Tuesday 29 September 2015

Instant cures, shared experience and versatility

I was inspired by the #whyGP project to consider why I chose general practice. Here are just a few of my reasons.

Instant cures

What could be more satisfying than curing someone in the space of ten minutes? I was inspired to become a GP after observing the healing power of the GP consultation itself.

I had this epiphany in Woolwich whilst sitting in with GP Simon Lundy. A mother was worried about the health of her child. Dr Lundy expertly reassured her that it was a self-limiting illness which required no specific treatment and from which the child would make a full recovery. Her relief was palpable.

Such consultations occur several times a day for every GP. Years of training and experience and first class communication skills allow a rapid assessment, a diagnosis based on probability, reassurance or simple treatment and safety-netting in case of a less common cause. This is not “fobbing off” or “missed diagnosis” but pragmatic, family medicine that achieves personalised healthcare with unrivalled cost-effectiveness. This approach should be celebrated: the NHS relies upon it.

Shared experience

I really value being a part of the same community as my patients. Some colleagues prefer not to live in the practice area lest patients consult them on the street. However, I like that sense of connection with my patients: whether it be simply experiencing the same traffic, power cut or weather event; whether it be having enjoyed the same local festival; whether it, sadly, be a road traffic accident or some other tragedy; or whether (in my case) it be an opportunity for patients to provide feedback on my choral singing!

All of these shared experiences help to build rapport and mutual understanding and respect, putting patients’ health firmly into their social context.

My memory of working in hospital is that special effort is needed to understand a patient’s social context and to maintain their dignity within that sanitised, other-worldly environment.

In general practice, patients often apologise for attending in their work clothes. Of course, apology is absolutely not needed, as it helps to bring to the fore the person rather than the illness.

Understanding the social context is of course vital in any walk of life, but is something that is particularly important in general practice, even if it is not for us to change social factors.


As a GP registrar, I came to enjoy the sophisticated interactions with my patients. They treated me as their advisor, albeit one whose advice occasionally required me to write a prescription. They did not come like a car to be “fixed” but to work in partnership to understand their health concerns and needs, drawing from my medical expertise.

Doctors have tended to accept blame as a legitimate way of allowing patients to cope. If media, charities, regulators and courts encourage complaints and a culture of blame and punishment, we risk losing this precious partnership. Let us work together to build on this collaboration which allows GPs to help so many patients.


One of the things I really enjoy about general practice is the pace. Every 10 minutes, a new patient walks through my door with a new set of concerns. Beyond clues in their records, I have no idea what they might want to discuss with me. They might have severe depression and need an emergency referral, or they might have just discovered their xiphisternum and need reassurance that it is normal.

I am not a specialist. I am proud to be an expert generalist. That means, amongst other things, that I am expert in treating common conditions, basic treatment of less common conditions, recognition of what is normal as opposed to what might need further investigation, and considering how different aspects of a person’s health might interact.

This variety and pace is a marvellous challenge and keeps one on one’s toes throughout the working day or even career!

There are opportunities to develop special interests. There are also strong arguments that appointments should be longer than 10 minutes and perhaps even that there should be some kind of triage process (to ensure, for example, that some issues are dealt with by colleagues). However, I am glad to say that the pace and variety of work in general practice is in no danger!

Flat hierarchy

When I was sitting in with Dr Lundy in 1999, the partnership model of general practice was at its height. By and large, if a practice wanted a new GP, they had to take them on as a partner, a fellow principal with whom patients could register with for their GP care.

Clearly, each partner brought different skills to the team, whether it be seniority, expertise in a particular clinical area or responsibility for a particular area of practice management. However, once established in a partnership, each partner within each practice drew an equal share of practice profits (with the exception of seniority payments) and had an equal vote in practice decisions.

Thus, just 3 years after leaving medical school, there was a relatively flat hierarchy and a culture of respect for differing opinions and skills. Nowadays, many GPs choose a salaried contract over partnership. Nevertheless, the culture of respect remains strong in most practices and is something that, as a profession, we should prize.


My GP trainer said he would equip me to practise independently anywhere in the UK.


It seemed a tall order at the time, but that is indeed what he did. In reality, with the skills I learned, I could practise just about anywhere in the English speaking world (with the exception of the USA). With NHS contracts about to be revised, that is highly comforting.

However, this versatility is not confined to political geography. There are so many opportunities for UK GPs, trained as they are to an increasingly high standard.

I could work in a town (as a I have). I could work in a rural setting (as I have for many years). I could work in a city (as I currently do). I could work at a walk-in centre. I could direct a walk-in centre (as I do). I could work training tomorrow’s GPs (as I do). I could work as a locum GP, under contract as a salaried GP or in partnership. I could work out of hours (as I have done regularly). I could work with a hospital specialist as a clinical assistant (as I have done). I can undertake minor surgery and joint injections. I could represent my practice to commissioners (as I have). I could work with colleagues to bid to provide new services (as I am doing). I could represent GP colleagues within RCGP regionally (as I have) and nationally (as I do).

These are just a few examples of the opportunities available to GPs. Other GPs work as researchers, as occupational health physicians, in the military, on cruise ships, in Public Health, as politicians … the list is almost limitless!

The medical, interpersonal and management skills honed through GP training are second to none. The only uncertainty at the current time is who pays us.

If this sounds a little like a CV, perhaps it is: my family wish to move and I am looking for a new practice. Just as well I can practise almost anywhere in the English-speaking world!

Originally published on WhyGP.uk.

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