Tom Ronan: Why I'm choosing general practice

A lot can change in six years. I came into medical school filled with the kind of ambition and bravado only accessible to fresh-faced medical undergraduates.

There was a healthy dose of anxiety and imposter syndrome mixed in there too, but a significant part of me entirely bought into my personal statement promises of saving lives and changing the world.

Six years down the line and my current career plans point towards general practice. The pragmatism of adulthood, right?

Wrong. Far from scaling down my ambitions, a career in general practice would provide me with fresh new challenges. No other specialty demands such a breadth of medical knowledge.

GPs have to follow subtle clues whilst keeping the differential wide open. They grapple daily with uncertainty. Hospital specialties can bombard in-patients with investigations until a root cause is uncovered. Things aren’t so simple in general practice. So, who can go home safely, and who should leave the practice in the back of an ambulance? When is a funny turn the sign of something sinister, and when is it nothing to worry about? Getting it right takes careful judgement and decades of experience.

On my surgical placement I gazed in awe as the consultant sutured two sections of bowel, his fingers nimble, quick and effortless. But mastery and expertise are not the preserve of consultants.

When a sick child is brought into the practice, the GP has to make a series of snap judgements about the severity of the illness and the directions for management. Swathes of complex information are integrated simultaneously, from the presence of intercostal recession, to the parent’s ability to cope at home. A talented GP can have all these cogs whirring in the background whilst deploying the communication skills needed for a carefully-pitched consultation.

On GP placements I have the privilege of glimpsing into patient’s everyday lives, from the mundane to the profound, from the joyful highs of a young woman finally able to conceive, to the crushing despair of an elderly gentleman diagnosed with advanced metastatic cancer.

Making a difference

When reading patient notes before a consultation I glance at the last few visits, and find myself scrolling upwards indefinitely, tracing a ribbon of narrative trailing back into the distant past. The story’s outcome can be swayed by that brief ten minute glimpse, sat squarely in the middle of two chapters.

There is scope to enact real and lasting change in general practice. GPs follow not only the stories of patients, but of whole communities. Moving placements from an affluent Cambridgeshire village to a deprived seaside town, I was shocked by the contrasting burdens of disease, both mental and physical. In our fragmented and compartmentalised society, few of my graduate peers find themselves interacting with such a cross-section of society.

By pursuing a career in general practice I hope to play some small part in redressing these imbalances, in promoting health, and helping people at their most vulnerable. It almost sounds like something I wrote, aged seventeen, on my personal statement.

  • Tom Ronan is a sixth year medical student at the University of Cambridge

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