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The inspiring and stimulating work of rural general practice

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'All you need now is for someone to give birth!'

'50% of you will end up as GPs’ is a common threat stated at the start of medical school teaching

And at that moment, we highlighted to Brendan - one of our elective students - that there was indeed someone in labour upstairs in our maternity suite.

Like many of our students, Brendan came to rural practice eager to see whether there was interesting work in island practice, or whether the stories of tumbleweed and Battenberg cake were true. Having come from a placement in Scotland’s busiest A&E unit, there was a real potential for adrenaline withdrawal if high-paced medicine wasn’t to be found. So it was with some relief, perhaps, and pleasant surprise that there was plenty to see in our microcosm of rural community hospital work - an exemplar of generalist medicine that keeps many of us rural GPs enthralled and stimulated.

He had just seen the effective analgesia that intranasal diamorphine can bring to a child with a painful fracture. Earlier, he witnessed a case of acute coronary syndrome, with near patient testing and pathway-guided care leading to referral directly to tertiary care colleagues for angioplasty. The rapid and effective transfer to high-level intervention wasn’t lost on Brendan. We also saw a patient with a sore throat - here on holiday between chemotherapy cycles, leading to a tricky judgement situation given that we don’t have easy access to a differential full blood count. The power of the patient’s story, combined with accurate clinical examination become so easy to appreciate when number-generating tests are not so easily to hand. He had had an opportunity to see the value of an ABCDE assessment of a cyclist who’d come off his bike at lunchtime, and escaped with only ‘gravel rash’ and an intact c-spine (and learning how to clear one was a useful experience).  

And so now. Just when he thought the spectrum of community hospital medicine couldn’t get much wider, we reassured him that it could, with our two midwives upstairs overseeing a green-pathway delivery, but knowing that a GP oncall could be around to assist if things became more difficult - even if that simply meant assisting with a rapid transfer off the island.

This is rural general practice, a specialism that is accessible to many if they choose, and a line of work that has the capacity to inspire and stimulate. Students only get a true understanding of this when they get out and see it for themselves. It’s an experience which certainly made Brendan reflect on some of the stereotypes of GP that he had previously been informed of.  

’50% of you will end up as GPs’ is a common threat stated at the start of medical school teaching. More and more of our students are realising that this isn’t necessarily a threat, but in fact a reminder of the scope of medicine that an MBChB provides access to, and that’s not a bad thing.

Dr David Hogg is a GP on the Isle of Arran, Scotland. You can follow him on Twitter @davidrhogg

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Readers' comments (4)

  • You mention that during a delivery the "GP oncall could be around to assist if things became more difficult".Does that mean that the midwifes feel they're less experienced than you in obstetric matters?Do you perform caesarian sections?

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  • As always, a great article Dr. Hogg. Nice to have some optimistic respite!

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  • David Hogg

    Hi 9.18am - absolutely not; our midwives are the experts but we can give them assistance if necessary - from helping with phone calls and being an extra pair of hands, to advanced life support, if that were to be necessary. In obstetric emergencies the main aim is to get unwell patients off island as soon and as safely as possible. Thankfully the work of our midwifery and obstetric colleagues means that any riskier situations are anticipated in advance, and are delivered (or strongly advised to!) on the mainland.

    We don't do C-sections; that's slightly above our capabilities! I think only larger units with surgical and anaesthetic cover would attempt this . Australia seems to be a different matter however, I suspect because they have much larger distances involved.

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  • Honestly David, don't you ever tire of being so relentlessly optimistic? It's exhausting trying to empathise with your enthusiasm.

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