The Greener Grass? Life in Primary Care Medicine

As I type this I can only describe a ‘buzz’  about me; physically and mentally I feel pretty good right now. I don’t mean to sound smug when I say that but rather just that I feel I have been on quite a tortuous journey with medicine and how it aligns with my way of life and desires for the future. I am more relaxed, happier, driven and my old self again – after probably 3 or 4 months of losing those aspects a little. Even my family tell me this – and as we are all aware, probably the majority of families know their children best.

So what’s changed?

The short answer is that I have moved out of secondary care medicine (that’s hospital medicine) for 4 months and am now working in primary care (that’s general practice). Life is very different for a doctor in primary care. Now although I am still very wet behind the ears in general practice, being stumped by how to treat Mrs Smith’s achy joints, or little Jimmy’s sore red toe after his swimming lesson – for I am used to patients with severe sepsis, widespread infections, acute heart failure, and massive strokes – I never had to worry too much about the less acute side of medicine.

General practice doctors are true generalists – and I envy their knowledge. It is so broad, so encompassing, that they have to know a little about everything – both the chronic conditions, such as Dementias, Parkinson’s Disease, Chronic Heart Failure, Diabetes, and the acute conditions such as recognising meningitis in a sick child. To make this all more challenging – they typically have about 10 minutes per consultation to take the history, examine, diagnose, and make a plan – whether that be for further investigations or management. And they do it all without the support of investigations on their doorstep – you can’t get a ‘quick X-ray’ or ‘blood test’ or’ MRI scan’ to see if they do have a disc prolapse. You have to use your intuition and experience.

This week, as it is still part of my ‘introduction’ phase of my rotation as an FY2 to general practice, I am doing joint sessions with a GP before getting my own patient list next week. This means that we are both in the consultation room, and take it in turns to sit in the ‘hot seat’ and lead the patient consultation with the other watching in the corner. This is great fun! However, what is beginning to wear a little thin is, during the times when it is my turn to sit in the corner and observe, the patient walks in and says “oh, you’ve got a medical student with you”.

I AM NOT A MEDICAL STUDENT!

I have to just smile, and usually say nothing and bite my lip. My poor lip – it has taken quite the beating this week.

I really enjoy the set up of general practice too – you get a nice big office which, as Louis from X-Factor would say “you can make your own!” and super-comfy chairs. And SO much tea.The training scheme too is more condensed that hospital medicine (though I do appreciate for the ‘patient’ that this may be a less than favourable situation) and so you are qualified much sooner – with a lot more flexibility.

Now I have spent a lot of time reflecting this week about that word – flexibility. I know that I my ambitions are slightly skewed compared with many junior doctors for I not only want to be a good, safe doctor first, but I want to write about health, do some sports and exercise medicine, get more into media work (for the love of talking about it not the public eye status, I should add), and also some expedition medicine. This globally is within the context of having a family – most importantly for which, I have time for. General Practice is the ONLY career path (beyond leaving medicine altogether) that would allow me to do this. I will stand to be corrected on that…

That is food for thought and something that I need to mull over in the lead up to choosing my career route. The deadline for that decision, out of interest, is this November – so not long to go. I feel I know what is the most natural decision to make but I will talk it over with my family first – they are often my voice of reason!

This week I also got a better understanding of what a GPSI is. Now, pronounced “GYPSY” , I never really quite got why all these GPs had such a strong affiliation with the Gypsy community…and then I discovered that is stood for GP with Special Interest. Oh. As my mum would always (and still does in fact) – for someone seemingly smart, I can be very stupid. I cannot disagree. In the practice that I am at currently, we have GPs with special interests in maternity, diabetes, genito-urinary, musculoskeletal, and dermatology. I could be a GP with a special interest in Sports and Exercise Medicine.

I like the sound of that.

 GP

Needless to say after a relaxing weekend seeing friends, going to the cinema (Expendables III, oh dear), and some reflective walks through Battersea Park, I feel very good about things. I am looking forward to hitting the GP practice tomorrow for another good week. It’s a busy week too – I have to finish another article for the Independent, and I am doing my final filming session for the Discovery TV show called “What Have I Got” – more on that perhaps another time. All in all, life is good.

Have a great weekend everyone,

Dr Nick

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