How to get through your first year in general practice
Five GPs give their top tips for approaching the first 12 months with confidence
Dr Kamal Sidhu, GP trainer in Blackhall, County Durham
Dr Hamed Khan, GP in Surrey and board member of the RCGP South London Faculty, medical school lecturer
Dr Richard Ma, GP in Islington, north London
Dr Phil Williams, GP in Lincoln and the RCGP’s national lead for First5
Dr Farah Jameel, GP in Surrey and Sussex
1 Don’t try to solve everything in 10 minutes
A 10-minute consultation offers a limited amount of time to build rapport, take a history, do an examination, look through a patient’s records, arrive at a differential diagnosis and initiate investigations or institute treatment - all while showing empathy and demonstrating gold-standard communication skills - so it is imperative that you use your time wisely.
Find out how many problems your patient wants to discuss, and then decide together which ones you will deal with that day. Accept that you will run late from time to time. Thanking patients for their patience if they’ve been waiting a long time, or making a simple apologetic acknowledgment can make a big difference.
Clear communication is particularly important for paperwork: prescriptions, patients’ notes and blood tests. Ensure that you flag up concerns if necessary. For example, if you’ve noted when processing a repeat prescription request that a patient hasn’t had the relevant blood tests done, flag it up in the notes and on the prescription to alert the patient and the next clinician they see.
This is especially important if you are a locum.
2 Learn from ‘heartsink’ patients
Heartsinks - complex patients and people with medically unexplained symptoms - may seem challenging and make you nervous. But some patients just want to talk and have a doctor who will listen.
Establishing a mutually trusting relationship can do more than looking for ‘incidentalomas’. Some patients may be more likely to accept your reasons for avoiding unnecessary investigations and treatments when they have developed trust in you.
3 ‘Troubleshoot’ the little problems
While it is good to deal with the problems that the patient feels are most important, it is imperative that you have time to exercise your clinical acumen and identify the problems that are clinically urgent such as breast lumps, moles that have changed recently and acute chest pain. Try to troubleshoot problems that won’t take a long time to deal with - for example repeat prescriptions for emollients or routine simple medication reviews.
4 Reassure patients who want to see a different GP
Encountering patients who say they preferred their previous GP is a common scenario for newly qualified doctors and it is only natural that patients wish to see someone who knows them and their families. But remember we all have our unique qualities that attract different sets of patients.
So, the first step is to appreciate and acknowledge that you may not be the patient’s preferred GP. You may also need to focus on involving them more in the consultation.
If they feel that you have listened to them, they will appreciate this and you will develop your own set of loyal patients over time.
5 Ask GP colleagues for a second opinion
General practice is more about breadth than depth and all GPs will have an area of medicine in which they are less confident that in other areas. Don’t be afraid to ask your GP colleagues for a second opinion. They won’t mind you knocking on their door, instant messaging them (a facility available on almost all practice computer systems these days), or discussing patients over coffee. Partners usually have a huge amount of insight into patients and their families. And senior GPs will feel reassured to see newly qualified GPs ask for help, as it demonstrates an awareness of their limitations, and shows they are not over-confident.
If nothing else, it will make other GPs feel valued, and empower them to do the same when they have uncertainties.
6 Apologise when necessary
It is inevitable that you will come across complaints in your career. Don’t let it work you up too much. Speak to your colleagues - they can provide an invaluable support system and are likely to have come across similar issues in their careers.
Depending on the nature of the complaint, consider seeking formal advice from your medical defence organisation. The majority of complaints stem from communication errors. It is important to think through things pragmatically and systematically, being clear not to let emotions spill into any formal response. At the end of the day, we may mean well but may not communicate it well, and this can be directly related to how the patient perceives your advice. The same words can mean different things to different people. An apology costs little and can prevent complaints from escalating further.
