Being a GP is easy

Post-script: this article is written tongue-in cheek. I'm not suggesting the work of a GP is easy, it's an immense privilege and an intellectual challenge every day. The focus of the article is that while clinical presentations remain largely unchanged, how we are expected to manage them is becoming protocol-driven, and while that can be a good thing, it can also create its own problems in that once a protocol is out there we have to follow it, and protocols are becoming more complicated and more numerous. So now it's as much about keeping up to date with the latest protocols as much as it is about knowing your clinical stuff as a GP. It's intended to stimulate debate, not to simplify the work of hardworking GPs, nor to actually suggest what we do is simple!

When I was a GP trainee, I was amazed when my trainer said to me ‘within 15 seconds of most patients walking in, I know what’s wrong and what I’m going to do’.  I was even more amazed when, after several years of being a GP myself, I said this to a trainee of my own.

Being a GP is mostly about pattern recognition, and putting round pegs into round holes.  After several years, these pegs become more quickly identifiable. A cough usually fits into one of four or five main causes.  A red eye likewise. A UTI is usually a UTI, right?

It used to be this straightforward.  Once upon a time (about five years ago) when a patient told me it burned when they had a pee, and they were going to the toilet more often, I would disptick the urine and probably give them trimethoprim.  I didn’t always disptick.

Now it’s a much more complicated affair.  My local antibiotic guidance protocol has gone from one line - nitrofurantoin first choice, trimethoprim or amoxicillin second choice’ - to five pages of complicated flowcharts depending on age, sex, star sign, month of the year and whether you like marmite or not.  And I’m never quite sure whether I am meant to dipstick, even after following the right page of the flow chart, assuming I can find the right page.  

And woe betide me if I get the wrong page - perhaps the patient will actually recover 2 hours slower than if I got it all spot-on; worse, perhaps they’ll suddenly go off marmite.

Clinical presentations remain similar; it’s really just pattern recognition.  UTIs, red eyes and coughs haven’t really changed. Round pegs are pretty much still round pegs.

Unfortunately we can’t just put them into round holes anymore.  We are advised exactly which hole, which way, at what time and how quickly to insert said round peg.   And we better have a mighty good reason for not precisely following these guidelines or we’re wide open to GMC investigation, castigation and flogging.  Ignorance is not an excuse. Apparently it’s all about evidence.

It's amazing to think our patients survived so long without it.

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