Golden rules for registrars

Medico-legal adviser Dr Jim Rodger offers some expert advice on how to excel as a GP registrar.

Do remember that you've joined the best and most rewarding profession in the world, and celebrate that you are about to embark on a career that offers fascinating insights into people and the lives they lead.

Try to develop a personal working culture that ensures everything you do is to the patient's advantage

Don't, however, forget that you are now part of a community. GPs are visible, highly respected and usually living among their patients. That means being careful of your behaviour at all times, whether at work or not. You are GMC-registered 24/7, 365 days a year. Social activities, if excessive - that includes drink or drugs - can put your GMC registration at risk.

Do remember that you do not know everything about general practice or your patients and their lives. Recognise that you will need help from books, colleagues and websites. General practice is very varied. You may see 20 or 30 patients a day, each for 10 minutes, and each with a different ailment. If necessary, ask for help and advice.

Do feel free to explain to patients that you are new and inexperienced.

Don't tell patients you know little about general practice.

Do write in the notes. Write as much as you can or want to. In later years you will learn to cut this to a minimum, but in the early years it helps you to learn and others to monitor your work.

Some computerised records may limit free text entries but add as much as you can.

Do sign and date all entries.

Don't alter records, for whatever reason, without making it clear when and why you have done so. It is permissible to add to records but it must always be clear why.

Don't embark on a treatment plan, procedure or referral if you are in any doubt.

Do remember your GP trainer is there to act as a teacher but also a mentor. You must always feel able to ask for advice and help. In practice, a range of other professionals - doctors, nurses and receptionists - are also there for advice should you need it.

The essence of general practice is the wealth of knowledge that a GP has about an individual patient over years, rather than any specialised clinical skill. Registrars need to be able to tap into that knowledge. Dr Cameron in Dr Finlay's Casebook would be the archetype.

Dr Finlay's Casebook? Ask the oldest GP in your new practice and you may see them mist up.

Don't be dismayed if a patient or a relative makes a complaint about you. We live in a society ready to complain. Complaints are more frequent and therefore to be expected. Try to make yourself receptive, in a productive and professional way, to criticism. Seek help and advice from your trainer before responding to any complaint.

Do respect the experience and skills of your fellow professionals. Primary care in the UK is team-based. Everyone relies on everyone else, and their particular skills, to deliver high quality care. You may not always see eye to eye but you must not allow that to interfere or undermine the clinical care of the patients. Effective care suffers if professionals indulge in personal squabbles or disputes. To do so is wholly unprofessional.

Don't forget that other professionals, such as nurses and health visitors, have different skills and knowledge. Don't underestimate the help they can give in your training years.

Do use your training years wisely. Engage early with the RCGP. Knuckle down to study and prepare yourself for sitting the necessary postgraduate examinations.

Do remember that general practice is about learning and not simply the pursuit of a certificate or diploma. You need them for your future but they shouldn't dominate your training.

Do try to develop a personal working culture that ensures that everything you do with regard to patients is to their advantage.

Don't forget to join - from day one - a medical defence organisation. Keep your membership up to date. You may need it one day.

And finally, do enjoy your general practice training. It is the perfect opportunity to grow into and enjoy the best 'specialty' in medical practice.

  • Dr Rodger is a medico-legal adviser and head of professional services at the Medical and Dental Defence Union of Scotland.

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