Posted by: GPs To Be26 July 2016
'So, are you a GP or psychiatry trainee?'
I hesitated. My heart sank.
Perhaps we forget that, as GP trainees, we might only know a little, but it’s about a lot
I’m coming to the end of my last ever hospital rotation. And in some ways, I’m relieved. It’s getting pretty tiresome. Just as you start to get to grips with a specialty, and remember to turn around when someone calls for the gynae or paediatric SHO, the merry-go-round starts up again. A loud ‘CRACK!’, and like the Boggart from Harry Potter, you’re expected to morph into an adroit junior of another specialty, and replace the rare tube of lubrication you smugly carry for speculums with a reel of equally valuable Peppa Pig stickers.
Another induction, another set of computer passwords to grapple with, another few weeks of scurrying around looking gormless and wishing you could merge into the gaggle of medical students hovering at your elbow. It’s like being an F1 all over again. Except you can’t use the ‘foundation’ prefix to excuse your ignorance. And you spend the first few weeks trying to stop yourself slinking into a corner, as the bright-eyed specialty trainees around you babble in acronyms and talk about drugs you’ve never even heard of.
But a few recent encounters in my psychiatry rotation have made me wonder if we underestimate ourselves.
'GP trainee,' I replied to the neuro registrar, dreading the snide retort that was likely to come next.
'Oh great, so you’ll understand then…'
He seemed relieved, as he launched into a helpful explanation of what he thought might be happening with our patient.
I was thrown off guard. I’d become accustomed to mumbling my answer to that question whilst intently avoiding eye contact, fairly sure that anything I said from that point onwards would be treated with a dose of skepticism.
But his comment made me think twice. Perhaps we forget that, as GP trainees, we might only know a little, but it’s about a lot. Once you’re propelled into a specialty training pathway, even at the most embryonic stage, it’s easy to displace the other chapters of the textbook imprinted on our brains at medical school. But for us, the whole textbook stays open. And bookmarked.
As patients lie in a ward being scrutinised through a specific specialty lens, it doesn’t halt the course of their problems in other systems. Languishing beneath the whiteboard earmarked by a particular specialty, the ‘whole person’ underneath continues. All too often, I’ve overheard patients in hospital take the opportunity of being lent a kind ear to mention another ‘bit of them that needs fixing’. And I’ve seen the blank smile that‘s sometimes returned, and the problem swiftly glossed over as though the listener hoped that no one else had heard.
But we can help. After all, we’re specialists in people. And as the consultation around the bed ends, the patient will soon become one of ours. So our ears are more attuned to prick up at the other things.
Like the young renal patient who I could see was terribly embarrassed about his acne, and was so grateful to have someone discuss some treatment options. Or a GP trainee friend, who told me how the other psychiatry trainees balked when she suggested discussing a DNAR with an elderly man with recurrent chest pain, who was ferried to and from A&E weekly despite his pleas to be left alone. Or the terminal lung cancer patient in the hospice, who acted like I’d solved most of the troubles in the world with a cream for his piles.
It might not always be the most glamarous things that we can help with. But I think the value of GP trainees is underestimated. Even by ourselves. We retreat into the shadows of our specialty trainee colleagues, forgetting that we’re that subtle, pervading thread of generalism woven through the fabric of secondary care. And alongside fears of the reel running out altogether, perhaps we should also consider how the recruitment crisis will affect the hospital gaps we tie over.
I think the registrar’s palpable relief this time was a bit extreme. But after that call, I’ve stopped hesitating before telling people I'm a GP trainee.
Dr Nishma Manek is a GP trainee in London. You can follow her on Twitter @nishmanek