Variety is the spice of general practice life

5 minute read

Excitement is not the most important factor when choosing a specialty – think of satisfaction.

It was just one of those throw-away conversations. The exact opposite of a D&M. I was chatting with a young English friend of mine whose sister is currently doing different clinical terms after graduating from medicine in the UK.

As you do, my friend’s sister was actually using her experience in the different terms to help her to decide what area of medicine in which to specialise. Apparently she really enjoyed the emergency medicine term which was then followed by a term in general practice which she found extremely boring.

Having the terms one after the other didn’t help. The contrast was stark. According to this young English new-graduate, the most exciting thing she saw all day in general practice would have been considered ho-hum, run-of-the-mill in the emergency department. As a result she is hoping to train in emergency medicine.

Of course, at this point, you might have expected I would have leapt to the defence of our noble specialty! Surely I could have followed up with some pointed repartee to counter such damaging aspersions.

The reality is …. I said nothing. I had nothing. I did nothing. I just left the miserable comparison lying there as the conversation quickly moved on, as it does, to the UK COVID situation and Trump politics.

As you can tell, it’s played on my mind ever since.

What should I have said? What could I have said? If excitement is your key motivator in choosing a career then general practice is hardly likely to rate, is it? Certainly not compared with emergency medicine. If you’re after an adrenalin rush I totally understand that will be hard to find between the childhood immunisations and the STI screening checks.

But, if I’m honest, the criticism I find most irksome is that general practice is boring. Of all the negative adjectives you could choose for the specialty – challenging, frustrating, anxiety-provoking, exasperating, demanding, over-worked and underpaid – boring doesn’t cut it.

Variety is one of, if not the greatest benefit of practising as a GP. Sure we may sit in the same room for hours at a time, but through our door comes the full spectrum of the human condition – and the real kicker is we have no idea what we will be faced with until they are in there. Every 15 minutes we are the star in our own GP version of  “Thank God You’re Here.”

And even when our days are filled with “regulars”, there is always something new. Which brings us to the other enormous advantage that general practice has over almost every other specialty, especially emergency medicine – our long-term relationship with our patients. Yes I know, I know, we all have those patients we’d rather not have a long-term relationship with. But on the whole, the ability to be engaged in a person’s life, through all their tragedies and triumphs, often playing an integral role through some of their most challenging time, well, that’s a job satisfaction that’s hard to put on the prospectus for new graduates.

It’s hard to sell the sense of worth you can feel from something so long-term especially to a 20-something, ultraclever, ultra-enthusiastic resident doctor who is still reeling from having put in a chest drain for a tension pneumothorax or revived a child in acute anaphylaxis.

They are excited by the medicine, as we all were, and still are to some extent. But what you learn in time, and with time, is that the people behind the medicine are often just as interesting, and GPs get to know that.

When worry wakes me up at 2am it’s always Yvonne’s scarily high BP or Val’s possibly violent partner, never the epileptic seizure in bed 7 or bed 22’s oesophageal varices.

Horses for courses I know. But I think I would find a professional life without the personalities of my patients far less satisfying. And in terms of boring, imagine doing nothing but hip surgery every day, or cataracts, or even something like sleep medicine.

I would never argue that general practice is more exciting than emergency medicine. But what I should have argued is that general practice is not boring. In fact it is one of the most interesting and satisfying specialties there is.

If we are to see demand for training places increase we are going to have to get this message through to our new interns and residents. We are going to have to make them realise you can generate just as much heat with a slow burn as you can with flash of fire! Satisfaction should always beat excitement when choosing a career – it lasts longer.

Of course, it would help if I could think of all these arguments at the time the topic comes up in conversation, rather than the following week! Glad I’m not head of the marketing department.

At least I’m ready for next time.

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