Viewpoint: Why I'm Choosing General Practice: Alisha Esmail

What does general practice mean? We know it involves counselling the chronically depressed patient. We know it requires delving into the hearts of homes on 'home visits.'

Alisha Esmail: 'Variety, continuity of care and security  – which medical student could refuse this?'
Alisha Esmail: 'Variety, continuity of care and security – which medical student could refuse this?'

We also recognise the weight on developing that all-important rapport with the man you’ve witnessed a boy become, as well as with his newly built family. Now, why would I want to take on this Herculean juggling task to merely become a ‘Jack of all trades, master of none’? Many reasons exist for me.

The first couple of these reasons are continuity and variety; one of Bevan’s founding principles for the NHS, patient care from the ‘cradle to the grave’ is an apt summary of general practice. This phrase paints an identifiable perspective, not only of the breadth and depth of cases that a GP will address within one day, but of the continuity of care for a patient throughout their life.

Who knows what could waltz into your consultation room next?

The variety in general practice inevitably chisels a master of selecting relevant detail, who can simultaneously eliminate myriad diagnoses, from the moment a patient enters (not to mention, maintaining conversation all the while). As a medical student, I equate this to being set a series of daily puzzles of varying difficulty (with missing pieces, of course) – but most importantly, of varying type. Who knows what could waltz into your consultation room next?

Being the first port of call for a troubled, and potentially vulnerable patient, is a responsibility and privilege that few others are granted in healthcare. This initial contact is the pivotal filter in shining a clear path through the patient-perceived murky depths of a healthcare system - after all, what good is the system with a faulty filter and a consequential horde of lost, confused patients?

Furthermore, rapport and familiarity of the setting creates a safe, reassuring environment for an honest and frank discussion – opportunities alike remain scanty along the care pathway. This brings us to a GP’s duty of care to ‘safeguard.’ The critical time to prevent irreversible harm, whether it be physical or psycho-social, resides with the GP. This particular privilege is only accessed through tactful probing and acquired patient trust: further utensils in the toolbox of a GP. This GP-patient trust phenomenon, attained through continuity of care, is second to none that I have observed in healthcare, so far.

Finally, if we now cast our mind’s eye towards the future, the sheer expanse of ‘extra-curricular’ opportunities open to GPs is vast and still growing; medico-legal affairs, medical education, partnerships and specialist interests are but to name a few. This fluidity and flexibility to spread your wings is a rare asset in healthcare, today, and for yet further peace of mind, a community-based doctor will always be needed in an efficient health care system.

Variety, continuity of care, enhanced doctor-patient rapport, career flexibility and security  – now, which medical student could refuse this?

  • Alisha is a fifth year medical student at Imperial College, London

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