I Am Officially in My Final Year of GP Training

A haiku:

Passed ARCP

GP next year, by God’s grace.

Starting to feel real.

The End of My 2nd Rotation of GPST2

I start my last rotation of GPST2 tomorrow – time is really flying by! As always, I try and book leave at the end of my rotations so I have a break before moving on, and this time changeover coincided nicely with Easter, so I’ve had an extended time off which has been really nice.

This rotation was in a county GP surgery that was definitely different in terms of patient demographics – in my first week a patient came for their appointment in a Jaguar, so to say this was a more affluent area would be an understatement!

I saw a lot of patients who asked for private referral letters when faced with NHS waiting times, so we’re really seeing the beginnings of a two tier healthcare system and that makes me really sad.

Anyway, a recap of this placement:

What was I good at?

Heart failure annual reviews! I got to do QOF Clinics as part of my time at this practice, and they really improved my confidence with management of heart failure patients.

What made me nervous?

Seeing patients who wanted to start on HRT, as there’s usually so much to cover before prescribing. A great tip I got from one of my Supervisors is to split it into two consultations – initial assessment/history and examination, and then a separate appointment to prescribe.

Useful thing I’ve learnt?

If a patient is struggling with hair loss and no other causes can be found, aim for ferritin levels greater than 100.

The last time I cried at work was?

The day I wrote this blog post. It had been a very overwhelming day of complex patients and feeling out of my depth – imposter syndrome was hitting HARD that day!

My happiest work memory?

Our weekly teaching sessions with my Clinical Supervisor were always a laugh – a highlight was a session where we spent some of it going through my previous clinics to find a patient I’d seen, to confirm that I hadn’t gotten them mixed up with someone else. I was absolutely sure that I hadn’t, so it was very satisfying to be proved right.

Would I work here again?

Absolutely! Everyone from the Reception team to the Admin team, Secretaries and Partners were so so nice and approachable. One kind gesture that I won’t forget is how the rota managers went out of their way to make sure I had home visits that I could walk to, as they found out I was taking Ubers to my visits, and were adamant that I shouldn’t spend money. So nice of them, and just reflective of the atmosphere of the practice, because everyone really looked out for each other and it was great being part of the team.

So watch this space; this time next year I might be sending them my CV to consider me for a salaried GP job…

I PASSED THE AKT!!!!!!

The Applied Knowledge Test is one of the compulsory exams of GP training in the UK, and anyone who follows this blog will know that preparing for it has been a big part of my life over the last few months.

So what a RELIEF to find out this week that I passed, hallelujah! I took the exam last month and waiting for results has been excruciating – I’ve been unable to fully relax or make social plans from March onwards because I was so worried I’d have to retake.

Still doesn’t feel real that the AKT is DONE and I am freeeeeee – all glory to God! I most definitely could not have gotten through the last few months of stress, anxiety and reduced confidence without support and encouragement from all the wonderful people God has put around me; I am so so blessed and grateful for them all.

Some Ways I’ve Made a Difference For Patients This Week, To Remind Myself That I’m Not a Bad Doctor

1. The patient I saw on a home visit and fought to get an ambulance to bring him to hospital, because I was concerned that he had bowel obstruction and his wife couldn’t drive him in. Spoiler alert: He had bowel obstruction.
2. The 1 year old I saw in clinic and referred urgently to Children’s A&E because they had an injury that didn’t add up with the explanation given. Safeguarding monitoring has now been put in place.
3. The patient who was embarrassed about her prolapse and cried because she was worried it looked “really bad”. My clinic overran by half an hour because I spent extra time reassuring and explaining it all to her, because she needed more time to settle for an examination of the prolapse. She was very grateful and shook my hand at the end to say thanks.
4. The teenager I saw for a follow up of her heavy, painful periods, who got embarrassed when her Mum told me that she said I was her favourite doctor because her periods were the lightest and least painful they’d ever been since starting the medication I prescribed.
5. The patient who made an appointment to speak to someone about her fear of dying, because she’s recently been referred on a 2 week wait pathway for suspected endometrial cancer. I sat with her as she cried, and she was grateful that I had asked her about her children, because no one else had considered how scary the thought of leaving a 7 year old and 11 year old without their Mum would be.

Today was not a good day at the office, but I am not a bad doctor, and though some days of GP training are harder than others and I feel like my brain will burst from all the things I need to know, God is good, and tomorrow is another day.

The End of My First Rotation of GPST2

Revising for the AKT exam is slowly taking over my life, but all booked for January ahhhhh.

The AKT is the Applied Knowledge Test and this is a 3 hour and 10 minute exam with 200 questions that we have to pass as part of GP training. It has questions covering clinical knowledge, primary care admin, and evidence based practice and costs £470.

