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ss nucleus - summer 1999,  Faith in Practice - Being a GP

Faith in Practice - Being a GP

Sophie Critchley interviews Peter May, General Practitioner in Southampton.

What hours does a GP work?

Surgeries may start at 8.30am and last until 11am. The next 4 hours are likely to given over to reading letters, dictating referrals, making phone calls, signing repeat prescriptions, doing medical examinations (eg for insurance companies), performing minor surgical operations (fitting IUCDs, removing skin lesions etc) and doing home visits. There is a good deal of flexibility as to how you organise your own day. An afternoon surgery may last from 3pm to 6.30pm. You will be lucky to get away before 7pm and may have at least an hour’s paperwork still to be done.

How many patients do GPs see in a week?

The average GP will have about 150 consultations in one week. Most run appointment systems, allowing 5-10 minutes for each. Some consultations, such as reassurance about a mole, require only two minutes, while counselling can take very much longer. It is difficult, therefore, to run to time. Some doctors run specific clinics for chronic diseases. Others prefer to mix their work load.

What do you think is the best part of the job and why?

The best part of the job is the people. If you do not like meeting people or have difficulty in establishing a rapport quickly, this job is not for you. After 20 years of running your own list, you develop a very loyal, supportive clientele, and every day you meet old friends. Unlike so many social contacts, these relationships have a depth to them. You become a friend of the family. You are someone who is always there for them. Patients often hate moving away if it means changing their doctor. He may have known them from infancy, counselled them in crises, shared their joys and their tears.

Intellectually, the mindset of a detective, probing for clues, observing behaviour, evaluating evidence and drawing conclusions is endlessly fascinating. Sharing your conundrums with partners adds to the interest. GPs are nowadays the only generalists left in medicine. Everything you learn at medical school finds its place (except perhaps biochemistry?) You need to know about psychiatry and orthopaedics, dermatology and obstetrics, pathology and anatomy. Every surgery presents a rich mixture of challenges. It is never dull.

What are the worst aspects of being a GP?

Running a complex business with a large budget is something for which most GPs are unprepared. Some find it a great burden and worry, others enjoy it. Hopefully, a given partnership has some members who enjoy finance, IT, management and medical politics. None of us are good at all these things.

The worst parts are the volume of paperwork, the constant threat of litigation if you make a mistake, the pressure of constant interruptions, unrealistic expectations from patients and the sheer busyness of a working day. The growth of Alternative Medicine, the poor understanding of science in the community, the time taken explaining why a specialist’s advice may be more valuable than a crystal therapist’s is very frustrating.

Despite being surrounded by people, there is an isolation in the job. The whirl of issues that you juggle with at any given moment are known only to you. However, there are not normally many outstanding issues at the end of the day to worry about. Most problems are left organised, if not resolved, when you go home.

What major difficulties will Christian doctors entering general practice face?

The opportunities for demonstrating Christian compassion, gentleness, patience, goodness and integrity, while upholding Christian values are a major daily challenge. Your professional life is lived out before a critical public - who recognise good doctors when they see them! Specific ethical difficulties are an occasional problem by comparison.

If we maintain a stand against euthanasia, we must demonstrate that we can practise terminal care to the highest standards. That demands knowledge, sensitivity, diligence and team-work. Dying people need visiting, sitting with and listening to.

The issues surrounding the status of the fetus before God require particular ethical attention. Your views - for good or ill - can have serious consequences. Once a particular stance has been chosen, a GP must learn ways of handling particular difficulties. For instance, he does not need to agree to sign the authorisation form in favour of a termination, but he is under obligation to allow the patient to consult someone else. He cannot ride roughshod over someone else’s ethical opinions.

Major ethical difficulties are unusual. The real challenge is at the daily round and the common task - of running late for appointments, of being asked to issue certificates without seeing the patient, and being a stickler for truthfulness.

What is the training structure like?

After qualifying, you direct your own training. Because of the broad nature of general practice, all experience is relevant to some degree. Doctors in partnership bring particular skills. Some may have specialised - perhaps in surgery, pathology or neurology. However, you cannot get far in general practice without a basic working knowledge of certain fields. Without experience in paediatrics, for instance, you will show a good deal of insecurity in your judgements which will probably be detected by sensitive, anxious mothers. Experience in obstetrics and gynaecology is essential.

SHO Rotation Schemes for general practice allow would-be GPs to enjoy some sort of domestic stability while gaining experience in a selected combination of specialties. The third year of such schemes involves working as a registrar in a training practice. Training practices must maintain particular standards including library facilities and allow ample opportunity for training, including a day release course during term-time.

General practice lends itself to on-going training. We constantly play for time in making a diagnosis (‘watchful waiting’) as the illness evolves. This gives opportunity to consult a textbook, phone a specialist or discuss with partners.

What opportunities exist to pursue other interests?

Different practices will have their own attitude to outside interests and their own policy about the financial implications of such work. Many doctors with small lists take on other work, and many prefer to work in this way. Clinical assistant posts are available for GPs in most hospitals, so a session a week doing Rheumatology, for instance, can boost income as well as stimulate some expertise to carry back into general practice. There is a steady demand for GPs to be police surgeons, which is demanding but interesting and varied work.

Industrial medicine is often done by GPs. A session a week caring for the medical needs of a local firm adds a whole new dimension to life. Being a prison doctor should have a particular appeal for Christians. There are constant opportunities for journalism, which can be done in your own time and at home. The media are constantly looking for friendly GPs, to help them with researching programmes as well as commenting on news items. Medical politics is another area for involvement.

Some practices manage to have regular sabbatical breaks, which can allow a partner perhaps 3-6 months working overseas every few years. However, the growing pressure on general practice is stifling such possibilities.

Does GP work lend itself to a life beyond medicine?

Plenty of marriages have been destroyed and many children have suffered because of the demands of general practice. It is a dangerous job for a workaholic. However, realising the dangers is half the battle. A GP does not have to work full time. Plenty of half or three-quarter-time posts are available, along with ‘job sharing’ and ‘retainer schemes’. Small lists are liable to be less demanding than big lists - but you do get paid less and still have to fulfil basic requirements.

Most doctors take off one or more half days per week, work Saturday mornings in rotation, and will do an evening or night cover each week. The recent development of out of hours co-operatives, where large numbers of GPs in a locality share the rota together has transformed this most demanding and stressful part of the job. They provide a cheaper option than using a deputising service.

How might a Christian medical student confirm a calling into general practice?

It is difficult to envisage anyone believing God has called them to a given sphere of work if they did not feel a natural aptitude towards it. Thirty years in general practice would be a very heavy cross to carry if you did not enjoy it. Indeed, you would not survive in it for long.

General practice is more focused on people who have illnesses than illnesses found in people. The holistic needs of the individual, a broad interest in the whole gamut of medicine, a concern to teach patients and engage in preventative medicine, and, increasingly, an ability to be a team player must excite you or you will not do this job well.

Involvement in the local community to a certain degree comes with the job . A GP is likely to find scope for a leadership role in the local church.

Since family and friends all have GPs, the people who know you best may well have helpful views as to your suitability to do this type of work. Doing a trainee year as a GP Registrar will be a valuable experience whatever medical career you pursue. Some people think that a little general practice experience should be mandatory for most specialist training programmes. Certainly, it is the obvious way to test a vocation. Many will decide that it is not for them, while others may find that this is one of the most challenging and rewarding fields in which to serve Christ.

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