Bear with me – this is more medically related than anything else I have written so far, but I believe it should be said.
My time in General Practice is over. Like many people who start studying medicine, I had no inclination of ever becoming a GP. My exposure to doctors was limited to getting jabs and being sick. Let’s face it, GPs don’t have the best reputation. They are constantly being blamed for prescribing too many antibiotics, referring too many patients, ordering too many tests, and not knowing enough. They have become a scapegoat for the problems of the NHS, but in most cases the reputation is undeserved. Their job is not easy. Vast numbers of patients come in and out of GP surgeries every day, and it is up to the doctor fix their problems. My GP tutor talked to me a lot about risk management, and how GPs have a different risk appetite to other doctors. In the hospital patients can be closely monitored, have frequent blood tests and investigations, and any potential risk is minimised. The GP does not have the same access to these tools, so has to be able to confidently send people home and reassure them. If every patient that came into the surgery was sent up to A&E then the whole system would clog up. The GP has to work with the information provided by the patient and whatever previous records he/she has, and determine whether the problem can be solved with time, antibiotics, or urgent admission for investigation (in the case of vague symptoms leading to a suspicion of cancer). It is up to the GP to know his/her patients and deal with their problems in a way that leaves the patient satisfied, while not necessarily catering to their every whim. The number of people who came in asking for sleeping tablets as though they (the tablets) were a panacea, and going to solve all their problems, only to be turned down. Diazepam and temazepam are popular hypnotic drugs, but prone to abuse, as they are addictive and the body can build up tolerance and dependence on them. If someone combined an antibiotic and a sleeping tablet into one glorious pill, and it could be marketed directly to consumers, they would fast become a multi-billionaire. Maybe throw in a painkiller too, just to make it perfect. Antibiotics and sleeping tablets seemed to be by far the most requested drugs, but like sleeping tablets, antibiotics are not a cure-all. Generally speaking, respiratory tract infections are viral, including the common cold and bronchitis, and antibiotics will add no effect above placebo, though it will feed into the ever increasing problem of antibiotic resistance.
To be a GP you have to be able to manage risk, and all importantly, know your limitations. I don’t know if you have realised this, but medicine is a huge topic and no one person can know everything about everything. GPs have to have a broad knowledge base including the management of everything that can be dealt with in primary care, and they have to know when to refer. Nothing is absolute, and people often report vague or medically unexplainable symptoms, making the art of diagnosis even trickier. Is the woman with vague abdominal discomfort and fatigue a frequent attender who sees the GP over every small problem, or does she have ovarian cancer? The GPs I was with over the past three weeks were fantastic, and I had a great learning experience. It has helped me to appreciate the role of the general practitioner, so I urge you all to do the same, and cut your GP some slack.
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