And no, this isn’t a fee that is covered by our study budget, as exam fees are yet another cost of being a doctor that most people don’t realise, in addition to college membership fees, GMC membership and indemnity cover. So I WILL pass first time (by God’s grace) because I most definitely will NOT be paying for this exam again!

In other news, this week brought me to the end of my first rotation of GPST2 year, which involved me having an integrated training post (ITP) that split my week between jobs in a specialised GP surgery for deprived patient groups and Children’s A&E.

I did mean to do more updates on my day to day life over the last four months but my brief hiatus from blogging meant that didn’t happen. So here are some highlights:

What was I good at?

Children’s A&E: Examining children and getting them to cooperate with this by singing to them. Kids love Disney!

GP: Medication reviews- did so many of these and now a lot more confident with them.

What made me nervous?

Children’s A&E: Rashes! I hadn’t seen a lot of these prior to working in the department as I hadn’t done a Paeds job before, and boy did I see these in A&E- really great learning experiences to see Scarlet Fever, HSP and Measles for the first time.

GP: Patients wanting to be prescribed Pregabalin. Always a tough consultation when I had to explain that they would need a urine screen first as per the practice policy…

Useful thing I’ve learnt?

Children’s A&E: See above re: rashes.

GP: How to start a patient on Methadone.

The last time I cried at work was?

The day I was asked to take off my Free Palestine badge in GP.

My happiest work moment so far?

The days I got to go to the post natal wards to practice newborn baby checks – sooo many cute babies, it made me so broody!

Would I work here again?

Children’s A&E: Absolutely YES. Great team, approachable seniors who provided a great environment for learning and I had so much fun everyday.

GP: No. I go into more detail on the reason for this here, but long story short I won’t work somewhere that would silence me from standing up for what I believe in. And that’s all I have to say about that.

Overall I really enjoyed this ITP rotation, and I feel like this is what I’d like my working week to look like when I’m a GP. Having a varied week makes work so much more interesting and less monotonous, and I would love to work in Children’s A&E as a GP in the future, which is something a lot of A&Es now have so watch this space…

A Day in My Life as a GPST1 in a GP Rotation

I’m officially at the end of my first year of GP training, and from Wednesday I’ll officially be a GPST2! The year has gone so quickly, and really had its ups and downs (most of them documented on this blog), so thanking God that I passed ARCP and can progress, YAY.

Looking forward to my ITP post next rotation that will see me spending half of my week in a GP surgery, and the other half in Paeds ED (more on that to come in another post), so I thought I’d do a post about a day in my life in my first GP post. At the moment, I’m still on 20 minute appointments, so this will slowly decrease as I get to my final year of GP training.

08:07 – Get to work and get changed.

08:20 – After logging into System One, I see 5 pathology results and 8 tasks to go through so I try and do some admin before my first patient.

08:30 – First patient: 67 year old man with blocked ears. Advise given about how to clean ears safely and added to ear syringing list.

09:00 – Second patient: 58 year old woman with a breast lump. She has arrived 10 minutes late which means I am now running late.

09:29 – Finish with breast lump patient and she needs an urgent referral for suspected cancer.

09:35– I’m currently running 15 minutes late and I call in my third patient: 1 year old with cough, raised temperature and reduced appetite – reassurance given to Mum that he doesn’t need antibiotics as he most likely has a viral infection.

09:52– Fourth patient: 79 year old woman with foot pain.

10:11– I suspect a deep vein thrombosis for patient 4, so I call Bed Bureau at the hospital to refer for a same day ultrasound scan; no scans available till Saturday so anticoagulants prescribed till then and safety netted.

10:33 – Fifth patient: 52 year old with vaginal bleeding. She had been waiting 30 minutes due to delays with the previous patient so asked for telephone appointment instead because she had to leave.

10:34 – Sixth patient: 29 year old with abdominal pain, recently seen in A&E and Gynaecology Assessment Unit and found to have an ovarian cyst.

11:07 – Finally finished writing up notes for the 29 year old patient – likely pain from ovarian cyst and referred to Gynaecology follow up.

11:10 – I call the patient from earlier who had to leave (52 year old with vaginal dryness and bleeding) – referred for pelvis and transvaginal ultrasound for further investigation.

11:30 – Head out for home visit: 55 year old with recurrent thrush. She lives near the surgery so it’s a short walk over. Swabs taken and further thrush treatment prescribed.

12:05 – Back at the surgery to debrief with my Supervisor about the patients I’ve seen this morning – Some plans tweaked, so off to update patients and send prescriptions.

12:45 – My first break so quick lunch!

