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Welcome to GP-land: a student’s perspective

Medical student Melanie Ranaweera wasn't expecting much from her placement in general practice. But she found it an eye-opening experience

Medical student Melanie Ranaweera wasn't expecting much from her placement in general practice. But she found it an eye-opening experience

So let me take you back one year ago. I had just completed two years of pre-clinical lectures, in the safe haven of that big orange lecture theatre we quickly learned to call home. But now like Christopher Columbus as he set sail, we young explorers were about to embark on an entirely new adventure into the unknown... our first year of clinics.

And oh the tales we had heard. The blood. The gore. The vomit. The dangerous rainforest where defenceless medical students are found quivering in the corner following a feasting by the mighty king of the jungle... the consultant. The sadness of death, as patients move towards that part in their circle of life.

But like all explorers we needed equipment, and off I charged to the medical supply shop, proudly resonating my childhood Brownie motto: Always be prepared!

I had to find a stethoscope. The very tool that would enable me to do my job - the tree surgeon's chainsaw, the writer's pen, the seasmstress' needle. Without it I was the ultimate personification of Achilles heel: completely and utterly weakened.

And oh, the selection! Hunter green, Caribbean blue, peach... In that very moment I was suddenly transformed into Harry Potter, the part where he enters Mr Ollivander's wand shop and is overwhelmed by the complexity of choice. Ollivander's advice - ‘try each one and it will find you' - ran through me, so I did. One by one I placed them across my shoulders and neck, waiting to be weighed down by experience of medicine. And then it happened. That spark. That fizzle. That first date feeling. That certain va va va voom. Raspberry model A356 would be my companion through the stormy seas of my medical life.

So on the first day, I went to the London hospital with that explorer's passion, that thirst to learn and discover new things. My stethoscope - check. Cheese sandwiches - check. Mum's good luck card - check. Notebook and pencil - check.

Yes, I was ready.

My first month was incredibly busy - never-ending, yet incredibly exciting. Kind of like the working efficiency you see in the hub of an ant-farm. The consultant, the queen ant, overlooking and guiding her team to success. The junior doctors, nurses, physiotherapists, porters and pharmacists all scuttling around the hospital doing their jobs with competence and pride; without whom the farm would falter and fail. I too became part of this team and bit by bit my knowledge and experience began to grow. I could take blood. I could do examinations. I could give you the differentials of shortness of breath, chest pain, hearing loss.

I do not know if you have ever noticed, but when an ant is injured, the rest of them will flock around it and carry it back home. That to me was the crux of the hospital. The first time I saw this was when a man symptomatic of a myocardial infarct was rushed straight into the cath lab. The brilliance of each member on the team I shall never forget: the paramedic who drove him in within minutes, the doctor who did a quick history as they ran down the hall, the nurses who attached his ECG leads and reassured him constantly, the medical student (me) who made his wife a cup of tea and sat holding her hand, the patient, a 53-year-old, who had an emergency PCI and lived to attend his daughter's wedding. This to me is medicine and why I love it.

Even though I adored it, something within me was still niggling. Even though the excitement was there, sometimes the overwhelming busyness of hospital medicine kept the team so occupied in their own jobs that a tiny pang of loneliness and isolation crept in.

Anyway the time had come to move on to pastures new, so my clinical partner and I set sail on the 453 bus down to GP-land. Unfortunately it is the trend, but this poor profession is under continual and brutal stigmatisation. The newspapers thrive on every opportunity to report the uselessness of primary care and the apparently extortionate salaries earned. And it is the current attitude amongst us students that ‘half of us are going to settle and end up being GPs anyway'; perhaps demeaning the value of this profession. I had no expectations of this placement but at this point was convinced I was cut out for a life in hospital medicine.

As soon as we entered the GP practice, the warmth and the hospitality of the place hit us like the heat that immediately hits you when you get off the plane in a tropical country. We were greeted by our first names... (they knew our names, an absolute first!) and our coats and bags were placed in the cloakroom. Tea and jammie dodgers were prepared for our first visit.

Initially we observed the expertise of the GP with regards to his history-taking and examinations. His approach was relaxed and calm, very much unlike the stressed house officer constantly pushed for time. He had that kind of smooth fluency you find in experienced linguists; in the way he greeted the patient, elicited the patient's concerns, addressed their worries with compassion and more often than not offered a solution. It was truly inspiring. And you could see the change in the patient's demeanour: from an unsure caterpillar to a positive butterfly, strengthened by the GP's cocoon of support.

Then it was time for us to venture out on our own two feet and lead the histories and examinations single-handedly. At the back was our own personal cheerleader, our GP, eager to encourage us whilst highlighting where we could improve.

Each time a new patient came along, we took on the roles of detectives: we would have to listen to their story, piece the jigsaw puzzle together, work out the likely causes, explore further so as not to miss anything vital and simultaneously retain a good rapport. We had become Sherlock Holmes juggling a whole lot of balls!

The most frightening aspect - but the part that gave us the biggest buzz factor - was the fact we had no idea what the patient would present with. It could have been absolutely anything from a mild case of asthma to a threatening case of meningitis... (OK so the GP gave us the usual cases of heart failure, COPD, asthma... but still you never know!). And we were the patient's first port of call. If we made a mistake now, and dismissed their symptoms as being minor, that would be our fault. No-one else to fall back on but ourselves. My respect for these mortal souls grew week by week, as boy oh boy what a massive responsibility they have.

Once or twice we were taken on home visits, and it took me back to my youth, when news of a school-trip would make my week. So we went to see an elderly gentleman. After the initial formalities of asking George if the antibiotics he had been given last week worked, our doctor enquired about how the gentleman's golf game was coming along and if his son had an enjoyable honeymoon. Those rumours we had heard about the GP profession, of having continuity of care with patients and being a family doctor, could not be truer!

And later, when I reflected back on my time in clinics, that niggling feeling of loneliness and isolation at the GP surgery... well I never encountered it. Both myself and my clinical partner say, hand on heart, it was our favourite part of the year. We really felt like we belonged.

I have only completed one year of clinics but during this time have covered so many various fields and am absolutely brimming with new-found knowledge. I am a long-time off deciding what my final career choice will be.

But one thing is for sure: I am definitely keeping my return ticket to GP-land.

Melanie Ranaweera is a medical student at King's College, London.

Melanie Ranaweera

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