I had always assumed that primary care lacked excitement and wasn't intellectually stimulating. Despite professions to the contrary on my personal statement, I initially pursued medicine because I am competitive and wanted a career that was respected. Until my primary care placement, I did not realise that the aspect of medicine that makes it so rewarding is the privilege of helping others. My time at Friarwood surgery changed my attitude towards primary care and now I actually want to be a GP.
At Friarwood, I had a fantastic teacher who demonstrated that although medicine is a science, ultimately being a good doctor involves being able to have a conversation; being able to listen and communicate. On several occasions during my placement I witnessed how the communication failures of hospital doctors meant GPs were left to console confused or angry patients. These patients had been treated medically, but were annoyed because they did not understand the need or reason for their treatment. Effective listening and communication are foundations of medicine and nowhere are they used more than in general practice.
How can general practice be intellectually inferior?
My mentor, Dr Kirby, showed me that in order to take a good history you have to really understand the patient's story. Not just their physical signs or symptoms, but the patient's version of events and how their lives are affected. The effect a disease has on a patient's occupation, hobbies, social life and family are often their greatest priorities. As a GP, you have the opportunity to help patients with these concerns and therefore you can give them the assistance they want and deserve.
As for my previous assumptions concerning general practice, they were completely flawed.
How can general practice be intellectually inferior? The varied presentations and lack of clinical context within primary care make diagnosis incredibly difficult. GPs act like a detectives, trying to uncover why each patient visited them and what they can do to help.
And how can primary care not be exciting? As a GP you are often the first person to encounter a patient. Therefore you literally have no idea what will come through your door. That first visit is the beginning of a relationship that can last years, providing continuity and security for many patients, often until the end of their lives. This continuity of care, combined with the work GPs do within the community, allows patients to be seen by someone they trust in a place where they are most comfortable.
General practice is where doctors really help people. Not just by treating patient's physically, but by addressing their fears, understanding their beliefs and providing care to suit them.
General practice is where the real medicine happens and that is why I want to be a GP.
Edward is a third year medical student at Leeds Medical School.
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