GP attachment

Last week I was on my GP attachment, staying with a GP in a village near Maidenhead, and seeing what she and the other staff at the practice do. Each day I did soemthing different, sometimes sitting in on one of the GPs clinics or minor surgeries, or going on home visits with them, and sometimes following the practise nurse, district nurse or health visitor. After spending 5 weeks on the general medical ward, where very few patients are under 60, it was astonishing to see such a variety of patients. I was also impressed by the relationship the GPs had with their patients. In the hospital, bed and time shortages mean that the doctors are constantly trying to get people off their lists by discharging or transferring them, but in general practice they had an interest in addressing all of a patients worries during their consultation, as the patients would come back otherwise! However, the GPs also had the ability to review patients' problems over long time periods, giving them longer to work out the best solution. Another big difference to hospital medicine was the level of knowledge the doctors had about their patients' lives, especially in a practice where some patients had lived in area for their entire lives, with their families also visiting the same GP. Interstingly, two of the GPs at the practice had left hospital medicine to become GPs, so that they could settle down and start families more easily, so I was able to discuss the advantages and disadvantages of each with them.

One great opportunity I had during the week was researching a report on the impact of disease on a single patient, and the roles of healthcare professionals in her treatment and care. I was assigned a very chatty middle-aged woman with the debilitating condition diffuse cutaneous systemic sclerosis. She basically wrote my report for me, by telling me so much information without me having to ask many questions. I was also able to talk to her husband about the effect of his wife's disease on his life, and I am hoping to get in contact with the patient's consultant, a specialist in systemic sclerosis who works in London, for his views on her treatment and prognosis.

Now that we've had a good taster of hospital medicine and general practise, highlighting how much more we need to know about diseases and treatments, we're back to lectures in a pathology course until christmas to learn some of that information. Since we are split into two groups for the GP attachment, with the other half of the year doing it this week, we have teaching as just half a yeargroup at the moment, before we start on the pathology course next week. Yesterday we had lectures and tutorials on Evidence Based Medicine, where we built on our knowledge from last year about how to analyse research papers, with more emphasis on clinical rather than preclinical research. Today we each have to do a presentation on a paper, based on what we learned yesterday. I have chosen to look into the treatment of systemic sclerosis a bit more with this task, so that will help me to write up my GP report at the same time. We also have teaching this week on disability and lab medicine, and on Thursday we have a miniOSCE (little practical test) on clinical examinations.