One of the first things I remember noticing as a new GP registrar was the isolation. After working as part of a team for two or more years in the hospital system, suddenly you are in a room by yourself. Managing your own patients. All by yourself. If you have a nice, approachable supervisor then good advice is a phone call or door-knock away, but you are the one who decides when to call, when to knock.
It’s like you’re on an island sometimes, working as a GP. The patients one by one maroon themselves on your island and you try to help them get back to shore. The other practice doctors are like ships passing in the night. Sometimes you blink SOS signals to each other. But they have their own islands to attend to.
The responsibility skyrockets. After working in a hospital where the ultimate responsibility rested with your consultant, as a first term GP registrar, you see patients who are ‘yours’. If they sink or swim, you are responsible. All the enormous problems they carry in with them are yours for the sorting. You are heavy with this weight and can rarely put it down, if you are anything like Dr. De Loony.
There is so much to know. So much that is barely taught in medical school and that you aren’t expected to know in hospital. The whole of dermatology, for instance. Musculoskeletal medicine, the non-emergency kind. Counselling. Managing depression and anxiety disorders. Nutrition. Advanced paediatric medicine.
You are never finished learning. In any branch of medicine it is the same, but it’s a wider array of subjects to learn about in general practice, that are continually evolving. You not only need to read the studies, but also need to assess the quality of the evidence, to determine how seriously to take the findings.
The RACGP exams are no walk in the park. Dr. De Loony considers she was lucky to pass and credits this achievement entirely to her study group. She was not entirely useless in study group, being voted the most likely to ‘volunteer to fetch beers from the fridge’.
If you are going to sit for the college exams, having a small group of peers (ideally people you like) that you study with is my top tip for success. Resources and knowledge are pooled. You cover more ground and keep each other on track. ‘Have a study group’ and ‘Go to Work’ are the two most passed on exam tips I have heard.
For those non-medicos and medicos-who-don’t-know-any-better who think being a GP is easy and you just have to type referrals, print scripts and sick certificates, trust me. It’s not an easy job. Well, it’s not an easy job to do WELL. And if you’re not doing it well, or suspect you’re not, it’s a scary job to be doing.
A GP, slaving away in the trenches, can encounter any problem in any patient. Newborns, children, adolescents, young adults, the middle aged, the elderly… No patient is ineligible for GP attention. They can walk in with anything and they bring with them their own context, history and emotional baggage. The good doctor engages with them and sifts through the history, performs a laying on of hands, thinks hard while tapping out notes (leading some patients to think we are feeding info to the computer that then spits out ‘an answer’).
There is the world of billing to contend with. It takes practice to charge people for your time, especially when there is a strong altruistic element to your work. Bulk-billing means you take a pay cut, but you may do it too readily as you are kind. Your patients ask you to do it, perhaps not realising your take home pay can be drastically reduced as a result of bulk-billing. You end up not being paid enough to do what you do, to work so hard. Resentment brews.
A GP doesn’t sort out one problem and then send their patient back… to their GP. The patient comes back again and again. You are never finished with them. They are never finished having issues. They are never fixed.
It’s not easy.
As a junior registrar I would find myself fretting over clinical conundrums and finally thinking ‘what this person needs is a really good GP.’ Then I realise ‘Oh. That’s supposed to be me.’
Image courtesy of freedigitalphotos.net.