When starting medical school, the choice of potential areas of clinical practice to specialise in is extensive and it's not uncommon for students to dream of becoming neurosurgeons, surgeons, oncologists, cardiologists and paediatricians.
Those who have aspirations to enter hospital specialities might not necessarily consider the benefits that experience in general practice can bring. However, 35.8% of FY2 doctors took up places as GP trainees in 2017, and students entering other specialities can enhance their clinical and communication skills by getting some experience working in general practice; the value of this should not be overlooked because of decisions made about your career aspirations early on.
On a personal note, the prospect of having to complete a four-week attachment in general practice during my fourth year of studies left me rather reticent. Already determined to pursue a career in surgery, I thought little would be gained from this placement. However, I could not have been more mistaken.
After an introductory couple of days sitting in with one of the practice GPs, I was allocated my own room and given the privilege of conducting independent patient consultations, followed by a review and debrief with a practice GP after each consultation and at the end of each day.
This was without doubt the most immersive clinical experience I had had in my clinical attachments so far. I was given the freedom to speak to and examine my patients without feeling pressured or overly scrutinised by a supervisor. I also came to appreciate some of the challenges faced by GPs. I had to build patient rapport, take a pertinent history, perform a focused examination, reach a diagnosis, and instigate a management plan – all within a limited timeframe.
During those few weeks in primary care, I developed greatly as a doctor. My communication skills, examination technique, clinical reasoning and management plan development improved immensely. The concept of 'joint decision-making', which before had seemed obscure to me, became everyday practice; there is no logic to starting every medication under the sun to control a patient's blood pressure if they are unwilling to take them. The patient's concerns about taking medication must be explored, then the benefits of the treatment need highlighting before finally re-visiting the prospect of starting a tablet.
During those few weeks in primary care, I developed greatly as a doctor.
I was also directly confronted with the diversity of patients encountered in general practice. In one morning, I might see a young child with a cough, followed by an elderly gentleman with heart failure, or a patient suffering with vertigo. I came to understand the challenges of being a generalist and dealing with such a wide variety of conditions and complaints.
Primary care can also provide other stimulating challenges. For example, in addition to the routine consultations, opportunities outside of clinical work are readily available, such as pursuing roles within clinical leadership and quality improvement, as well as academic endeavours.
A final word to those students starting medicine - do not be put off by spending time gaining experience in other specialties, just because you have decided what career path to pursue. I strongly recommend starting every new placement with enthusiasm even if you remain convinced that that particular specialty is not for you. There are always opportunities to be gleaned and possibilities to expand your skill set.