My First Wave experience in general practice

Emily Jenkins, a medical student at Monash University, gives her personal take on the GPSN First Wave Scholarship Program.

The pre-clinical years of medical school are important years of learning and self-discovery that lay the foundations for long careers in the medical world. While no curriculum is perfect, many universities, including mine, are struggling to appropriately prioritise the various demands upon student time – and career guidance is left wanting. Adequate time must be allocated to considering the most important question of these early years.

That question

That question that never goes unasked, whether it be by the consultant you’re supposed to be shadowing for the afternoon (or the intern you instead get palmed off onto), by the guy or girl you try to make polite conversation with in the coffee line, by the long-lost family friend who hasn’t seen you since you were “this big” or, worst of all, by your fellow meddies. Yes, that question. “So what type of doctor do you want to be?”

Sexiness scale

I think it’s fairly true to say that general practice has a little bit of an image problem. On the specialty sexiness scale it sits somewhere between radiology and deregistered practice nurse. But what is perhaps the greatest shame about all this is that if med students regard general practice as a specialty at all, it’s very much as a second-rate one – a tier below the standing of other “proper” specialties. Coming from an emphatically non-medical background I think I was particularly susceptible for this mentality and the surreptitious pressure that exists to aim for what the masses deem to be the highest echelons of medicine. So along with my peers I spent my first year of medical school falling madly in love with whatever specialty had featured in the preceding lecture.

Medical polygamist

However, one thing I gradually came to realise as I matured into a marginally wiser second year student was that I could not really see myself in many of the career options I had been throwing around in my head. When it came down to it I just didn’t want to commit myself to one tiny little area of medicine. This wasn’t a matter of falling out of love with any of the various “ologies” I had now been introduced to, rather I wanted to marry them all as a medical polygamist who would be able to do a little bit of everything. But equally importantly, I didn’t want my experience of medicine to only show me what could go wrong. I wanted to be involved in sickness but also in health. In essence, I wanted to work with people, not with illnesses. And so the seed of general practice was planted.

Orientation workshop

With this budding interest I naturally jumped at the chance to be involved with the GPSN First Wave Scholarship Program as an opportunity to further my understanding of general practice. I was lucky enough to be selected and in September 2009 headed up to Sydney for an orientation workshop. This was an intensive weekend of inspirational guest lecturers, GP “mythbusting”, personal experiences of current GPs and GP registrars during the training process and in practice, and of course an introduction to the scholarship itself. I found this to be a very positive experience. It was very refreshing to be in a forum in which general practice was not seen as a second-rate option, but instead was embraced and promoted.

Placement

Back in Melbourne I was placed with GP registrar Dr Mark O’Meadhra at Rowville Health, which thanks to my trusty GPS I discovered to be a large multidisciplinary clinic located in the south-eastern suburbs of Melbourne. My key objective for the placement was to get a sense of what general practice was really like and Mark kindly consented to put up with me for a solid week so that I could try and achieve this. Reflecting back over my placement now, what really stands out is the variety. I spent the majority of each day sitting in on Mark’s consultations, but far from the steady stream of coughs and colds I was expecting, I saw everything from broken bones to blood pressure checks, slapped cheek to suspicious lumps, contraception advice to chest pain. Several consultations would have been ideal for a “dealing with emotion” OSCE.

Tricks of the trade

One patient came in so unwell he was immediately sent to hospital, others were simply there for routine immunisations. Consultations could be as short as a script renewal, or have a detailed history and examination necessary with a complex presenting complaint. What I loved was that there really was no “typical” day or “typical” patient. Simply watching Mark in action was an incredible learning opportunity – not just to see his competency when questioning or examining patients, but also to pick up on all the tricks of the trade which only come with experience, and the many subtle nuances of non-verbal communication.

Clinical exposure

Opportunities for clinical exposure – especially quality patient time – in pre-clinical years are few and far between, so the clinical side to the placement proved an invaluable learning experience. With so many musculoskeletal injuries presenting, I could really consolidate these examination skills. Mark also had me listening to chests and taking blood pressure at every chance. Even more excitingly, I was able to do some cryotherapy, syringe out a few ears and inject the local anaesthetic and suture up after a skin tag excision. A further added bonus was the opportunity to spend time with several of the other health care professionals working at Rowville Health, and experience an efficient and effective team approach to health care provision. This included spending time in the mole clinic, with a physiotherapist and with a chiropractor.

Inspiration

What my placement highlighted to me was the variety, lifestyle flexibility and continuity of relationships with patients offered by general practice. I immensely enjoyed my time at Rowville Health, and found it enormously inspiring to have the opportunity to be mentored by such an enthusiastic and passionate doctor. Was my placement what I was expecting? Not really. It was better! This experience has got me pretty hooked.

And as for that question? I feel I can finally answer it with confidence.

I want to be a GP.