New GP

I was not sure I wanted to be a doctor. In fact, thumbing through the university prospectus when I got to ‘M’ for Medicine, I thought it looked quite interesting. I am not from a medical background but my dad thought I would make a good doctor. I liked science, liked variety and liked people, so I applied to medical school. I did not go into medicine with any preconceived ideas about saving lives, being an altruistic saint or living the life of a character from ER.

Medical school was great fun. I went to Cambridge, so the course was very science based and we did not see a patient until the fourth year. The clinical years were a shock at first. All of those ill people! I enjoyed learning about the different specialities and every clinical attachment I did, by the end I thought that was the career for me (except surgery — I never enjoyed going to theatre). I had a particularly good experience doing Paediatrics in a district general hospital with a very enthusiastic consultant and so I spent my elective at Sydney Children's Hospital doing Paediatric A + E, which was a great experience. The following summer, I spent a wonderful couple of weeks on attachment at a rural general practice in Norfolk. The GP who supervised me had worked in the practice for 20 years and knew all his patients very well. They all seemed to think he was fantastic. I saw all sorts of cases from paediatrics to elderly care and really started to appreciate the role of the GP within the community and the importance of continuity of care. Then came the run up to finals and adult medicine seemed to be the area I most enjoyed learning about and I somehow graduated with a distinction in Medicine.

After qualification, I got an innovative house officer job, which involved a 4 month GP post. So my first day working as a doctor I was a GP house officer-slightly terrifying given the complex and uncertain nature of general practice. Patients would appear with any number of symptoms, which did not necessarily fit the textbook diagnosis I had become so familiar with during my revision for finals. Nothing was straightforward. I could not send everyone who had a headache for a CT scan but at the same time those patients on the neurosurgical ward with brain tumours had stuck in my mind. I thought GP was all about cups of tea and being a good listener but I quickly realized there were some serious diagnostic and management skills required too. This was going to be far from easy. I had a great trainer and an enthusiastic registrar who I chatted to over lunch about her own career. By the end of my 4 months in general practice, I wanted to be a GP. So that was decided then.

The rest of my House Officer year was based in hospital. Vascular surgery then urology followed by 4 months of medicine. Problem was I enjoyed these jobs too! Even the 4 months of surgery was a good experience, learning how to do dopplers, catheters and managing a ward round and all the jobs that went with it. A decision was needed, I had to apply for a Senior House Officer post. A job in Accident and Emergency came up at the same hospital where I was a house officer. I got it and loved the 6 months I spent seeing every aspect of medicine, surgery, gynaecology and paediatrics. The hours were tough but an A + E post is something every doctor should experience. Prioritizing, managing sick people and coping with pressure are all vital skills for a career in any speciality.

I liked managing the medical patients the most in A + E and so I went on to do a 2 year medical rotation. I loved the variety of general medicine. My rotation included cardiology, respiratory, gastroenterology and elderly care and by the end I felt competent in managing adult medical patients. I gained Membership of the Royal College of Physicians and registrar posts (equivalent to ST3 posts) were being advertised. The choice was between acute medicine and elderly care. I liked the variety of these disciplines and the need to know a bit about everything. I had enjoyed the clinic environment, particularly during my cardiology job where we did two or three clinics a week. Clinics were busy but I appreciated the uninterrupted time with the patient without a bleep. I worked with a couple of registrars on the wards during my respiratory job who were despondent with the constant busyness, lack of lunch breaks and sometimes disorganized nature of the ward environment. I realized I wanted to hear the end of the story, find out what happened to the patients when they went home, but I rarely did unless they were readmitted or I saw them in outpatient clinic. I realized that actually all the areas of medicine I loved — the variety, continuity of care and talking to people — could all be found in general practice. I had to make a quick decision. I needed a year of other hospital experience relevant to general practice before the new training system came in, so I applied for a one year Paediatrics post.

Paediatrics was terrifying at first. I went from being a competent medical senior house officer to a novice children's doctor and I wondered what I had done. However, Paediatrics was my original career plan and spending a year working on a children's ward, special care baby unit, post-natal ward, delivery suite, admitting children in A + E and attending Paediatric outpatient clinics was a year thoroughly well spent. I enjoyed Paediatrics but I knew my heart was in general practice.

I applied for a GP training post and was successful. My training has been in a busy inner city practice in Birmingham serving a very deprived ethnically diverse population. I see as much medicine in my surgery as I did on any medical ward. My experience in Paediatrics has made me more confident in managing sick children in primary care and able to recognize those patients who require admission and also those who do not. GPs see undifferentiated illness and I have learnt to use time as a diagnostic tool. This was difficult at first for a medic who was used to having a definitive diagnosis and management plan for most patients. I continue to learn that patients are complex and the psychosocial aspects of illness must not be underestimated.

I qualify as a GP in six weeks time. As I near the end of my GP training, I can reflect on the decisions I have made since flicking through that university prospectus 12 years ago. I love being a GP and I can see this being a fulfilling and rewarding career for a professional lifetime. Career choices have to be made earlier these days and the changing around I did is not as easy as it once was. There are many who will influence you along your journey: family, friends, consultants and peers. All doctors should choose a speciality for the right reasons which suits their strengths, their skills and their personaility and for me this is definitely general practice.