Carry on screening.

664 Whose life is it anyway? Helen Lester A TALE OF THREE PRACTICES I have the privilege, or to rephrase, am mad enough each week to work in three general practices. Each practice could be considered to be located at the tip of an equilateral triangle with each line measuring around 3 miles. Three miles is not far when we think of distance, in fact I can and often walk between the three. While geography does not separate them, other socioeconomic factors do making my working life across the week as different as working across different continents. One practice, in Peckham, has the dubious honour of having fatal gun shootings as its highest cause of death among young men, with fatal stabbings coming a close second. The high street is a vibrant multicultural tapestry to the diverse populations that have settled in this poor area. Chickens at £1 each sell alongside Khat and saris. Music constantly blares out from loud speakers, competing for air space with the ever-present noise of police and ambulance sirens. What of the practice patients? So undemanding are the patients that we have coined the phrase ‘the unworried unwell’. No one wants or expects to bother the doctor for longer than a few minutes. Serious illnesses are brushed aside as ‘God wills’ or ‘oh well’. Any accompanying husband or wife is grabbed so that we can carry out health checks on them, invariably picking up diabetes and/or hypertension. My second practice, a short cycling distance away, is in Lambeth, close to the architectural catastrophe called the Elephant and Castle. The practice is located on the first floor of a seventeen story housing block and such is the density of the housing that 90% of patients are within a 5-minute walk from the practice. Of our registered population around one-tenth comprise of Lords and Ladies, Members of Parliament, doctors, dentists and medical students, and young city workers on their way to greater things. The remainder are a mix of socially deprived people and the elderly. The Ward boasted the highest teenage pregnancy rate in Western Europe and the highest rate of drug misuse in London. Working here is firefighting demand, where demand for appointments always outstrips supply no matter what new government initiative we try to implement. Surgeries here are never dull. Drug users make up around 20% of my workload, with the other 80% a mix of serious mental health issues and the ‘worried well’, usually made up of the new European immigrants just checking that that cough they had 2 weeks ago ‘wasn't something more serious’ and can they have a vitamin injection for their stress. The third practice is a new build practice based within a swanky mixed private/social housing development in Vauxhall, built on the site of a previous car-pound. Starting with a list size of zero, the practice has grown over the last 18 months to serve the needs of around 2000 patients, mainly young (only five patients are over 50 years and only 10 under 18 years), and mainly employed individuals. I have worked as a GP in South London for 20 years, and working in this practice requires a whole new set of skills. Each patient comes armed with ‘their diagnosis’, supported by sheets from The Internet Doctor and piles of photocopies from magazines and sometimes even medical books. Reassuring the 22-year-old that his tiredness is not due to Addison’s disease but more likely because of his late nights, excess alcohol, and occasional cocaine use is a skill that I am rapidly learning. Equally, explaining to the Diplomat from a very wealthy Arab State that his 4-year-old child does not need to be brought into the surgery every time he sneezes requires certain expertise. But what has each practice got in common? All of the practices I work in have recurring themes. Quite obviously, the patients all need my help, even the 22-year-old ‘know it all’, and all require me to have listening, communication, and other general practice skills. All of my patients require a doctor who cares, respects and knows them, and I believe that providing them with such a doctor not only benefits their health, but also benefits my working life. All my practices require that I become involved, not just in the patients but also in the local community, something that is a challenge working across three different sites. For me, I find that no matter how many hours I work, or how many patients I see, I am always learning. Finally, I marvel how 20 years since starting out as a GP I derive as much pleasure from my ever changing work as I ever had.