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Let medical students see what it takes to be a great generalist

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A major hurdle to improving GP recruitment, which is going to be crucial if primary care is ever to recover from its current crisis, is the negative impression of general practice that some medical students form during their largely hospital-based early careers. I’ve never understood why breadth of knowledge is so undervalued. Ironically, my own decision to go into general practice was shaped by a hospital doctor who despised GPs.

He was a sub-specialist within a small specialty, and had the kind of narrow view which that kind of position occasionally fosters. A master of about half-a-dozen exceedingly rare diseases, he had undiluted disdain for anybody who didn’t know as much about his pet pathologies as he did. It never seemed to occur to him that every case he saw had been pre-filtered by layers of other clinicians. Or that the only reason he could specialise so minutely is that there were armies of generalists dealing with everything else.

I once sat in on a clinic of his, in which he was happily mocking the GP referral letters that accompanied the day’s patients. A particular delight of his was to use these letters as a springboard for some old-fashioned teaching by humiliation. Halfway through a morning of this, he found a letter that particularly pleased him.

‘This one can’t even spell!’ he crowed gleefully.

The three or four of us sitting in with him kept quiet.

‘You,’ he said, turning to me, ‘spell “ophthalmology”.’

‘O-P-’… I said, watching him lean forward and start to grin with anticipation; ‘H-’ I continued.

He stopped me with a wave and sat back, disappointed, then grunted and turned back to face away from us again, silently passing the letter back for us to read.

Even with the little bit of knowledge we had then, it was clear that this patient’s GP was exceptional. She’d dictated a thorough, perceptive letter, and tentatively suggested the unlikely yet correct diagnosis. Somewhere at the bottom of the first page was the offending spelling error, which she had signed off without correcting. As if it mattered.

We also knew the GP would have had to do this in limited time, whilst sifting a huge mass of normality to find an unlikely nugget of pathology. I knew then which was the more skillful doctor, and the one I most wanted to be like.   

Dr Nick Ramscar is a GP in Bracknell, Berkshire

Readers' comments (18)

  • Frankly i would discourage medical students from entering general practice for all the reasons given elsewhere.But each to their own.

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  • Bad spelling is not a problem- the ability to tick the right box is far more important !

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  • Well as GP are going to be no longer the prefered provider future GPs may not have a job to go to

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  • Medical students are not stupid.It would be highly unethical to given them falsely high expectations.Hopefully they will decide wisely by staying well clear of general practice.

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  • If you like trawling through hundred cases of crap for every "nugget",as you put it,then i guess general practice is for you!

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  • This article is a little too sincere ....

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  • this article is nothing but a lot of grovelling sickening nonsense

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  • Posters above are being unkind.

    Unfortunately our skills are being eroded away by the constant requirement to be a business manager, NHS budget minder, commissioner and recently a punch bag for deluded politician.

    What a pity.

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  • @above
    No one forced you to be a self employed independent contractor.
    No one forced you to engage with commissioning.
    You have no one else to blame for the skill erosion except yourself.

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