The end of an era has arrived: I’ve nodded sympathetically through my CSA, clicked mindlessly through my online safeguarding modules, and scraped the barrel to come up with ten learning logs about genetics in primary care. As of last week, I am finally a qualified GP. Cynical long-term readers of my blog might wryly reflect that it is time for me to stop pontificating about general practice and actually start doing it.
My imminent entry into the Real World has prompted some reflection. My GP training has been eventful. As a relatively inexperienced doctor – I came straight into GP training following my foundation years – it has been a steep learning curve. In a specialty where anything can walk through the door every ten minutes, how can three years of training ever be enough? I have come to realise that, as the Royal Australian College of General Practitioners says, ‘the good GP never stops learning’.
Whatever you think of the AKT and the CSA, cramming for them ensured that I had a good overview of the science of modern primary care, and eighteen months in GP surgeries taught me the art of how and when to apply that knowledge. Probably the most important skill that GP training has cultivated within me is the ability to manage uncertainty safely and with confidence.
However, there’s much more to general practice than seeing patients, and even an encyclopaedic knowledge of NICE guidelines and a stratospheric PSQ score will only get a newly-qualified GP so far. (For the avoidance of doubt, I claim to have neither.) Our specialty is unique because of the independent contractor model. Regardless of your own employment status, if you are working in general practice, you need to be able to recognise inappropriate or unfunded work. For that reason, I believe that the single most useful thing I have done during my training was to immerse myself in the world of GP social media, and I’d urge anyone reading – trainee or fully-qualified – to do the same.
Although there have been ups and downs, and I have my fair share of detractors on social media, the online GP world has been the making of me.
My first introduction to GP Facebook came when, as an ST1, I joined Tiko’s GP Group.
Tiko’s is a fairly gentle environment – a forum, established by Dr Kartik Modha in 2011, in which GPs can discuss suitably anonymised clinical cases and learn from each other. Only last week, I learnt that, apparently, urine dipsticks are more accurate at detecting blood than sending a sample for midstream specimen of urine (MSU). I hadn’t realised before that the red cell count on an MSU report is often inaccurate because of haemolysis. That will change my practice, as has so much of the information I’ve learnt on Tiko’s. The group isn’t perfect – advice from peers should be interpreted with caution – but overall I’ve gained a lot from the group.
My political awakening is attributable to two other Facebook groups: GP Survival and Resilient GP. Resilient GP focuses on helping individual GPs to practice sustainably, while GP Survival is a grassroots pressure group considering wider medico-political issues. These helped me learn the difference between contractual and non-contractual work, and that, as a GP, I might be asked by patients, hospitals, and parachute jump organisers to do things that were not my job, and that it was perfectly reasonable to refuse such requests, or to do them for a fee. They taught me that, if GPs consume resources doing unnecessary or non-contractual work, they will have less capacity to deliver essential services. Most importantly of all, that as a GP my time will be valuable, and I am entitled to treat it as such.
These Facebook groups are are all ‘closed’ groups, so their content can only be seen by members. Rightly or wrongly, people tend to change the way they speak when they know they are being watched, and that’s where Twitter comes in. Although you can create a ‘friends-only’ account, most use Twitter publicly and, if you post something that strikes a chord with your readers, it can reach a wide audience quickly. Most high-profile figures have a Twitter presence, and the flat hierarchy of the site means that it’s surprisingly easy to engage with them. Twitter allowed me to challenge Health Education England about their infamous ‘Nothing General’ videos, and, at the other end of the spectrum, allowed me to gossip about fashion with College officers before the last RCGP Annual Conference.
No online platform would be complete without trolls, and GP social media is sadly no exception. Dogpiles – numerous, similar, challenging replies which can have the appearance of coordinated hostility – are common, and some doctors go beyond plain speaking into the territory of being frankly offensive. Furthermore, what one person perceives as bullying, another would see as healthy debate, and the best advice I can give is to roll up your sleeves, get stuck in, and try not to take it personally if others disagree with you, even if they express themselves in a way that feels unconstructive or overly personal.
If you enjoy your initial foray into GP social media, and want to get more involved, one way is to assist with the daily mechanics of running a forum. I currently moderate two Facebook groups: GP Contract Forum, a public group for discussion of the GP contract and its ramifications, and OpenRCGP which aims to help College members have predominantly non-clinical discussions without having to spend every thread justifying why they remain members of the College, as can happen elsewhere.
In September I will be starting a five-session GP partnership. As this month’s Pulse GP trainee survey shows, few young doctors embrace partnership straight out of training. I doubt I’d have felt ready for it without the education I’ve had on Facebook and Twitter. For better or for worse, social media has changed my life: get stuck in and it might change yours too.