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Independents' Day

I love general practice because of the breadth of work

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One of my favourite pastimes, and one which I would encourage everyone to do, is to try and encourage medical students and junior doctors to take up a career in general practice. Once I’ve run out of skydiving forms for them to watch me sign, I’m often challenged with misconceptions about general practice – that it’s boring, and that it somehow isn’t ‘real’ medicine. When this happens I throw back my head, snort, and ask them to listen carefully.

General practice is as real as medicine gets. We spend years at medical school learning the art of history and examination, only to start working in a hospital environment where a patient has probably already had blood tests and imaging before you meet them. Towards the end of my stint in hospital medicine I became bored with what felt like diagnosis-by-proxy. Shadows on an X-ray and a high CRP? Crack out the co-amoxiclav. What’s that boy? Jonny has ST-changes and a troponin in the numbers of the chief exec’s salary? Get some aspirin on board, STAT.

It is a privilege to be in a specialty which has such breadth of knowledge of medicine

I would argue that what is more real is sitting with Mr Smith and using only your five senses (admittedly taste not so much) to decide whether his chest pain is a bit of reflux, or unstable angina. All we have in that moment to make such a decision makes one of the arts of general practice. This is intellectually challenging, and hugely rewarding. I suspect more experienced GPs can actually be so good at this they forget the level of mental gymnastics that is actually going on. Generally, if a GP misses a septic joint the patient might suffer untold joint damage. If a hospital doctor misses it, it is more likely that a colleague or senior is going to pick it up. I don’t buy into the argument that general practice is in any way medically inferior.

We go to medical school and learn a bit about almost every branch of medicine. It seems sad to me that we are put straight into specialties as foundation doctors and then encouraged to specialise after just two years. During last night’s out of hours shift alone I was exposed to paediatrics, urology, respiratory medicine and psychiatry. I can’t imagine anything more soul-destroying than only dealing with bones, or lungs, or the loop of Henle for the vast majority of my career. It is a privilege to be in a specialty which has such breadth of knowledge of medicine. I have utmost respect for the in-depth knowledge and skills of specialist colleagues, but I’m afraid it isn’t for me.

Obviously there are drawbacks to being a GP. I miss the buzz and excitement of the hospital. But paperwork, increasing patient demand and the like are prevalent in every branch of medicine. So it is important to highlight what makes a career in general practice an attractive proposition.

Now get this patient on a statin, STAT!

Dr Danny Chapman is a locum GP in east and south Devon


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Readers' comments (10)

  • There is a Junior doctors contract forums, a consultant contract forum, where is the GP contract forum or equivalent? We may still get shafted but its united us and it has helped significantly

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  • I admire your enthusiasm. Most of us are not so enthused. We now have to send in every chest pain in case we miss that mi that might end our careers. We now have to practice so defensively if we want to have a career at all as a doctor, forget general practice. With the help of all and sundry encouraging patients to complain,and us having a duty to remind them if they are not happy with our repsonse then they can complain to NHSE, the health ombudsman, the CQC, any no win no fee solicitor, we are made to shoot ourselves in the foot on a daily basis. The GMC are there at the end or beginning of any process to make our lives more miserable by carrying out a Gestapo witch hunt after any vexatious complaint (annonymous or otherwise). And with colleagues being given jail sentences recently, why would you take the risk. Practice totally risk averse medicine, follow protocols, refer and admit if any doubt (any at all) and most importantly, write every patient note as if it is your last with no holes in it that anyone can critisize you for. That is your only defence. I can not and will not suggest anyone becomes a doctor in this country, especially a GP. Train and go abroad if you must be a doctor, you will be respected and well paid. I have influence on many with the roles I do and am very truthful. You have a duty of care to fellow professionals tell the truth about what it is really like.

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  • Do you enjoy the box ticking that is appraisal and revalidation?

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  • Pipin Singh

    Truly agree. The only holistic professionals left who truly know are patients. The rubbish that comes with it though is clearly becoming more frustrating. We now have a referral management system in our area that has to approve OUR already made decision to refer and I now need funding approval for things like ganglion and see cysts before they can be excised - The list of these procedures goes on. I agree though wouldn't do anything else in medicine. NHS would crumble without us.

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  • Me too. I'd get bored doing one thing in ever narrowing breadth and increasing depth and prefer the challenge of making the diagnosis whatever the condition with the option of referring on for management if necessary. If only we could just be left alone to practice medicine and go back to doing the job as it should be.

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  • Dear GP Partner 5:35pm,

    "Practice totally risk averse medicine, follow protocols, refer and admit if any doubt (any at all) and most importantly, write every patient note as if it is your last with no holes in it that anyone can critisize you for. That is your only defence."

    What you have stated here is good solid advice that I would support both as a patient and as a practice manager.

    Yet I am reading some negative undertones in the context that this valuable message is presented.

    I do enjoy setting up systems in which our GPs have the time to record notes appropriately.

    We self-audit our referral rates and I love having the discussions with the CCG's regarding those. It is not often that I allow them to get past me on this subject to bother my clinicians.

    And most of all, I enjoy working with energetic and enthusiastic GP's even though we are on a pitiful GMS contract for the time being without much resource to go on bells and whistles.

    Whats grinding your gears?

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  • I thought this was a spoof article at first.

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  • You speak about the side of general practice that we all admire and as you say, are so good at we sometimes forget about.
    It's the box ticking and relentless interference that drives us all bonkers. Leave us alone to do the job we all want to do!!!

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  • Mate, I dont know how long you have been qualified for but its been two years for me and have lost ALL enthusiasm and optimism. Gimme some of what you're taking dude!

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  • Nice article. Thanks.
    A gp in med school told me it was like being a jack of a trades and a master of none. I replied he was "a master of generality". Toadying little shite I was but stand by it, and good a good grade 😝.
    Keep signing the forms they're 25 squid each!

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