Viewpoint: Why I'm Choosing General Practice: Joshua Strange

'Why be a GP?' my colleagues question me. 'Isn't it just coughs and colds?'

Joshua Strange: 'The GP is the juggler on the front line of the NHS, with no idea what is to be thrown at him next.'
Joshua Strange: 'The GP is the juggler on the front line of the NHS, with no idea what is to be thrown at him next.'

I wonder if they could be more wrong. I think back to my last GP placement. In the space of a single morning’s clinic I had seen cases from countless different specialities; psychiatry, dermatology, immunology, oncology, gastroenterology, cardiology… my list could go on indefinitely. Would I rather spend the rest of my career immersed in variety, or stuck in a single micro-speciality? I do not even have to ponder my decision.

'But are you not just always referring to other doctors?' I am asked next.

I know who I would be referring if I needed to know more of my patient’s story

I must at least appreciate where this point comes from. Much of primary care is of course referring onto highly qualified and excellent medical teams at secondary and tertiary centres, and an excellent job they do. However, is it all that I believe a GP does? Of course not – the role of the general specialist goes far deeper. How many of the patient’s medical team could tell you all of their past medical history? Could any of them tell you the complexity of their home life? How about information on the patient’s hopes and fears? Of course I cannot proclaim that no consultants would know such details. I do however know who I would be referring if I needed to know more of my patient’s story – their GP.

'Is it not just the easy profession to go into?' is the final question.

Again, I understand where this preconception comes from. Health Education England set the target of 50% of medical graduates moving into general practice by 2015. Perhaps this could make it look like the easy route to take, but the RCGP’s entrance examinations are as strenuous as any others. Regardless of this, does that make it an easy profession? I certainly do not believe so. From all I have seen, primary care is the most challenging of all roles. The physician usually has just 10 minutes to take a history, diagnose and decide on a management plan.

The GP is the juggler on the front line of the NHS, with no idea what is to be thrown at him next

10 minutes?! With absolutely no idea of what comes through the door next, to a satisfied patient leaving in just 10 minutes? The general specialist must differentiate between infinite numbers of potential diagnoses, test their theories and then decide on the next course of action. I wonder how many other doctors face such a mental challenge with every single patient they meet. And all of this on top of retaining the holistic view of the patient, being mindful that their quality of life is determined by far more than the disease they present with. The GP is the juggler on the front line of the NHS, with no idea what is to be thrown at him next.

Perhaps my colleagues were somewhat surprised by my passionate responses. Perhaps they were enlightened as to why general practice is the only career for me. Perhaps they may even consider it for themselves.

  • Joshua Strange is a second year medical student at Manchester University.

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