Prior to applying for GPST training, I was training to become an acute medical physician. Having done numerous medical and acute care jobs, I thought I would be at a distinct advantage compared to new trainees whom had only done foundation training.
But what I did not expect was that my considerable years as a hospital doctor actually put me at a disadvantage compared to new doctors, especially when it came to consultation skills. My consultations were too doctor-centred and paternalistic rather than the preferable patient-centred approach of primary care.
At the start of this six-month job, I found it quite difficult to allow the patient in front of me to just tell me their Ideas Concerns and Expectations (ICE) and for me not to say something like:
‘Mr Jones, I think X is wrong with you and you must take medication Y to feel better.’
Asking a patient how a particular complaint was affecting their mood or affecting their work was something I had not asked in a long time –actually, not since medical school.
Hospital acute work had ‘trained’ me to do a quick and focussed clerking and to remove any extraneous material that may unnecessarily lengthen a consultation – or, heaven forbid, allow me to get to know the patient.
Many GPST trainees will have learnt about the different consultation models in their teaching sessions, with the Neighbour model (1987) being the easiest model to apply to their own consultations. Many hospital doctors are probably still using the same clerking template they used at medical school, with no emphasis about how a condition really affects an individual. Being expected to ask about ICE of a patient would probably get the response, ‘GPs love all that tree-hugging stuff, don’t they?!’
Now as I approach the final few weeks of my ST2 post, I feel I have made some headway in my consultations. I have gradually moved away from my ‘old ways’ to the patient-centred approach by videoing consultations and being critiqued afterwards, which can be daunting. I often think when watching myself, ‘Sheesh, do I really sound that Essex?...’
Although I have much to learn still, I look forward to developing my new skills in my ST3 year.
Dr Avradeep Chakrabarti is a GST2 from Swindon
