Finding my own general practice: doing the simple things well

Mehwish Sharif is a salaried GP in West Bromwich and does locum sessions in the Black Country.

2018 is my seventh year as a GP. Looking back, the learning curve has been steep at times and constant at others. There is much to keep up to date with and this is expected more with each coming year.

There has been much that I have learned through my clinical contacts which, for me personally, has helped me grow into what defines a better GP.

I wrote my submission about general practice in 150 words for Dr J. Hynes’ survey back in May 2017:

General practice: a career that encompasses all your skills, potential and knowledge, emotions, reserves and yet surprises with new challenges and creates resilience but enthusiasm to better yourself as a practitioner. Beyond doubt to provide that special attention to detail for the patients that leave a bit of insight into their lives with a doctor so trusted. The rapport in one consult or many consults, whether big or small, a difference can be made. The middle ground between a vocation and a job. Whether in a permanent or a locum role- it’s always a learning curve. A diverse rewarding career and a privileged position offset with difficulties and challenges to rise to. A remarkable career for those that continue the passion.

For me, this defines general practice in a nutshell.

I would like to share some learning points and I’m sure this will stimulate some personal thought for others who may identify with some of these or seek to identify their own.

Pride in our role

I went to my younger sisters sixth form open day recently and had a conversation with some of the year 11 girls who wanted to pursue medicine. The reasons were exactly what I recall saying in my university interview: a wish to help the community, a love for science, an inquisitive mind, wanting to work closely with people and a diverse rewarding career. It made me smile.

I think it’s very important to preserve these intentions and continue to feel we are in a noble profession. At times this is difficult with climbing pressures and time constraints as well as workforce crisis. If we go back to our pre-doctor days, the essence of why we chose to follow this path will motivate us to continue as we always meant to.

Communication

The role of communication in day-to-day general practice is vital. We covered good communication skills at length through our training and continued to attend relevant courses.

However, I understood the importance during a recent consultation with a young patient. The patient had a complex condition which had affected speech – initially mute and then staggered speech with a very pronounced stammer. Initially consultations were done in a written form but one day I asked how much speech had come back. Very hesitantly we spoke and I realised how frustrating and depressing it must be to be unable to communicate verbally. The loss of eye contact, the hesitation and distress a speech condition can cause the individual. The ease with which others may finish their words and sentences as they struggle to find or say words.

I had a new insight and realisation. It was not just this one patient but all the children and adults we see in varying capacities and with varying conditions. With that realisation, I was able to say “take your time, the words will come”. It was a new found patience for my patient.

Emotion

I think self awareness of our emotions and how we manage these is integral to our daily practice. We are often dealing with complex issues and a wide range of people on a daily basis.

From very early on, we learn how to break bad news well, handle death and dying, handle angry and aggressive patients as well as the upset and distressed ones.

We are not superhuman and we are not robots. We are trained at times to control our own emotions but there is no harm in recognising we are human after all.

We work closely with many patients and family who will see us regularly over a course of time and we have a close insight into their lives. The loss of a patient through illness and death is something that affects us all in varying ways. I think it’s OK to recognise that sadness and make sure we deal with it well. We need to be aware of our own sources of support.

Teamwork

Team work is essential between primary care teams and through to secondary care. With this difficult winter, all NHS staff have been feeling the pressure.

I recently met an old university friend who is pursuing a medical career in hospital medicine. Seemingly our roles are different, one being a GP and one in the medical training programme at senior registrar level. Although the roles are different, the trials and triumphs seem the same. The pressures and stresses seem the same. The learning and satisfaction from being thorough and doing your best is the same. Neither feels superior or inferior to the other.

We are in the same boat working with the same aim: to be the best we can be in our jobs, to support and empathise with our colleagues between primary care and secondary care, to give the best care possible to our patients. I’m sure this is the same sentiment across all healthcare staff involved in the NHS.

Self care

We seek to provide care to our patients following the biopsychosocial model. In the same way, we must ensure we make time for our own health and well-being.

It is important to factor in breaks, make time for chat with colleagues and pursue our interests. We have roles outside of work too and we fulfill many obligations and duties. We must not lose our happiness in our ‘busyness’. A happy healthy mind will lead to a positive day.

Featured photo: Easton Oliver