How did you first get into medicine?
Both of my parents, three uncles and a grandfather were doctors. I always preferred science at school. A lack of imagination on my part, and perhaps on the part of the careers teacher, meant that my work experience was in a medical setting, and the decision seemed to be made. That said, I have (almost) never regretted it.
What inspired you to pursue your specialty?
As students, spending most of our time on acute hospital wards, I was aware that we only ever saw a snapshot of our patients, often at their most vulnerable. However, I also spent time in two very different general practices, one very rural and one in a deprived inner-city area. What they had in common was that the GPs in both knew their patients, their patients' families and social circumstances, and provided true 'cradle to grave' care.
In my first SHO job, one of my roles was to go into the community in the mobile coronary care unit – a Renault Laguna estate driven by a porter and staffed by an experienced nurse and an SHO. GPs would call us out to unstable cardiac patients.
Once the patient was stabilised, and while waiting for the paramedics to join us to transfer the patient to hospital, I got the chance to chat with the GPs. Their collective experience helped me to decide that general practice was something I wanted to do.
How does it differ from other medical settings?
Enormously. A GP is expected to be a jack of all trades. You can be dealing with a suicidal patient one moment, and a cardiac emergency the next. GPs are increasingly taking on work which was formerly the domain of hospital specialists – chronic disease management, or the monitoring of high risk drugs being two good examples.
A GP is also often seen by their patients as a confessor, counsellor, social worker and more, in a way that is often not the case with colleagues in secondary care.
Working away from the acute hospital setting, without the onsite resources that go with that (such as instant access to laboratory facilities, radiology and so on) means that GPs have to rely heavily on their clinical skills when assessing patients.
Patients often present early, with undifferentiated symptoms or signs. Most will have simple, often self-limiting illnesses, but some who present in the same way may have something more serious. This can lead to complaints and claims if the GP is felt to have 'missed' something which the patient feels, with hindsight, should have been detected.
A GP is also often seen by their patients as a confessor, counsellor, social worker and more
Dealing with patients with all manner of illnesses is hugely educational. Patients may need the expertise of specialist secondary care colleagues to treat serious, complex, or rare illnesses, but they will expect their GP to know about what their treatment entails.
What additional skills have you learned as a result?
The consultation is the cornerstone of GP practice. Many books have been written discussing the theory and practice of this, and it forms a central part of GP training. It all boils down to good communication skills.
Being able to listen to a patient without interrupting, to hear not only what they are saying, but what they are not saying but perhaps want to, and to then advise them, and involve them in this without being overly directive, is not easy. Even the most experienced GP gets it wrong sometimes. Being able to reflect on the times when something has gone wrong, and to learn from it, is helpful.
Although GPs have to be versatile, they cannot know everything. Knowing what you don't know is probably more important than knowing what you do know. It's important to know that some problems cannot be solved. Patients know this. Often all they want is someone to talk to, and empathetic listening can be greatly appreciated.
What advice would you give to a student who is considering this specialty?
Anyone reading medical or lay newspapers will know that GPs are under considerable and increasing pressure. However, it can still be a rewarding career. A GP can still treat three or more generations of the same family on the same day, and provide true lifelong care. There are now opportunities to develop special interests, and 'portfolio' careers for those who don't want to follow the traditional partnership model.
A rotation in general practice as part of foundation training can give you a great insight into it as a career. It might also be worth discussing your interest with the department of general practice in your university.
Dr Edward Farnan
Dr Edward Farnan
MB BCh BAO LLM FRCGP DGM DCH DRCOG
Dr Farnan graduated from Queen's University, Belfast, in 1995 and completed his GP training in Northern Ireland, practising as a principal in general practice in Armagh for 11 years. He also sat on a research ethics committee, and had a particular interest in clinical governance.
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