November's free article
What does FY2 in primary care have to offer a general
surgeon?
I want to be a general surgeon. I love surgery. I love the
theatre environment, the strong team set up, the buzz of hospital,
and most of all, I love being involved in and performing surgical
procedures. So what does 4 months of working in a primary care
setting as a GP have to offer me? At the start of the placement I
was sceptical if it would have anything to offer me at all.
During those months as an FY2 GP I performed no surgical
procedure. I rarely saw patients with surgical problems and I
didn’t admit anyone directly to a general surgical ward. So what
did I do? I developed communication skills. I improved my general
medical knowledge. I learnt about cardiovascular risk and
prevention. I learnt how to better communicate with patients and
other healthcare professionals. I developed an appreciation for
management techniques I’d not used previously such as watch, wait,
and review. I even enjoyed it!
In primary care I had more time to discuss problems, medical,
psychological and emotional, with patients than before. Having a
quiet room and time allotted to that patient without the call of
nurses, other patients to attend to and a pager meant I could focus
on the patient and listen to them. I remembered the ‘ICE’ technique
was taught as a student and hadn’t used since. I’ve never attempted
to elicit these issues let alone address them before working in
primary care. This is now an important aspect of my practice when
taking a history or communicating with patients and relatives.
Negotiating skills were added to my repertoire of communication
methods. I’d suggest to a patient that their blood pressure wasn’t
well controlled, blood sugars were too high, I’d like them to take
a statin and while we were doing all this, could they please stop
smoking? The patient would happily (and retrospectively
unsurprisingly) refuse my advice! This wasn’t something I’d come
across before and opened up new challenges. I learnt the importance
of explaining why I felt these changes were necessary and the
benefits this had to offer. Allowing the patient time in attempting
lifestyle and dietary changes was not only sensible management but
also good for the patient’s understanding of their influence over
their own health. Mutual agreement also strengthened the
doctor–patient relationship I was developing with them and made
future consultations easier.
I discovered how little patients understand about their hospital
experience. Patients recently discharged came to see me for an
explanation of what the hospital team had inflicted upon them. The
only information I had was an illegible, incomplete TTO letter
containing very little description of investigation, procedures, or
management. Why had the patient’s medication been stopped? Was it
deliberate, an error or simply omitted on the TTO letter? When I
reflect upon some of the patients I’ve managed within secondary
care I realise how little time is spent explaining what operation
was done, why and what implications this has for the future. A
cursory ‘we’ll see you in 6 weeks’ may have been all that was
given. Since returning to surgery as an ST1, I have been mindful of
this and place more emphasis on explaining procedures. Discussing
the operation, the benefits, disadvantages, and need for new
medications post-procedure is essential information that can easily
be forgone in secondary care.
An audit of my caseload found that I was seeing much larger
numbers of minor illness and injury compared with the average
partner (50% versus 29%) and a relatively unbalanced share of
gynaecological and contraceptive problems (21% versus 9%). The
likely reason for this being that I, a temporary member of the team
with no fixed, regular caseload often had appointments available at
short notice. Weekly shared surgeries were of great value when the
balance of case mix was much more typically representative of that
of a GP and gave me greater insight as to the work of a partner.
Without this, my time as an FY2 could have been very biased toward
minor injury and illness.
In conclusion, I learnt much from my time as an FY2 in primary
care. I may have seen a relatively unbalanced caseload compared
with an experienced partner but I now feel better prepared for life
as a hospital practitioner and have become a more balanced,
well-rounded doctor. The most valuable learning experience was that
of communication: to listen and explain more carefully, to
communicate more effectively with team members including the
primary care physician and to value doing so. I would recommend 4
months of primary care experience to any future surgeon.
Elizabeth Elsey
DOI: 10.3399/bjgp08X342688
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