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A day in the life of a GP...

The following is an extract from "So you want to be a General Practitioner" by Dr David Haslam which is reproduced with permission from the Royal College of General Practitioners, January 2003. Copies of "So you want to be a General Practitioner" are available from the RCGP, 14 Princes Gate, Hyde Park, London SW7 1PU.

You ask for a typical day. That's difficult. Every day can be different, as I have no idea what problems will present themselves. But I can tell you about yesterday.

Morning surgery consisted of a real mixture of patients. There were cases of high blood pressure, bronchitis, depression, sore throat, unhappiness and thyroid disease - and that was just the first half dozen. A student burst into tears and told me about her anorexia nervosa. A man with angina needed teaching about the tablets the hospital specialist had prescribed for him. A businessman asked me about cholesterol testing and a bass guitarist needed help with a repetitive strain injury of his wrist.

After surgery I had a cup of coffee as I dealt with incoming letters, repeat prescriptions, and made a couple of phone calls. My secretary brought my dictated letters to be signed, one of nurses asked my advice about a leg ulcer and I looked at a computer printout of the latest results of some research I am doing on how well we care for a diabetic patients.

Visits came next. One was to a lady who is dying at home of cancer. I go almost every day as she hasn't long to live. The nursing team also call regularly, and whilst the situation is desperately sad, I feel pleased to be able to offer a high quality service to this family. I saw a child with a bad cough whose mother is handicapped and can't get to the surgery, a man with backache and a lady whose chronic bronchitis is playing up.

At lunch we had an administrative meeting to discuss ways we can organise some of the practice's screening clinics. The other doctors, a couple of nurses, the practice manager and one of the receptionists attended. People often forget that general practitioners have to be administrators too. It can be frustrating, but at least we have a real input into the way we run our lives.

The afternoon was taken up with teaching my GP Registrar about coping with the severely mentally ill, running a cryotherapy clinic where we treat warts and other skin problems by freezing with liquid nitrogen, and dictating more letters.

Then it was evening surgery, with as varied a case load as I saw this morning. It was average busy day and I was glad enough to put my feet up once at home.

I wasn't on call tonight. When I am on call, I do shifts at our local GPs out-of-hours co-operative where almost all the local GPs have jointed together to share out-of-hours duties. The shift system means that I can at least be guaranteed some sleep every night.

The main parts of my work are prevention (helping people to stay health or improve their health), clinical diagnosis and treatment, educational (not only keeping myself up to date, but helping to train the practice team) and administration. As a GP I see people from the whole community and I am the first contact patients have with the NHS. If I need special tests performing, or guidance with a complex diagnosis, I can always refer patients to a hospital consultant.

Thinking about it, I did all those tasks today. Maybe it was a typical day after all.

Dr Mohan Kumar is a GP Principal, GP Trainer and Course Organiser in the North Western Deanery.

We asked him...

What made you decide to go into General Practice?

When I applied and was selected to go into the Vocational Training scheme for General Practice 13 years ago, the usual comments from my friends who had chosen ‘cooler’ career paths like Surgery and other hospital consultant posts were either derogatory or a patronising ‘ Why GP?’, as if it was some kind of ‘giving up’. Although things have changed a lot and Primary care has really come on strong as a career options, some of the misconceptions of what being a GP is all about still remain.

I actively chose General Practice as a career after being in a rotation for surgery and also working in A&E because I missed the continuous patient contact and the ability to follow up at my own choice. I came into medicine and liked the variety and the act of diagnosing to me was like detective work. Unfortunately the trend in hospital medicine is to specialise to the nth degree until you’re the top man/woman in the UK for the fourth lash of the left eyelid. While we certainly need our specialists, my heart lies firmly in the daily mysteries of General practice where things don’t come wrapped in neat packages; where we place value of human narratives; where the range can be as broad or as narrow as you want it to be and where the emphasis is firmly on long term relationships with generations of families who value and respect us tremendously.

The training to be a GP is now standardised as a three year program that you can enter after completing the 2 year Foundation programme. VTS schemes comprise of various rotations through relevant specialities in the hospital for first two years followed by a one year GP Registrar post spent in an approved training practice. Normally it takes 5 years to qualify as a GP from graduation. (FY1, FY2 + VTS)

What are your main duties as a GP? Can you describe a typical day?

Although Primary care is vast, the mainstay of GP’s job is patient consultation, this has interestingly is measure for measure the cheapest and yet the most effective aspect of the NHS compared any hospital episode.

A typical day comprises of morning and afternoon surgeries, with a couple of hours of paperwork/ telephone triage/ home visits/ follow up investigations etc. As we are often the first port of call for patients, a lot of time is spent chasing after coherent communication from the secondary care and increasingly our tendency is to refer less and less to the hospital and do more in the community – this generates more work.

Most of my hospital colleagues think I spent the long hours in between consultations playing golf or driving around in my BMW having long liquid lunches a la peak practice. If only!

I gained my post grad degree (MRCGP) in 2005 and got interested in teaching and am currently both a practising GP and a GP trainer and Course organiser for GP Registrars. I take on a GP registrar and mentor /teach/support them in our practice for a year. I love the one to one nature of GP training where you get a trainer all for yourself as a learner, which is something unique and special unlike other specialities.

As someone who has spent some time in a surgical rotation I continue to retain some of those skills by running twice monthly minor surgery sessions where I remove cysts and skin lesions.

Due to the endless possibilities within primary care and the DOH initiative to move most services into the community, you will often find GPs like me juggling a portfolio of specialities like teaching, management work, clinical sessions that may be in medical or surgical specialities and working in diagnostics like Endoscopy Clinics.

What are the best and worst aspects of your job?

There are so many best bits: the shy child who brings in a picture he/she has drawn for you, the grateful families; the sheer joy of unravelling symptoms and diagnosing the underlying problem ( Sir Arthur Conan Doyle was a GP !) ; The freedom and flexibility of being your own boss and the warmth of the supporting practice team ; The variety and unpredictability… I could go on...

The worst bit I suppose is the sheer uncertainty and the weight of responsibility one faces and the constant undermining of patient confidence by the tabloid media in NHS and General practice. When was the last time a headline in the tabloids read ’GP saves a life’ or ‘ GP helps depressed patient to recover’ despite this being a regular occurrence.

I feel General Practice has done itself no favours by not upholding all the good things and generally getting on with the good work without promoting all the tremendous changes in primary care. But this certainly is changing.

Perhaps even the term ‘General Practitioner‘ is too tweedy and bland. I am a ‘Primary Care Consultant’ and proud to be one!

What advice would you give to others wishing to pursue a career in General Practice?

Gosh! I usually tell students to follow their own instincts and generally be wary of people trying to advice you … but if pushed I can say General Practice is a vocation and you need to give a part of yourself to the Job. The GP is itself a therapeutic entity, a ‘drug’ if you wish. It is certainly fascinating, rewarding and the last frontier of ‘true’ art of healing. You need a breadth of knowledge but oodles of compassion. It gives a better work life balance but it is by no means an ‘easy’ option. It’s a tough job and you well be wishing that you were the ‘top specialist in the land for the left great toe’ at times!



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