7 Talk to all team members and take treats in every now and again
It is in the interest of every member of practice staff to work well in a team, and getting on well with your colleagues will make your working life enjoyable. Taking the initiative to talk to reception staff, bringing in treats from time to time and saying ‘thank you’ can go a long way to reducing any barriers and anxieties.
We tend to forget that the reception staff face many kinds of challenges, especially when juggling patient demand and the appointments available. If you’re friendly, proactive and helpful, you’re likely to be remembered by admin as the nice, smiling, patient doctor who always made time for the staff.
8 Take a day off
The 11-hour working day has become the norm and the working day is more intense than ever before. This is particularly true when you are in your first year of working - learning with no official supervision for the first time is always daunting.
Taking a day off to do something different that is paid or unpaid can help to make you feel refreshed on your return to work. It may leave you with a more modest income but could mean you enjoy your job more.
It may also help to take a day off to reflect and spend time thinking about how you want your career to progress, and where you see yourself in five or 10 years.
9 Don’t set up remote access to your computer system
It’s important to maintain your work-life balance if you want to avoid burnout in your first year, so avoid the temptation offered by remote access to your practice computer system. It is tempting to do your paperwork and check blood results at home, but it’s not a good idea in the long run. You also don’t need to go to every meeting or course that arrives in your inbox, or take up every extra role that is offered. Instead, just set aside a bit of time each week for learning.
10 Keep your paperwork available to hand
The paperwork you need includes: performers list registration; defence organisation phone number; certificate of completion of training; hepatitis B certificate; Criminal Records Bureau/Disclosure and Barring Service checks; and terms and conditions of your employment or chambers membership. This is especially important when doing locum work. You could keep these papers on your email system or in a folder on your computer or carry hard copies with you. Or you can keep a folder on your phone that can be emailed out on demand. You do get asked for these documents from time to time and it’s simpler if you keep them easily accessible.
11 Familiarise yourself with the local dialect
This is an essential step to take if you’ve moved to a new area, whether it’s rural or urban. There are many resources available for deciphering local dialect (for example, there is a booklet on Geordie terms). You may consider compiling your own list with the help of staff. Pubs are also a good place to pick up the vernacular.
12 Be ready for anything
Remember, your training practice is likely to have been operating at a fairly high standard. Once you qualify and embark on your own journey of self-discovery as a clinician, you are likely to find that there are many different types of practices, with differing policies, systems and styles of working.
Of course, the large majority of the tricks of the trade are learned by doing the job. Arrange to be given a brief overview of how to arrange follow-up and investigations, and how to refer or admit patients in each practice you encounter.
Don’t forget, you are an autonomous practitioner with authority. If you find that you don’t like or agree with something, you can challenge it and change it.
13 Join a peer group
A peer group will help to maintain your confidence and is also good for sharing good and not-so-good experiences with regard to clinical work and employment issues. You can join a sessional group if you are a sessional GP or a local First5 CPD group that can offer the chance to keep up to date with the latest guidelines as well as get those vital credits for revalidation. You can find your nearest group by getting in touch with your local RCGP faculty.
Mixing work meetings with some form of social interaction can help share stress and anxieties as well as foster long-term relationships. Remember that if the meetings are minuted, they can also form a part of your appraisal and contribute towards your CPD.
You could also set up your own group or join online support groups, such as Tiko’s GP Group on Facebook.
14 Prepare well for locum work
As a locum, it is important to get an accountant and contact HM Revenue and Customs straight away. Another of your first steps should be to email all the practices in your area to introduce yourself. Come up with a standard list of questions when discussing work with new practices. Useful questions to ask a new practice could cover the numbers of hours to work, type of shift work, which IT system it uses and whether you will be the only doctor there.
It is also worth clarifying what you are being paid for. Is it just for seeing patients? What about the paperwork? What is the policy if a patient arrives late? Choose your practice carefully; negotiate and agree what you are and are not willing to offer.
Once you get work it really helps to have your own door sign and stamp, which looks professional and also saves you having to write out your name and GMC number repeatedly.