Arrival and anxiety!

There’s so much to say, it’s hard to know where to start.

It takes 14 and a half hours overnight on a ferry to travel the distance from Aberdeen to Lerwick, Shetland. It’s a very long way.

An easterly swell during the first half of the night meant I took to my bed very early and I was quickly regretting the slap up dinner we had soon after boarding. However, after a decent sleep we arrived in Lerwick at 7.30 in the morning. After wandering around for a bit as nothing was open and taking the obligatory photo of the beach featured next to Jimmy Perez’s house from the “Shetland “ crime series we grabbed a coffee and headed over to the Island of Whalsay. 

Another ferry ride later and I was chatting to the current GP locum and practice manager (I probably only understood about 1/2 of what she said due to her Shetland dialect which came as a bit of a shock!) to get the low down on GP work in a remote and rural environment. The consulting room view was just incredible:

We then drove to Unst (from the “mainland” as it’s known by locals). Two ferry rides and two hours later we arrived on the island that will be home for the next 3 weeks. 

I had one day free before starting work - so John and I visited Hermaness, the most northerly nature reserve (everything here is “the most northerly….”) in the U.K…..

I recommend watching David Attenborough’s Wild Isles, first episode and you can see where we walked which is where they filmed the Orca whales. Sadly we didn’t see any whales but we did see a massive gannet colony and the brilliantly named Muckle Flugga lighthouse. We survived the Bonxies (also known as Great Skua) which are known for dive bombing anyone who gets too close.  It was THE most beautiful walk we had ever done and made me feel very small surrounded by the coastal wilderness. We didn’t see another human being and so for a few hours we were the “most northerly” couple in the U.K. 

Earlier last week I started work and spent my first 3 days shadowing the outgoing GP who had a lot of recent A&E experience and worked on Tiree for 7 years. He was amazing and gave me plenty of useful advice. The photo below is Unst Heath Centre the small grey 60’s building on the right, it’s nicer inside, honest.   Incidentally the big white house next door is for sale at a bargain price of £186k if you’re looking. 

I had a lot of logistical and process issues to learn rapidly in the first few days. Not easy with a menopause brain.

Blood tests get spun in a centrifuge in the surgery and go down to Lerwick on the public bus each morning! (so there is a one-day delay with routine bloods). 

A couple of patients did not want travel to Lerwick for tests or appointments due to the cost. Patients on low incomes can apply reimbursement of travel expenses but they seem very reluctant to leave the island.

There is no regular GP on Unst so the visiting locum doctors can’t hand back to “registered GP” which is what locums tend to do in a more traditional GP practice. It’s certainly a different type of locum work where you have to take ownership, proactively follow things up and have a clear handover to the incoming GP. 

Every patient I see is new to me - in my GP practice in Dorset that I’ve worked at for 11 years I’d know about 2/3 of the patients in my surgeries which cuts down on consulting time and stress. The IT system here seems quite antiquated - it’s an old fashioned version of Emis and is very clunky. And for my GP friends …there is no Accurx, Accumail or Arden’s 😱. Risk scores such as Qrisk need calculating manually and adding to the record so filing results is laborious and lengthy especially when you don’t know the patients. 

I spent 2 hours going through the car kit which sent my anxiety levels and heart rate through the roof. Some of which I wouldn’t be able to use such as a chest drain kit (I’ve only ever done one chest drain and that was circa 1997!) . There’s Thrombolysis for MI’s - 😱 that’s a whole other story and anxiety level, but in summary I would administer it on the advice of cardiology and I can phone the EMRS (Emergency Medicine Retrieval Service) and ask for a “multi-way conversation” with the interventional cardiologist at Aberdeen /local medical consultant at the Gilbert Bain hospital in Lerwick and the EMRS doctor. 

There’s no on call paediatrician on Shetland - advice is sought from the Consultant of the week in Aberdeen and children who are not too unwell but need admission locally are admitted under a general medical consultant at The Gilbert Bain Hosptial.  

I drive around in an electric car. Here is a small selection of the car kit:

There is only one main road through the island but as there are few house numbers or road names I think it’s going to be easy to get lost on this small patch of land measuring just 12 x 5 miles in the North Sea.

I found out that The Scottish Trauma Network has a “Trauma Desk” - I would phone them if I had a major trauma case, for advice and for arrangement of retrieval of the patient. The nearest major trauma centre is Aberdeen but patients often end up at the local Gilbert Bain Hospital initially for stabilisation, due to distances involved. 

Anyway I’m hoping the bread and butter of my work will be general practice which I’ve been doing for 24 years so you’d think I’d know what I’m doing by now, but it doesn’t feel like it! 

And now for a photo of some adorable Shetland ponies.

Next up - first day and first weekend on call. Warning it involves a chopped off thumb (not mine) 👍