11 Feb Thoughts of an aspiring GP
On attitudes towards GP
As med students we saw enough during our ubiquitous 5-day work placements to create positive experiences of General Practice – experiences, which unfortunately, did not seem to survive the prevailing attitudes of medical school.
“That look. A little remark. An ill-placed smile. Some specialty lecturers were doing a great disservice to the aspirations of budding physicians, either implying or outright declaring that GPs are lazy, overpaid and underworked.”
That they are incompetent part-timers, sell-outs that deal with the soft side of medicine, or that they follow the line of least resistance like an inguinal hernia… My student experiences of GPs themselves demonstrated exactly the opposite. Unfortunately, many student experiences of GP teaching in undergraduate curricula didn’t go far enough to dispel them.
Being associated with, dare I say, the “softer” side of medical education (public speaking & presentation skills, broad team-working skills, the patient journey, and many a contrived reflective essay) this flavour of General Practice teaching might on balance be good for medical schools, but bad for the future of General Practice. A year from graduating, many of my colleagues had no capacity for describing the then QOF system, how GPs are funded, the concept of ‘general practice as a business’, or the role of a GPwSI. Why? We spend disproportionately more time in contact with GPs than representatives from other specialties throughout 5 or 6 years of medical school. Why doesn’t it convince us?
The clinical side of GP, involving ‘acute appointments’, review appointments and follow ups, home visits (including palliation), phone calls, teaching, and to a greater or lesser extent, the development of one’s own ‘specialty interests’ and out of hours work clearly provide an opportunity for a varied and challenging career. I think the positive case for this side of the day-to-day work as a GP makes itself.
On building relationships with patients
Contrast to this is my current job. I have been working inpatient FY1 posts since August 2016. It is relentlessly task-orientated, as is the nature of high turnaround, acute inpatient care. However, every day I am asked to update the relatives on a patient’s progress. I take them into the quiet room away from the bustling ward, or with the patient by the bedside. Pull up a chair, adopt an open body language, polite introductions, manage expectations.
“For all the blood-taking, test-ordering and interpreting, examinations, referrals, and management issues, it is here I am most comfortable. That’s also where the patient and their relatives want me.”
Managing and processing data, interpreting and explaining results, and building trust so that I might be asked for – by name – to do the same again later today, tomorrow, or sometime next week. It is time that patients want from me, which unfortunately in an inpatient setting is time to the detriment of another patient’s care.
On first experiences in a GP practice
Although ‘practicing’ (closely supervised) in an extremely premature role, the mini-surgeries I ran as a senior medical student in GP demonstrated the essentiality of excellent communication skills that extend beyond the walls of the practice. I watched and learned as the named partner in my rural GP placement nurtured close professional relationships with the LNC, hospital specialists on the phone, the local pharmacy, every non-clinical and clinical member of the practice staff, a psychiatrist, the police, the schools, and even local shop and business owners – in every case to the betterment of the patient.
“GP is truly a community enterprise. Most people are happy enough with the community aspect but more dislike the idea of GP as an enterprise. As someone who has always found a fascination in systems, hierarchy, and process, this enterprising half of the job is also half of the attraction.”
I was fortunate enough to sit in on practice meetings, appreciating the invitation to suggest improvements to the appointments system – and being impressed when my thoughts were judged on their own merit and not the seniority of their source.
Ultimately, the idea of establishing unique partnerships and collaborations to help the practice develop, providing population-appropriate services, attending meetings where my practice is represented, while allowing for variation in practice from one GP to the next – over decades in the same place – appeals greatly to me.
On how GPs and pianists are alike
This all sounds dry for a 23-year old. I do have other interests; for example, I’m a natural pianist. Much to the annoyance of my teacher and the examiners, I always struggled to read sheet music, relying heavily on that “ear” you hear people talking about. Hugh Laurie speaks to my attraction towards GP.
“I think there is an interesting psychological difference between those instruments [guitar and piano] and the attractions they exert over various people. Some people are drawn naturally — there are natural guitarists, and there are natural piano players, and I think guitar implies travel, a sort of footloose gypsy existence. You grab your bag and you go to the next town. Piano, by its nature, is a fixture: You become a fixture, you have roots, you have the same seat, the same nights, in the same bar, and then people come to you.”
I’m a pianist. And don’t you think we need more of them in General Practice?
Dr. Craig Wylie is a Year One Foundation House Officer/FY1 working in Tayside. Having graduated from Dundee University Medical School in 2016, Craig stayed in Dundee to remain near his familiar teaching hospital, his church family, his friends, and his fantastic fiancée, Sarah (to be married July ‘17 in Northern Ireland!).
He is an associate staff member of Dundee University Medical School, where he acts as Supervisor for Junior School portfolios, and does the occasional spot of bedside/ward-based teaching. Originally hailing from Shawlands Academy in South Glasgow, Craig has also supported school students through the Medical School application process.
Craig decided to study medicine after a work experience placement in a Practice in South Glasgow, and to apply for General Practitioner training after an inspiring “outblock” in a rural Practice in South Ayrshire.
Craig has always had a keen interest in written and spoken communication, and this short opinion article represents his first foray into online blogging.