Reflections on the GP registrar year

Deen Mirza

Projects, past papers and prescriptions; hot topics, templates and trainers reports; MCQs, consultation models and the MRCGP. This last year as a GP registrar has been very busy.

The first few months were spent feeling clueless while trying to look wise, as patients watched me flicking through the Oxford Handbook of General Practice. My trainer had the patience of a saint: he needed it as I used to ring him every 5 minutes asking about painful ears and itchy bums.

I managed to ingratiate myself with our receptionists early on, getting regular cups of coffee without having to beg: this was probably the single greatest achievement of my career so far.

The practice manager, who would sit with her office door open watching the staff toilet entrance, also took some getting used to. Her main task seemed to be keeping a log of how long I spent in there and whether I used the air freshener or not.

The middle of the year was dominated by the ‘videoed consultations’. While consultation skills are fundamental, and watching your normal consultations with a trainer is invaluable, the current MRCGP format is not to my liking. Having a set list of questions that I had to ask, based on only one consultation model, made my consultations inflexible and unnatural. Also, I spent a far greater amount of time on this single module than any other. And while I may have benefited, it's like having a delicious meal by a nasogastric tube: you don't enjoy the experience. But at least I've learnt how to use a camcorder!

The final few months were filled with deadlines and exams, which unfortunately changed my learning from what should have been consolidation to cramming.

As for the summative assessment written project, I had reassured my trainer that this would not be left to the last minute; long gone were my medical student habits. So quite how I ended up frantically typing all through the night before the deadline, I don't know. I staggered into London to hand deliver it with just an hour to go.

And, after jumping through all the various hoops and hurdles, everything was finally finished. But just in case I got bored, the Deanery kindly arranged an appraisal in the last month.

So after all this, what have I actually learnt? Out of the vast amount of clinical and non-clinical information I have been exposed to this year, what can I now remember? Is it the fascinating DVLA guidelines? All those consultation models? How to critically appraise a paper?

All of this information has now merged into one indistinguishable blur. However, what I recall in specific detail are some of the patients.

There were certain consultations when something unusual or striking happened. Maybe when Mr J revealed that he had been self-harming. Or when Mrs P, recently bereaved, broke down in tears. Perhaps even Mrs E who attended after being beaten severely by her husband.

I remember their faces and their feelings in those consultations. I remember how much it helped them that I simply listened. They left not necessarily with their problem solved, but at least in the knowledge that their doctor cared.

And so what I have learnt from this year is this: that it is a privilege to be the one that patients come to at a time of distress or need. And, as I move on to pastures new and financially-greener fields (hopefully), I carry a vivid memory of those patients with me.

So my first year in general practice has finished. I have enjoyed it, despite it being so busy. I look forward to the new challenges that future patients will bring. And hopefully I'll still get cups of coffee without having to ask.