The Press and Journal (Inverness, Highlands, and Islands)

Im­por­tance of GPs is one of the cru­cial things that med­i­cal stu­dents can learn

- David Knight Medicine · Arctic · East Kilbride · George Clooney

For some rea­son I started shak­ing un­con­trol­lably on my hos­pi­tal bed as I was be­ing ex­am­ined. It was odd as I felt per­fectly calm and re­laxed oth­er­wise. It dawned me on that I was not the prob­lem; the bed ap­peared to be shak­ing. But then my eyes came to rest on a pair of hands which were grip­ping the bed – and they were not my own. They be­longed to a med­i­cal stu­dent, and it was he who was shak­ing as though he had just stepped out of an out­door plunge pool in the Arc­tic.

It was not the most promis­ing bed­side man­ner, but I must point out that we were thrown to­gether in a par­tic­u­larly fraught sit­u­a­tion and he was gripped by a bad case of stage fright.

It might sound pe­cu­liar, but I was one of sev­eral vol­un­teer pa­tients roped in for an im­por­tant as­sess­ment in med­i­cal school where stu­dents were role-play­ing un­der the ea­gle eyes of se­nior tu­tors. Stu­dents were briefed on our imag­i­nary “symp­toms” before hav­ing to demon­strate how to carry out de­tailed and tech­ni­cally cor­rect ex­am­i­na­tions.

It was a big chal­lenge to prac­tise on real peo­ple – and oc­ca­sion­ally rather un­nerv­ing for “pa­tients”, too. Now and again a stu­dent doc would go off-brief and start ex­am­in­ing me for real, point­ing to ac­tual po­ten­tial af­flic­tions around my body which alarmed them. They alarmed me even more.

After th­ese in­quis­i­tive types de­parted one of the of­fi­cial in­vig­i­la­tors (a se­nior medic in their own right) would grab a stetho­scope and ex­am­ine me hastily before the next one came in, and as­sured me I was not about to have a heart at­tack after all.

It demon­strated to me that some in­tu­itive stu­dents were al­ready dis­play­ing an in­stinc­tive ap­proach to look be­yond the ob­vi­ous. This could save lives later.

I have to con­fess that nerves and fear of the un­known also dogged my early days as a stu­dent jour­nal­ist un­til I started bank­ing valu­able front-line ex­pe­ri­ence. The shak­ing stu­dent was tak­ing his first fal­ter­ing steps to what might have been a great ca­reer; what con­cerns the NHS to­day are the fi­nal steps med­i­cal stu­dents take when choos­ing a spe­cial­ity, as we cry out for more GPs.

Dr Linzi Lums­den is a GP part­ner in a large Aberdeen prac­tice, and a se­nior clin­i­cal lec­turer in GP and com­mu­nity medicine at Aberdeen Univer­sity med­i­cal school for stu­dents in years one to three. She would like to see more of them be­come GPs in an era when short­ages of fam­ily doc­tors are be­ing ex­ac­er­bated by ris­ing re­tire­ments, prac­tice clo­sures and pa­tient lists.

Health boards in Grampian and High­lands throw the net wide to find ex­pe­ri­enced GPs, but their own med­i­cal stu­dents are also part of the so­lu­tion.

So why do many med­i­cal stu­dents find GP prac­tice a turn off? Is it not glam­orous enough for them?

So why do many med­i­cal stu­dents find GP prac­tice a turn off ? Is it not glam­orous enough for them? Per­haps they have over­dosed on too many film and tele­vi­sion med­i­cal dra­mas, or the TV se­ries 24 Hours In A&E?

Dr Lums­den, a GP for six years, met me to dis­cuss the prob­lem amid the chat­ter of med­i­cal stu­dents hav­ing lunch a few feet away – the very peo­ple who have th­ese huge ca­reer choices to make dur­ing a study and train­ing pe­riod which can last at least 10 years.

“Med­i­cal schools ev­ery­where are not get­ting enough stu­dents to be­come GPs,” she told me. “Neg­a­tiv­ity to­wards GP prac­tice can de­velop dur­ing their stud­ies and train­ing, and the views of some peers and col­leagues might drive this along. It cre­ates a per­cep­tion of a di­vide be­tween GPs and the hos­pi­tal side of things.

“Some­times stu­dents have per­cep­tions that the GP sec­tor has lower sta­tus.”

Myths are of­ten dis­pelled by meet­ing and work­ing with GPs, which is built into med­i­cal school train­ing.

Third-year Aberdeen stu­dent Caitlin Ste­wart, 26, from East Kil­bride, agrees with that.

“We vis­ited a GP’s house where we had break­fast. We saw the life­style along with the prac­tice, com­mu­nity hos­pi­tal and moun­tain res­cue,” she told me. “The highlight was speak­ing with ac­tual GP trainees about their work at a speed dat­ing-style event. I was im­pressed with the whole GP ex­pe­ri­ence.”

I also came across an Aberdeen­shire doc­tor

While the GP sec­tor may not match the glam­our of Ge­orge Clooney in the TV show ER, med­i­cal stu­dent per­cep­tions that it has lower sta­tus than the hos­pi­tal side of things are of­ten dis­pelled by meet­ing and work­ing with GPs

blog­ging about his switch into gen­eral prac­tice at a late stage of train­ing in­stead of be­com­ing a re­nal spe­cial­ist. He de­scribed his pre­vi­ous mis­con­cep­tions about “bor­ing” or “too sim­ple” GP work, now blown away by his new­found call­ing in com­mu­nity medicine.

Dr Lums­den said: “The great thing about GP prac­tice is that you don’t know what will come through the door. We are like NHS gate­keep­ers, fil­ter­ing peo­ple through. GP prac­tice and hos­pi­tal ca­su­alty are sim­i­lar in th­ese re­spects.”

This is where in­tu­ition based on ex­pe­ri­ence kicks in. “You have to be like a de­tec­tive at times. Some­one might come in with seven things wrong with them, but it’s the last one which sets alarm bells ring­ing,” she added.

My ear­li­est GP mem­o­ries are as a kick­ing and scream­ing three-year-old when our fam­ily doc­tor sewed my hand back to­gether after a hor­ri­ble gash caused by fall­ing on bro­ken glass.

Decades later my GP de­cided the time was right for me to visit a con­sul­tant. Hos­pi­tal tests showed I had prostate cancer, but it was caught early. What would have hap­pened to me with­out th­ese de­ci­sive in­ter­ven­tions by GPs on the front line of medicine?

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