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Variety and the essence of general practice

Last week, a relative asked me why I’d chosen general practice.

I explained that a major pull was the rich spice of variety: a medical mélange dropped at our doorsteps, raw and unedited.

No two surgeries are ever the same. One will produce a flurry of referrals, another a monotony of minor illness. For every URTI, there’s a weight loss or bleed. We see a healthy load of emergency medicine too: in the last few weeks, I’ve admitted a sickle cell crisis and an evolving STEMI, fresh off the street and dropped at my doorstep.

As a cavalier rugby-playing medic, I’d always seemed destined for the world of surgery. Yet there seemed to me something inherently tedious about hospital specialties. Broadly the same stuff, most of the time, for years.

I remember reading Atal Gawande’s Complications,reflecting on his difficulties as a trainee surgeon. The drive and motivation came not from variety, but from the quest for and eventual achievement of perfection.

The magic of general practice is the elusiveness of perfection: we can never be excellent at everything, all of the time. Peace of mind comes from acknowledging the fact.

Matthew Parris, the Times columnist and former Tory MP was pretty unequivocal in his analysis of our profession last year. He said we were little more than glorified receptionists, an unnecessary obstacle to specialty medical care. He made the point too that, in a world of rapid medical advancement, we couldn’t possibly keep up. Yet in recent years, we’ve done just that. Our colleagues in the 1970s sent hypertensives to the hospital. General surgical lists were comprised of skin tags and seborrhoeic keratoses. No GP would dare dice with a warfarin prescription.

A few years ago, fresh-faced and keen off the VTS boat, I met a barrister in a London pub. The inevitable question came: ‘And what do you do?’

‘I’m a GP,’ I responded proudly.

‘GPs…’ He paused. ‘…Triage par excellence.’

There’s a certain dissonance at work here. The very thing that draws us to general practice is the same that attracts pithy patronage from smug city types. They won’t ever understand, of course, and it doesn’t matter that they will not. They will write their columns, and trade remarks, while we go about our business. We’ll take on commissioning and man up to the imposed QOF changes. We will take on DESs and LESs just to stay afloat.

But aside from the current onslaught, let us continue to delight in the variety of our day job. One minute a verruca, the next a diabetic review, then the golden moment when someone we’ve never met sits down, looks us in the eye and pauses, before he proceeds to tell us, quite unsolicited, something he’s not even told his wife.

Tom Gillham is a GP in Hertfordshire and Specialty Doctor in A&E. You can follow him @tjgillham.