One of my favourite pastimes, and one which I would encourage everyone to do, is to try and encourage medical students and junior doctors to take up a career in general practice. Once I’ve run out of skydiving forms for them to watch me sign, I’m often challenged with misconceptions about general practice – that it’s boring, and that it somehow isn’t ‘real’ medicine. When this happens I throw back my head, snort, and ask them to listen carefully.
General practice is as real as medicine gets. We spend years at medical school learning the art of history and examination, only to start working in a hospital environment where a patient has probably already had blood tests and imaging before you meet them. Towards the end of my stint in hospital medicine I became bored with what felt like diagnosis-by-proxy. Shadows on an X-ray and a high CRP? Crack out the co-amoxiclav. What’s that boy? Jonny has ST-changes and a troponin in the numbers of the chief exec’s salary? Get some aspirin on board, STAT.
It is a privilege to be in a specialty which has such breadth of knowledge of medicine
I would argue that what is more real is sitting with Mr Smith and using only your five senses (admittedly taste not so much) to decide whether his chest pain is a bit of reflux, or unstable angina. All we have in that moment to make such a decision makes one of the arts of general practice. This is intellectually challenging, and hugely rewarding. I suspect more experienced GPs can actually be so good at this they forget the level of mental gymnastics that is actually going on. Generally, if a GP misses a septic joint the patient might suffer untold joint damage. If a hospital doctor misses it, it is more likely that a colleague or senior is going to pick it up. I don’t buy into the argument that general practice is in any way medically inferior.
We go to medical school and learn a bit about almost every branch of medicine. It seems sad to me that we are put straight into specialties as foundation doctors and then encouraged to specialise after just two years. During last night’s out of hours shift alone I was exposed to paediatrics, urology, respiratory medicine and psychiatry. I can’t imagine anything more soul-destroying than only dealing with bones, or lungs, or the loop of Henle for the vast majority of my career. It is a privilege to be in a specialty which has such breadth of knowledge of medicine. I have utmost respect for the in-depth knowledge and skills of specialist colleagues, but I’m afraid it isn’t for me.
Obviously there are drawbacks to being a GP. I miss the buzz and excitement of the hospital. But paperwork, increasing patient demand and the like are prevalent in every branch of medicine. So it is important to highlight what makes a career in general practice an attractive proposition.
Now get this patient on a statin, STAT!
Dr Danny Chapman is a locum GP in east and south Devon