 84 hours each… And all the overtime hours back then were paid at only one third of the normal hourly rate, so it was not lucrative!
Looking then to 1993 I think it was, the European Working Time Directive came in supposedly limiting the working week to 48 hours (Junior doctors were exempted from this). The hospital I was working in did a survey of Junior Doctors to see what hours we were currently working… so noting time in the hospital over a 2-week period my average time per week in the hospital was I remember 124 hours. This at a time when my son had just been born. It was quite inhumane I think now to expect anyone to give up that much time away from their family.

You’re going to miss it!

But after working through a 2 year training programme for general medicine, working in Cardiology, Dermatology, Immunology & Nephrology, I got onto a GP training scheme and worked in psychiatry, paediatrics and obstetrics & gynaecology each for 6 months.
This was in a small hospital in Rugby and I would often be the most senior doctor in the hospital for my speciality which did lead me to become quite self-reliant and independent.
I still remember clearly the stress of being called to my first caesarean as the on-call paediatrician and the baby needed quite a lot of resuscitation. I was so grateful my amazing Sudanese staff grade doctor Hassan who came to help and demonstrated then, and several times after, how to appear quite calm when the situation was life threateningly serious. No swearing or shouting… and he had such calm hands in a crisis.
Being called to help when an experienced midwife couldn’t deliver a baby was stressful too… I did have to use the old Ventouse quite often, as well as the dreaded forceps!

Hard Nights

When I joined Totnes we used to cover the nights ourselves so I used to get calls at home through the night and visit patients if necessary. I do remember once at about 3am arriving to someone’s flat on the high street and as I went in they asked if I would mind taking my shoes off. “Yes” I said and stomped grumpily in regardless. Not nice of me really.
I did enjoy doing small operations for people on skin things… and training junior doctors to become GPs was lovely too. In fact five of those are now training GPs themselves.
I did get quite involved with a national pilot programme called Integrated Personal Commissioning… getting patients some money to try an effect changes in their health.. It turns out we were the only pilot site nationally to actually get money to patients and make it work; for a bit… then it stopped…
I didn’t get to save many lives in General Practice, though did one or two… releasing the air from a spontaneous tension pneumothorax was one I think. (Plunging a large needle into someone’s chest cavity on the basis of a simple clinical assessment. I did feel quite brave for having done it.)
It was the not being able to save a life that stuck with me most… despite being on the scene when a young man had a cardiac arrest and despite all my best resuscitation and assisting the paramedics… It did ram home that despite being a doctor I had no special powers. Very grounding and still upsetting today.
Measles outbreaks, Foot and Mouth, Bird flu, COVID; “The beast from the East” – it was that day I took the photo of the arch in the snow that Graham sells on the street as I walked home.. Earlier that same day I had been called to Totnes Hospital as a lady had walked in unwell with a racing heartrate. In ordinary circumstances an ambulance would have been called, she would have been taken to Torbay and sorted out and likely kept in for a few days of assessment. As it was no ambulance could get to her so I ran over from the surgery- found some injectable medicine that should sort her out. Gave that and then when she seemed better she walked back home. It felt very odd.

Totnes is a weird special place.

It only struck me recently that I’ve seen quite a lot of cases of measles and mumps over my time… Some GPs go a whole career and never see a single case. Ah the joy of working in Totnes.
It may have been Totnes’ reputation for vaccination that led to me being asked to be interviewed by Mishal Husein on the Today program one morning in Autumn 2020… it surprised the hell out of my mum listening that morning in Wales to hear her son on national radio!
Another big stress back in 2010 was due to unforeseen circumstances having to remortgage my house to raise equity to pay the builders who were redeveloping Leatside… Some of the joy of being a business owner. Some people still think that the Surgery is somehow “provided” by the NHS… not so. I mean, the NHS does recompense GPs in some ways for the expenses associated with running a premises, but still….

Good Times – Not-So-Good Times

Many many more mosty happy memories and anecdotes…
The lasting thing though is the relationships with staff and patients.
It really is very special to have that privilege to be allowed to be so involved in such intimate parts of peoples lives… Sharing their distress and fear as well as joy and relief. And to be selected to be the one trusted to do that.
To be there to tell people the very worst news as well as sometimes the better news..
All the while trying to make sure that the person in front of me heard and understood the right message in the right way for them.
I had patients who I’d been at school with… teachers even, and living in Totnes it became a very blurred line, if a line at all, dividing who was friend and who was patient. To have someone you’ve known all your life choose to come to see you for advice was very humbling. Others would choose not to come and see me, as they knew me. That was fine too.
Living in the town meant I think having to treat every patient in such a way that if I saw them coming down the pavement towards me I wouldn’t feel like I wanted to cross the road to avoid them. I felt I had to get it right every time for that reason. Of course I should feel that anyway, but living in town allowed me no distance.
And all the staff I have worked with over the years have been amazing. Again, it almost goes without saying that all the work behind the scenes was to put the GP in the position to do the best job for the patient.

But after 26 years as a GP I’d had enough I think.
People would say “You’re going to miss it!” and I’d say back to them “I think I only had so much doctoring in me and I’ve used it all up”, and even now six months later I think that is true.
Burnout? Probably…
The state of the NHS hasn’t helped to be honest. When I started you could rely on timely support from specialists if you got stuck with cases.. referral meant the patient would get reviewed in a sensible time frame. Later on that just couldn’t be relied on. Sometimes my referral would simply not be accepted and just passed back to me. This meant over time that the GP would end up dealing with ever more complicated cases and coping with higher and higher levels of risk. Psychiatry services I think were particularly poor.

I am lucky to have been paying in to the NHS pension scheme all my career, and now can take advantage of that. They let you take a reduced pension after the age of 55… It is plenty enough to live on here in France at least.

Heading Out

We came over last summer to look at a few houses and chose one right in southern Brittany just outside Redon in the commune of Rieux. My house looks out down the Vilaine river and the garden is south facing. Lovely to sit out back and sun myself! We’ve got about an acre to garden with and plenty of trees with loads of wildlife. Deer in the field behind us most mornings and the occasional wild boar runs across it. I can head back to the UK whenever needed to see my mother in Wales perhaps… or visit Totnes..

Totnes is a weird special place.

Being born and growing up there it was my normal though. Coming back after 10 years away was lovely. Leaving it again after 26 years embedded in the community feels liberating though.
I used to say that living in Totnes was like existing in a bubble… and it is… breaking free finally is great. I feel liberated… it is a bit mixed up how much of that is being free of the bubble of Totnes and how much free of the work- the two remain terribly conflated.

I’m not quite sure what the future will bring yet… What do they say? “If you want to make God laugh, tell him your plans….”.
Motorbiking round France has always been lovely so I may do more of that. Photography is fun… keep doing that. Exploring Europe without the confines of the channel… Gardening.. Slow time things that I just never really had much of a chance to commit to before… Reading even. I used to love reading; but somehow in the last few years just haven’t been able to settle down with a book…

So we’ll see… I will keep popping back to Totnes- I still have many friends there and my youngest daughter still lives in town.