GP Land… Where myths are made and legends are born

I’m publishing this as Melbourne has finally been released from a two-week Covid lockdown which overlapped with my recent rotation. Luckily, this GP rotation qualified as essential work and I was still able to get the most from the experience, especially in the face of what has become one of the biggest health challenges in our lifetime.

I entered ‘GP Land’ having had ordinary experiences with general practitioners in the past. I’ve endured the bulk-billing, churning-and-burn GPs who never established any rapport with me in their consult and simply wanted to get to the next patient on their list. The rotation experience I’ve recently completed with my GP supervisor was the complete antithesis.

The diversity of different procedures was amazing to see and participate in. I was approved to perform most procedures – from ear syringes, COVID vaccinations and many of the examinations I learnt during my first two years of medical school. Implementing and performing them made me feel like a real doctor!

Often, you hear of the reputation GPs have from conversations with other specialties. Usually regarding the supposed simplicity and easy-going nature of General Practice. However, I think it should be commended more.

Immersing myself in GP Land over the last five weeks has been formative, as I got my head around the most common presentations with a preventative health approach. I was subjected to an absolute pimping so many times from my supervising doctor. Relax, it’s not what most think. ‘Pimping’ is another piece of med-jargon describing a style of questioning to help with learning development. During my placement, I was grilled with questions about drugs, various conditions, and differential diagnoses for a presentation. Now, if you asked a more inexperienced and naïve Anei, I would have said that this was embarrassing and how I hated being put on the spot. But being the person I am today, I realised I enjoyed this kind of environment.

It was 1-on-1 with the doctor, and so the answer I gave to a particular question helped my overall understanding of common presentations. The outcome was always the same – I would learn something new which I hadn’t known previously. It was through viewing these grilling sessions as learning opportunities, as opposed to an indictment of my character or intentional blow to my ego, which assisted in my ability to relish the opportunity and pick up on these gems of new information. The questioning forced me to think on the spot and use clinical reasoning in the way required in such an environment. So, by putting aside the need to show a semblance of fuller understanding, and by humbling myself, I was better able to get the most out of this placement. I definitely ate some pancakes on this rotation, going home with new content to look up and present to the doctor the following day.

The ordinary GP experiences of my past were superseded by those with my GP supervisor. My supervising doctor was kind, empathetic, and made the driest dad jokes – which I cannot help but appreciate. He subtly weaved the tapestry of his GP career through his religious, Buddhist background. Going from site to site, he spoke in detail about how Buddhism influences his practice and how he views patients, not as disposable, but as people influenced by different contexts. Watching him in his clinics, I felt an appreciation of the techniques he employed that made his consults meaningful. A great example was his use of the Golden Minute.

The Golden Minute is the first minute of a consult, where you give the patient the floor and they divulge their presenting complaints, uninterrupted and at their own pace. Then, as the GP, you follow it up with open questions. My doctor used this beautifully with a patient who had rheumatoid arthritis and red fingers. As she was explaining her complaint, eventually she mentioned a background of obsessive-compulsive disorder (OCD). Consequently, this opened the door to an understanding of her underlying condition, that which is related with her current complaint. All of this achieved by implementing the Golden Rule. Essentially to make a GP consult successful, this core, underlying reason needs to be ascertained; why are they in the consult? Why, specifically, now? Sometimes the underlying reason can be quite obvious, other times it is simmering under the surface. That’s where the challenge of being a GP is discovered, I think.

Toward the end of my five weeks, I unconsciously started to rush the consults I was having with patients. I learnt the importance of just slowing down history taking and giving myself permission to take the time it takes. My doctor said “Anei, you’re rushing today” as I missed out on pivotal inclusions from past medical and social history. At first it seemed like a simple consult for a rescript for prescription medication and, thus, I was motivated by what seemed a simple request. However, the simplicity is sometimes the complexity and my doctor wanted me to iron out the crinkles of the particulars with this patient. Essentially, he wanted me to perform the consult as if the rescript was not the only reason for the patient’s appearance. To perform the consult fully until I was completely sure I had ruled out all other considerations through an extensive history taking. Each patient is special, and each consult a chance to develop a doctor-patient relationship. They should always be given the time, the focus and the option to participate in their own health outcomes, which my GP underlined on so many of his consults.

Could I see myself entering GP Land in the future? Well, I am supposedly welcome back there if I qualify, so that’s enticing as a future job prospect – haha! However, I could definitely see myself at the forefront of preventative health and as middleman between the community and other health services. The ability to work your own hours and still maintain a balanced and fulfilling plate, with life and other commitments also in the mix, is motivating. And the prospect of being a voice in the community is enticing. So, once again, who knows what I will end up doing!

The end of this rotation means I’ve completed four rotations all up so far, meaning I am half-way through the year and through rotations… Yay! I now have a two-week holiday, which I am thoroughly looking forward to, and then back into the second half of rotations. During this break, I’m actually going to use it wisely and rest. I’m starting to feel the fatigue of having not had a decent break since the summer. So, I’m ready to not feel guilty about spending time not being immersed with anything to do with university. I’m planning to travel to Canberra, play some sport, cook food for my friends, get beaten at Uno by my best mate Dom, and read leisurely. Real balance.

Hope all is well on your end my friends.

Eat those pancakes (and get vaxxed when you can)!

Anei