A GP portfolio career in expedition medicine

Dr Daniel Grace explains how working as a portfolio GP has enabled him to develop a special interest in expedition and wilderness medicine – and offers advice to other GPs keen to work in this area.

Dr Daniel Grace while working in the South Pacific

Do you want to switch your GP surgery for a hammock on a tropical island – or perhaps help young people discover themselves in the wilderness of the Canadian Yukon? Working as a portfolio GP has allowed me to do just this.

I first developed an interest in expedition and event medicine at the end of my GP registrar year, when investigating what I should do next. Instead of spending my study budget on a revision course, I chose to attend an expedition medicine course run by World Extreme Medicine at Plas Y Brenin in Snowdonia.

As the name suggests, expedition and wilderness medicine involves practising medicine in an austere or remote setting, far removed from the GP surgery or hospital clinic.

That was back in 2017 and since then I have undertaken additional training, completing the International Diploma in Expedition and Wilderness Medicine at the Royal College of Physicians and Surgeons of Glasgow, and the Diploma in Tropical Medicine and Hygiene at Liverpool School of Tropical Medicine.

Over the past few years, I have worked on multiple endurance events and expeditions. These included supporting an ultramarathon in the tea plantations of Kenya, trekking the deserts of Jordan, wild camping in the wilderness of the Canadian Yukon and working in the South Pacific.

Closer to home I have covered the Delloite Ride Across Britain Land’s End to John O’Groats cycling challenge, as well as various multi-stage ultramarathons.

Trekking the Jordanian Desert

Each of these experiences has come with its own set of rewards and challenges, but overall, having the opportunity to support and empower people as they push themselves to their individual limits is fantastic.

Working on events and expeditions is a valuable way to stay refreshed, prevent burnout and gain transferable skills for use back in the GP surgery. I am lucky to have had a varied portfolio career, with a mixture of remote and traditional general practice alongside out of hours work.

I also work in travel medicine and medical education on a freelance basis, which gives me the flexibility to take time off to attend expeditions. While it is still possible to do this sort of work as a salaried doctor or GP partner, you may find additional logistical and financial challenges to consider.

What does the role involve?

Before a trip, it is important to screen and assess potential participants in order to reduce the risk of problems occurring in the field. It is also a good idea to evaluate the expedition company, review their risk assessments, and discuss the terms of employment.

While the majority of expedition medicine work is unpaid, and in some cases, the expedition doctor will pay for the privilege of working on a trip, there is scope for remuneration with more experienced clinicians.

Some of the more common medical issues you may encounter on expeditions can include musculoskeletal complaints, blisters, gastroenteritis, and dehydration. As with all things, prevention is better than cure, and briefing participants prior to the start of the trip can make your job much easier in the long run. You must also consider public health matters such as water sterilisation, toilet location, and handwashing, to prevent a diarrhoea and vomiting outbreak, which can really ruin a trip.

A significant chunk of the workload is providing motivational and psychological support, particularly on long, arduous treks and ultramarathons. You will usually be at the back of a trekking group, encouraging slower participants, making sure that they are OK from a medical perspective, and liaising with the expedition leader as needed.

Working in an austere environment can be a bit daunting at first: you are permanently on-call in the middle of nowhere, but you quickly get used to it, and the views are usually pretty epic!

A checkpoint on the Ride Across Britain Challenge in the Scottish Highlands

A lot of the medicine you will see often has a primary care focus, and being a generalist is ideal for this type of work. However, it is important to appreciate that acute medical emergencies and trauma can occur, and potential expedition doctors must possess the knowledge and skills to manage these, and be confident that the trip has a robust evacuation plan.

Often you are much more than just the medic and being a team player is essential. You may be the navigator, communications expert, mechanic, cook... the list goes on.

Having a keen interest in the outdoors is important, as you will be without the comforts of home in potentially hot, cold and wet environments. Being physically fit, so that you are not an additional burden, and possessing relevant technical qualifications and skills may also be necessary, depending on the type of trip.

After an event or expedition, you are responsible for informing a participant’s GP of any medical incidents, and if any follow up is required. Keeping good contemporary records is essential, and as with all clinical work, having appropriate indemnity is important.

Next steps

Many doctors working in expedition and event medicine are GPs, A&E doctors and anaesthetists, however this list is by no means exhaustive. Completing a trauma course such as Pre-Hospital Trauma Life Support (PHTLS) and attending a wilderness medicine course will stand you in good stead for working in this environment. There is a range of courses available currently:

To find out more about expedition and event medicine, you can visit my website www.thewildernessmedic.com to find a collection of blog posts and my podcast where I chat with some great and interesting people about the world of expedition medicine.

  • Dr Grace is a GP in south Wales

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