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The inspiring and stimulating work of rural general practice



‘All you need now is for someone to give birth!’

‘50% of you will end up as GPs’ is a common threat stated at the start of medical school teaching

And at that moment, we highlighted to Brendan – one of our elective students – that there was indeed someone in labour upstairs in our maternity suite.

Like many of our students, Brendan came to rural practice eager to see whether there was interesting work in island practice, or whether the stories of tumbleweed and Battenberg cake were true. Having come from a placement in Scotland’s busiest A&E unit, there was a real potential for adrenaline withdrawal if high-paced medicine wasn’t to be found. So it was with some relief, perhaps, and pleasant surprise that there was plenty to see in our microcosm of rural community hospital work – an exemplar of generalist medicine that keeps many of us rural GPs enthralled and stimulated.

He had just seen the effective analgesia that intranasal diamorphine can bring to a child with a painful fracture. Earlier, he witnessed a case of acute coronary syndrome, with near patient testing and pathway-guided care leading to referral directly to tertiary care colleagues for angioplasty. The rapid and effective transfer to high-level intervention wasn’t lost on Brendan. We also saw a patient with a sore throat – here on holiday between chemotherapy cycles, leading to a tricky judgement situation given that we don’t have easy access to a differential full blood count. The power of the patient’s story, combined with accurate clinical examination become so easy to appreciate when number-generating tests are not so easily to hand. He had had an opportunity to see the value of an ABCDE assessment of a cyclist who’d come off his bike at lunchtime, and escaped with only ‘gravel rash’ and an intact c-spine (and learning how to clear one was a useful experience).  

And so now. Just when he thought the spectrum of community hospital medicine couldn’t get much wider, we reassured him that it could, with our two midwives upstairs overseeing a green-pathway delivery, but knowing that a GP oncall could be around to assist if things became more difficult – even if that simply meant assisting with a rapid transfer off the island.

This is rural general practice, a specialism that is accessible to many if they choose, and a line of work that has the capacity to inspire and stimulate. Students only get a true understanding of this when they get out and see it for themselves. It’s an experience which certainly made Brendan reflect on some of the stereotypes of GP that he had previously been informed of.  

’50% of you will end up as GPs’ is a common threat stated at the start of medical school teaching. More and more of our students are realising that this isn’t necessarily a threat, but in fact a reminder of the scope of medicine that an MBChB provides access to, and that’s not a bad thing.

Dr David Hogg is a GP on the Isle of Arran, Scotland. You can follow him on Twitter @davidrhogg