13:07 – 8th patient: 64 year old woman with weight loss since her daughter has been diagnosed with a brain tumour – I book her for blood tests for further investigation.

13:36- 9th patient is a 52 year old woman who has come in for an examination of her ears after an ear infection, because swab results have shown heavy bacteria growth – I prescribe a further course of antibiotics as guided by the swab results.

13:56 – 10th patient of the day is a 51 year old man with joint pain “everywhere”. I find history taking with this patient tough because he gives very vague responses and then refuses to take pain relief because he thinks it shows “weakness”. Sigh.

14:22 – My 11th patient is more than 10 minutes late and hasn’t turned up, so as per practice policy, they need to be marked as did not attend and have to book a new appointment.

14:30 – Half an hour of precious admin time to catch up on referrals, letters, filing pathology results and getting through my tasks!

15:00 – Joint clinic with my Supervisor that involves her observing me seeing patients. I see a 22 year old patient with a rash that looks urticarial (antihistamines prescribed), a 25 year old with food poisoning (stool sample pot given and antisickness tablets prescribed) and a 27 year old with a missed period (pregnancy test negative – reassured that stress and lifestyle changes can cause missed periods, as she has just moved to the UK following her recent wedding).

16:00 – Finish joint clinic early because the final patient I was supposed to see left because they had been waiting for 20 minutes. The Reception team call to try and rearrange his appointment and he declines.

16:05 to 17:00 – I spend the next hour doing some more admin – filing blood results, going through xray and scan reports, writing referrals, and calling patients to inform them of their results.

So yeah, that was pretty much a typical day in GP! As you can see, a variety of different presentations and patients seen; some took longer than others, which meant that appointments overran, and this happens quite regularly in General Practice.

Some patients are more understanding of this than others, but I will always overrun if someone needs more time or has a concerning issue that needs more attention, because you would appreciate it if you were the patient.

It frustrates me when people don’t come to their appointments because it really is such a waste – especially when it could have gone to someone else if enough notice was given.

Still enjoying it though- still feel like General Practice is the right fit for me, and still find the admin side of things quite draining haha, but becoming more efficient with it, so thank God for that. I definitely feel like my confidence with seeing patients on my own has increased, as I can now get through clinics without having to call my Supervisors for help, so yay for progress.

Here’s to year 2 of GP training, BUZZING.

10 Years of Blogging

I’ve also just realised that this month makes it 10 years since I started this blog – 10 YEARS.

Wow, this means I’ve documented more than a third of my life so far on here, and I can’t believe how quickly time has flown by.

I’ve come a long way from 18 year old me, who initially started this blog to document gap year adventures because I had no medical school offers- I’m now two years away (by God’s grace) from becoming a qualified GP. Really wish I could go back and tell my 18 year old self that it would all work out – look at what God did!

Thank you so much to anyone who has followed this blog or read even just one post of the hundreds I’ve written over the years. From life as a medical student, to foundation training, being a Clinical Teaching Fellow, and now GP training, I appreciate you for stopping by and reading my ramblings – here’s to more of them to come 🙂

Highs and Lows: From Compliment to Complaint

It’s been quite a tough week.

I’ll start with the good:

A patient with severe agoraphobia came to the GP for the first time in years and was booked in with me. I was running very late that morning and feeling very overwhelmed so the message they left really made my day:

And now for the not so good: I had my first complaint this week.

A patient sent an email to the practice with a complaint about her experience with me, as she had been unhappy about her management.

It really took me by surprise and made me feel very sad initially, because I have never received a patient complaint directed solely at me before, so I definitely took it personally. I was particularly hurt by her dismissal of me as a ‘junior’ doctor, as she implied that I didn’t know what I was doing.

This was frustrating because my supervisors agreed with the management plan and didn’t think I had done anything wrong, so I feel like it’s harder to come to terms with complaints in cases like this, as maybe it might have been easier to accept if I had made an error.

It did knock my confidence at first, as I felt like my abilities as a doctor were being dismissed, which is something I’m a bit sensitive about, as I tend to get this a lot from patients, who sometimes question whether or not I’m a qualified doctor because I “look so young.”

I’m so SO glad I documented well following my consultation with her, as looking back in the notes showed that I’d managed her appropriately. So my supervisor was very supportive with this, and wrote back to the patient to resolve things.

It just reaaaalllyyyyy sucks that I now officially have a complaint in my record and I’m still so gutted. I guess this is a good lesson to learn early on in my career – not every patient will be happy with what I do, so I mustn’t take it personally.

Life goes on, and I thank God for getting me through this week of nonstop Ls. It is well!

