Right, so here we are: the chosen few*, fresh from serving our time variously in foundation programmes, CT training,locum and trust grade posts; fresh from time out travelling to Australia, New Zealand, even Wales; having scaled these summits, having done more MCQ preparation than we did for Med School finals (because more rides on the GP entry exams than it ever did for finals – fail finals and you can retake them a few months down the line. Fail the GP entry exam and you can consign yourself to at least a year of doing jobs you’d rather not, regardless of how useful they might be. A whole year! No pressure…), having explored Ideas, Concerns and Expectations until we were frostbitten, having used more situational judgement than Prince Harry’s private aide, we emerged from first the computer based test and then the selection centre with victory in our hearts. We had made it. And, on day one at my new trust, alongside all of the other trainees, it felt like we were at base camp, able to look at back at what we’d achieved, and look forward to what was to come.
Some people fall into GP as a career, some choose it for the lifestyle advantages it offers over other specialties, or because they have grown disenchanted with the career path they originally set out upon. All of these reasons are fine, I think. GP is by far the biggest employer of doctors out there, so of course our reasons are going to be very different for choosing to do what we do. For me, though, it’s because I really enjoy the interaction with the patient outside of the hospital setting. It seems more normal, more natural, more interactive, and more involved. Plus, as an added bonus, they’ve almost always got their clothes on.
So it was with this slightly heady feeling I sat through the trust induction, which, although in a different trust, was as familiar to me as an old pair of shoes. Not ones you would ever wear, mind you, but comfortable nonetheless. I think it was Jane Austen who said: ‘It is a truth universally acknowledged that a trust induction will in no way prepare you for working in that same trust, and you’ll probably lose that bit of paper with your library log-on details before the end of the day. The most you can hope for is a free pen.’
New log on, and password that doesn’t work? Check. No training into how to actually use the four different programmes used for bloods, imaging, clerking and discharging? Check. No paperwork received by Occupational Health? Check. Bleep that will only display three out of four numbers? Check. No parking permit? Check. Enormous bruise from the Occupational Health Nurse making a hash of taking your bloods? Check.
As I say, comfortable. Familiar. Reassuring. This was my first induction.
My second induction came when I was on call for the first time. At least I knew where I was supposed to be, and when. Shortly thereafter, the map ran out and I was drifting into uncharted territory. Suffice it to say, the instructions given to us on our first induction did not match up to the ideas, concerns and expectations of the rest of the hospital. Fortunately, all of the doctors working this particular shift were new to the trust, and so we could all reassure each other that no, we didn’t have the foggiest who was meant to be doing what, either. Or where. Or even how to do it, for that matter. Suddenly those incorrect log-on details jumped category from ‘slightly amusing if a bit frustrating’ to ‘oh, flipping heck**’. But out of chaos comes order, and our mutual ignorance bound us all together into some sort of entity that could perhaps survive the night. And so we continued on, the blind leading the blind, who were happy to have the company.
Over the course of that first on-call I somehow managed to stumble into reviewing a man admitted earlier that day. His blood results had come back with an Hb of 7, with nothing in his clerking to suggest that might be expected. He wasn’t communicating fully, was wired up to the cardiac monitor, had a catheter in place and definitely did not have his clothes on. Not my favourite sort of patient encounter. But again, we got through the necessary assessment and management with some help from the nurses and things were ok in the end.
This shortfall in knowledge between my two inductions has been somewhat of an eye opener. Not in the sense of showing me how inadequate my first induction was, that much is a given. But – and I am the first to admit this sounds cringe-worthy – the things that actually matter, that actually mean you can function and do your job vaguely competently, are the ability to work well with your colleagues, and to communicate with your patients. Which is probably why the GP recruitment programme doesn’t place too much emphasis on your ability to log on to a computer, because it’s the other things that are going to help you out.
And if you’re really, really nice to work with, then maybe, just maybe, someone will lend you their log-on.
* Alright, quite a few. A lot, even. Probably loads.
** Alternative phrases expressing frustration are available.
Dr Tim Cassford is a GPST1 in Chichester