Dr Conrad Witek  -  21 July 2023

I was quite apprehensive to start working in the community. As an internal medicine trainee, I was at home in my familiar surroundings of the hospital. Unsurprisingly, I learnt a great deal. No CT scanner, but I had my stethoscope and pretty much everything else I could need in the boot of the car. No more writing plans in the notes for the nurses to follow, and a lot more doing - drawing up intravenous antibiotics, picking the Amlodipine out of a dosette box and even emptying the odd catheter bag.

The first task I quickly learned was the skill of actually finding your patient. Gone was the convenient "bed 12", and instead crawling along in 1^st gear, squinting at front doors. I'm as big a fan as anyone for a lovely house name, but what happened to a good old fashioned house number? Wait, that one's got a key safe and a handrail outside the front door - surely it must be this one!

There's an innumerable number of funny stories, but a lot of the humour comes from the day-to-day quirks that you'll miss if you don't take a step back every so often. Trying to stay cool in a crisis during the hottest day of the year (not helped by Mrs Smith, who has the heating on all year round). "No, I would not like a nice hot cup of tea, but thank you very much for the kind offer" I say, as I untangle the ECG leads with one hand and pet her overly enthusiastic dog with the other. To top it off there's a nosy neighbour who has suddenly decided to start re-arranging their bins outside. I'm sure they're about to sustain a neck injury from the angle that they're peering over the front hedge. 

Jokes aside, what a privilege it is to step into our patients' homes and care for them in the real world, outside of the augmented reality of a hospital with its artificial fluorescent lighting. Allowing them to be treated in the comfort of their own homes, and even more importantly die in the comfort of their own homes. It wouldn't be possible without such a dedicated team. No job too big or too small, from cannulas to clearing up the kitchen to collecting a prescription.

What did I miss about the hospital? Not much really. Your day is infinitely better driving through the countryside where you don't have the bells, buzzers and bowel movements of an inpatient ward (I should counter this with the fact that I have not worked in the community during the depths of the British winter, where I expect my answer may be a little different). Not only is it great fun, it's a big part of the future of geriatric medicine. Just make sure you don't get car sick before you apply for the job.