I have started a new job recently, and now juggle three in total. I work at my local hospice, as a GP in the A&E department of our local hospital, and on its wards as a member of the palliative care team. In the various spheres that I move in, I often come across junior doctors (invariably a joy – so fresh, bright, enthusiastic!) and am frequently surprised by how many seem to want to train in general practice.
For the good of our broken country, and my own ageing self, I am delighted – but, frankly, taken aback. Then I remember why I went into general practice myself. I trained in it for two reasons: because I knew I would love the relationship I would develop with my patients (I did), and because of the amazing flexibility it would give me (it did).
I took full advantage of the latter – I have shuttled back and forth between Australia, New Zealand and the UK, worked in India, combined my job with my family, my interest in palliative care, my writing. But, 20 years on, the frankly risible 10-minute consultation has driven me out, and I don’t do surgery-based work any longer. That’s a decision I don’t regret for a moment – I still see patients every day, and my work remains rewarding and fulfilling. What I have lost is the long-term continuity of care that is (or rather, used to be) the bedrock of general practice – both a sadness (manageable) and a relief (huge).
I have pondered this at some length, but remain firm in my conclusion – I am happier now in my work than ever before, and managing to keep a small foothold in general practice, albeit in its urgent care form, because I am no longer anyone’s GP. It is an absolute liberation to have cast off that particular mantle. No longer do I pore over my results inbox late into the night on my laptop, anxiously weighing up the benefits versus the burdens of investigating mild anaemias and small variations in kidney function, while wondering whether there is anybody left in this country with a normal set of LFTs.
I no longer have the emotional capacity to add hundreds of patients to my load
I can consign to memory the nausea that used to wash over me upon seeing a particular recurring name on my screen – over the course of my career I have had a small number of complex patients with personality issues who have cast a very large shadow over my working life. The younger and more idealistic version of my present self was particularly good at attracting these people, and completely lacking in the skills necessary to manage them. I heartily wish that I had had more training in this area, in retrospect.
However, I remind myself that, for the most part, I was deeply fond of my patients, and they of me. And that the traditional model of general practice, fast disappearing, had a lot to recommend it (to the patient, at least).
But as things stand, I no longer have the emotional capacity to add hundreds of patients to my load, in terms of ‘people to whom I have an ongoing duty of care’. I am still adjusting to the responsibilities that have come with widowhood and single parenthood. GP work – as we all know – is incredibly emotionally demanding. I am lucky to have found alternative ways of making a medical living, for now.
It is possible that I will be able to slot into the new primary care landscape in due course, after its brutal current makeover, if I recognise anything about it; for now, I am keeping my head down and working away in my parallel medical universe, thankful that my GP surgery days are, if not over forever, at least mercifully on hold.
Dr Kate Harding is a locum GP and hospice doctor