Musings On My First Month in GP as a GP Trainee

Any keen followers of this blog will know that this isn’t my first GP job since I qualified, as I did four months in a practice up north when I was an F2 doctor, but GP definitely hits different when you’re actually in specialty training. So here are a couple of my thoughts on it so far:

1. Home visits make me feel like I’ve stepped back in time some days. I have at least one visit a day, and with working in a deprived area, I feel like I’m in Call The Midwife when I turn up at patients’ houses sometimes. A lot of them have their extended family there as I take a history and examine, so getting used to having an audience has been quite something! I have a snazzy bag with all my equipment, which definitely makes me feel and look official as the “Doctor calling!” I forgot my ID in my first home visit though, so convincing the patient I was really a doctor was quite a memorable experience that I will not be repeating again.

2. Portfolio is the bane of my life. As GP trainees, we have certain requirements, clinical assessments and mandatory training that we need to evidence in our online portfolios to be able to progress to the next year of training. Did I mention that we also have to pay for these portfolios as part of membership of the Royal College of General Practitioners (RCGP)? £291 registration fee then £423 per year as a trainee 🙃🙃🙃

3. Love that we have whole day teaching every 2 weeks, and LOVE that it’s mostly virtual because not only is the teaching quite useful stuff, I can catch up on life admin/chores as I listen. Love that for me!

4. Had to break bad news on the phone re: possible endometrial cancer, as the patient couldn’t come in person and we had to urgently refer. It was awful and thinking about the patient’s gutwrenching sobs made me struggle to sleep that night. She called back the next day to tell me how much she appreciated how I broke the news to her, giving her space to cry and ask questions. (I cried.)

5. When I tell patients I’m a GP in training, they assume I’m still in medical school, and are quite surprised when I tell them I’ve been a doctor for nearly 4 years now. They then try and guess how old I am – no one has guessed right so far.

6. Slowly building confidence with my intimate examinations – my supervisors have been so supportive, and I’ve now been signed off to do breast and rectal exams without needing supervision. Still not fully confident with vaginal and speculum on my own yet (#noregrets for not doing an Obs and Gynae job though), but slowly getting there!

7. Started off on 30 minute consultations and now down to 20 minutes, with the aim of getting down to 10 minutes by the time I get to ST3. I’ve found this tough, especially when patients turn up late and still need to be seen, grrrr. Make sure you’re on time to your appointments, people!

8. And last but most certainly not least, being in GP so far makes me happier than my hospital jobs did, so I’m very grateful to God for being in a specialty training post that I enjoy.

Special mention: A child I saw with his mum called me a “cheeky doctor” because I was making him laugh as I was examining him. At the end, while he was distracted with the stickers I gave him, his mum said that his previous experience with a doctor had not been positive, so she was grateful and relieved that I’d given him a happy memory. What an honour, really made my day!

Things I Won’t Miss About Being a Hospital Doctor

As of last weekend, I am officially DONE with hospital jobs! My first GP rotation starts tomorrow, and I’m super excited- praying it goes better than my last job did, and I’m definitely looking forward to having even more evenings free, yay!

To summarise my time in hospital, here are some of the things I definitely won’t miss:

1. Ward rounds. I’ve never been a fan of how long and tedious they can be, especially when you’re just writing in the notes and not learning much.

2. Consultants borrowing my stethoscope and not wiping it down when they’re done- I’m very possessive over my stethoscope so this is really annoying.

3. Discharge and Flow Coordinators hounding me for patient discharge letters. Unwell patients are a bigger priority than those well enough to go home, but sometimes the need to clear beds and improve patient flow causes people to forget this. Grrrr.

4. The chaos of medicine ward cover and being bleeped for silly jobs- I’ve definitely become more blunt and firm because of this. Like, why are you bleeping me at 5:30pm to prescribe sleeping tablets for a patient??? NO.

5. Understaffed wards that meant I ended up doing the work of 3 doctors and didn’t get a proper lunch break sometimes.

To end on a positive note, here are some things I’ll miss:

1. Being on nights. I’m actually more of a night person and actually feel more awake during night shifts, so I tend to be more productive during them.

2. Watching patients interact with each other in their bays and become friends/make plans to meet up after discharge. Always so heartwarming!

3. Doing cannulas. Who would have thought that I’d miss THIS? I guess I’ve come so far since I used to struggle with them (we thank God!), so I now find them much easier and quite satisfying to put in.

Ahhh, what a journey it’s been. We had a team takeaway during my last shift and it was very wholesome. My last AMU weekend was with an Endocrine Consultant and Registrar, so atleast I got to have some Endocrine and Diabetes teaching in the end!

NO MORE HOSPITAL JOBS WOOOOOOO (But I’ll definitely be back to locum in ED, ofcourse 😉)